Tricuspid Regurgitation Clinical Presentation

Updated: Nov 05, 2021
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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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 right ventricular (RV) dilatation or other conditions (eg, left ventricular [LV] dysfunction).

Common presenting complaints in patients with RV 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:

  • S3 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 ventricular heave and S4 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.