Tricuspid Insufficiency It is the lack of occlusion of the tricuspid orifice during ventricular systole, which allows blood to flow back into the right atrium.
Summary
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- 1 Syndromogenesis or pathophysiology
- 2 Positive diagnosis
- 3 Complementary exams
- 4 Etiology
- 5 Related Links
- 6 Sources
Syndromogenesis or pathophysiology
Regardless of its ethology, when there is tricuspid regurgitation, the right ventricular systole sends part of its volume as reflux to the right atrium, which expands secondarily and produces a stasis of blood in the vessels that reach it: veins upper and lower cellars. This dilation of the right atrium can lead to atrial fibrillation. During diastole, the right ventricle will receive a greater volume of blood from the atrium, and this fact will lead it first to dilation and then to hypertrophy, while the left ventricle will be smaller because it receives less return volume.
On the other hand, hypertension in the superior vena cava will result in great engorgement of the internal and external jugular veins, with its characteristic systolic venous pulse in the neck, capable of raising the sternocleidomastoid muscle . Venous hypertension in the territory of the inferior vena cava will cause hepatomegaly Congestive and painful, characterized by a palpable and expansive systolic liver pulse. Finally it will be accompanied by ascites and edema in the lower limbs. As we can see, this picture of the right heart is not exclusive to organic tricuspid regurgitation, but common to any cause that causes a failure of the right heart (pulmonary and mitral stenosis, compression due to tumors of the mediastinum and pericarditis with effusion or cardiac tamponade).
Positive diagnosis
Clinical Picture
- Dyspneaalways moderate and without nocturnal crisis of paroxysmal dyspnea or acute lung edema.
- Venous engorgement of the neck, with systolic venous pulse and evident Rondot hepatojugular reflux . This is reflected in very high central venous pressure.
- Tricuspid systolic murmurin focus , appearing in the xiphoid region, of a rough character and high tone on the left edge of the sternum that spreads towards the tip and the right armpit. Sometimes it is accompanied by a thrill.
- Painful congestive hepatomegaly, which may be associated with lower limb edema and hepatojugular reflux .
Complementary exams
X-ray . Great dilation of the right contour corresponding to a very visible atrium in the right anterior oblique position (OAD). Dilated superior vena cava easily visible posteroanterior, ascending and parallel to the vertebral column. Normal clarity of the lung fields .
Cardiac catheterization . Right atrial hypertension (up to 20.25 mm Hg), with low cardiac output. This causes high central venous hypertension. Electrocardiogram . Right axial deviation and incomplete blockage of the right branch. There may be signs of right ventricular hypertrophy.
Etiology
This insufficiency can be organic, and rarely pure, rather associated with other valve lesions, it is almost always secondary to endocarditis. Functional failure is very common in the course of right ventricular dilation.
