Tricuspid Regurgitation Clinical Presentation

  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Richard A Lange, MD, MBA  more...
Updated: Jun 02, 2014


Patients with tricuspid regurgitation present with the signs and symptoms of right-sided heart failure. The spectrum of presenting symptoms depends on whether the condition is secondary to left ventricular (LV) dysfunction.

Common presenting complaints in patients with LV dysfunction include the following:

  • Dyspnea on exertion
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Ascites
  • Peripheral edema

Exercise intolerance may also be observed. Rarely, patients report angina, which may result from RV overload and strain, even in the absence of coronary artery disease.[7]

These patients, especially those experiencing febrile episodes, must be questioned regarding risk factors for infective endocarditis , which is a common cause of tricuspid valvular disease. Risk factors include intravenous drug use, alcoholism, and a history of rheumatic fever.


Physical Examination

Findings on cardiovascular examination in patients with tricuspid regurgitation include the following:

  • S 3 gallop
  • Jugular venous distention with a prominent V wave
  • In some patients, a pansystolic murmur
  • Diminished peripheral pulse volume secondary to impaired forward blood flow; patients with this sign may have relative hypotension secondary to therapeutic interventions used to decrease volume overload
  • Pulmonary rales, if the tricuspid regurgitation is associated with left ventricular dysfunction or mitral stenosis
  • Right ventricularheave and S 4 gallop that increases with inspiration
  • Ascites
  • Peripheral edema
  • Cachexia and jaundice

The pansystolic murmur associated with tricuspid regurgitation is high pitched and is loudest in the fourth intercostal space in the parasternal region. The murmur is usually augmented during inspiration and is reduced in intensity and duration in the standing position and during a Valsalva maneuver. A short, early diastolic flow rumble may be present due to increased flow across the tricuspid valve.

Contributor Information and Disclosures

Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Society of Thoracic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.


Martin Gerard Keane, MD, FACC, FAHA Associate Professor, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine

Martin Gerard Keane, MD, FACC, FAHA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Society of Echocardiography, Pennsylvania Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Ikaria Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; Lung LLC Clinical Trials + honoraria; Bayer Grant/research funds Consulting; Medtronic Consulting fee Consulting; Novartis Consulting fee Consulting

Frank M Sheridan, MD Cardiologist, Providence Everett Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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