Tricuspid valve disease


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Tricuspid valve disease

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Tricuspid valve disease


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Tricuspid valve disease

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USMLE® Step 1 style questions USMLE

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A 50-year-old man comes to the emergency department for evaluation of progressive lethargy, shortness of breath, and abdominal pain for three days. The shortness of breath began suddenly while watching TV. His medical history includes hypertension, type 2 diabetes mellitus, obesity, and a thirty pack-year smoking history. Temperature is 38.2°C (100.76° F), pulse is 115/min, respirations are 22/min, and blood pressure is 130/60 mm Hg. Physical examination reveals jugular venous distention, right upper quadrant tenderness, and +2 peripheral edema. The lungs are clear to auscultation. The left calf is swollen and tender to palpation when compared to the right calf. Which of the following findings is most likely to be found on cardiac auscultation

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Tricuspid insufficiency p. 295

Tricuspid regurgitation

carcinoid syndrome as cause p. 359

Ebstein anomaly and p. 304

heart murmurs with p. 298

pansystolic murmur in p. 297


Content Reviewers

Rishi Desai, MD, MPH


Yifan Xiao, MD

Tanner Marshall, MS

The tricuspid valve has three leaflets: the anterior, posterior and medial or septal leaflets. Together, these separate the right atrium from the right ventricle. During systole, or muscle contraction, the tricuspid valve closes, and during diastole, or heart relaxation, the tricuspid valve opens and lets blood fill the right ventricle. Tricuspid valve regurgitation happens when the tricuspid valve doesn’t close completely and blood leaks back from the right ventricle into the right atrium. Tricuspid valve stenosis happens if the tricuspid valve can’t open completely, making it difficult to fill the right ventricle.

Let’s start with tricuspid valve regurgitation. Often, regurgitation is due to pulmonary hypertension which causes an increase in right ventricular pressure. This pressure then dilates the tricuspid valve, allowing blood to go backward. Another well-known cause of regurgitation is rheumatic heart disease, an autoimmune reaction that involves the valve leaflets and causes inflammation. This chronic inflammation leads to leaflet fibrosis, which makes it so that they don’t form a nice seal and instead let blood leak through. Still another cause of tricuspid regurgitation is damage to the papillary muscles from a heart attack. If these papillary muscles die, they can’t anchor the chordae tendineae, which then allows the tricuspid valve to flop back and allows blood to flow backward from the right ventricle into the right atrium. There are also congenital causes for this condition, like Ebstein’s anomaly, which is when a person is born with leaflets that are located too low, i.e., in the ventricle rather than between the atria and the ventricle, and this makes it hard for the leaflets to form a nice seal.


Tricuspid valve disease or tricuspid insufficiency is a condition that affects the tricuspid valve, which is one of the four heart valves that help regulate blood flow through the heart. In tricuspid insufficiency, the tricuspid valve fails to close properly during systole, allowing the blood to flow backward into the right atrium. Tricuspid insufficiency most often results from rheumatic heart disease, which causes damage to the valve.

Signs and symptoms of tricuspid insufficiency are generally those of right-sided heart failure, such as ascites and peripheral edema. Diagnosis of tricuspid valve disease typically involves a physical exam, echocardiogram, and other imaging tests that can evaluate the structure and function of the valve. Treatment may involve medications to manage symptoms, as well as surgery to repair or replace the tricuspid valve in severe cases.


  1. "Facts about tricuspid atresia" undefined (March 4, 2016)
  2. "Tricuspid regurgitation" undefined (June 2, 2014)
  3. "Tricuspid stenosis" undefined (September 25, 2016)
  4. "Clinical Methods: The History, Physical, and Laboratory Examinations. (3rd ed.)" undefined (1990)
  5. "Tricuspid atresia" undefined (undefined)

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