Tricuspid regurgitation: causes and treatment

The tricuspid valve sits between the right atrium and the right ventricle. MSD explains that it opens to let blood fill the ventricle and closes to stop blood flowing back as the ventricle pumps towards the lungs. When it does not close completely, some blood leaks backwards. This is called regurgitation.

The extra blood in the right atrium raises the pressure there and in the large veins entering it. MSD says the atrium can enlarge, and the liver and legs may swell because of the pressure.

The NHS describes heart valve disease in general as a valve that either does not open fully (stenosis) or does not close fully, which may be leaky (regurgitation). Either way the heart has to work harder to pump blood.

MSD says tricuspid regurgitation usually causes no symptoms. Some people notice pulsations in the neck because of raised pressure in the right atrium, and discomfort in the upper right part of the abdomen because the liver is enlarged. Fluid retention, mainly in the legs, is rare.

Because a leaky valve may also be silent, it is often found by chance. The NHS says heart valve disease is sometimes discovered when a doctor hears a heart murmur. The general symptoms the NHS lists for heart valve disease are below, and they have many other possible causes.

• Shortness of breath and feeling tired or weak.

• Feeling dizzy or having palpitations.

• Swollen ankles and feet.

• Chest pain or discomfort.

• No symptoms at all, which is common with mild leaks.

MSD says the most common cause is enlargement of the right ventricle with increased resistance to blood flow into the lungs. The ventricle stretches the valve ring, causing the leak. Resistance can be raised by severe, long-standing lung disorders such as emphysema, by pulmonary hypertension, by left-sided heart disease such as heart failure, and rarely by narrowing of the pulmonary valve.

Less common causes listed by MSD include infection of the heart valves, most often linked to injecting illicit drugs, birth defects of the tricuspid valve, injury, rheumatic fever and weakening of the valve tissue. Some heart procedures can also cause it. For example, a pacemaker wire may stop the valve closing properly.

In atrial fibrillation, MSD says an extremely enlarged atrium often beats rapidly and irregularly, and clots may form inside it.

A GP or cardiologist begins with your history and an examination. MSD says doctors may hear a characteristic murmur from blood leaking backwards, though the murmur tends to disappear as the leak worsens.

Echocardiography is the key test. MSD says it uses ultrasound to image the leaky valve and show how much blood leaks, so severity can be graded. An ECG and chest X-ray are often done too, and MRI or cardiac catheterisation may follow in more severe cases. The NHS lists echocardiogram, chest X-ray and ECG as the usual tests for heart valve disease.

BHF explains that doctors describe valve disease as mild, moderate or severe. For mild disease without symptoms it suggests echocardiogram check-ups about every 3 to 5 years, and every 6 to 12 months for moderate or severe disease without symptoms. This is general guidance for valve disease, so your own schedule may differ.

MSD says mild tricuspid regurgitation requires little or no treatment. The cause is treated instead, for example emphysema, pulmonary hypertension, pulmonary stenosis or left-sided heart disease, along with atrial fibrillation and heart failure where present.

Surgery to repair or replace the tricuspid valve is rarely done unless the leak is severe, or surgery on another valve, such as the mitral valve, is also needed. MSD says operations may use a ring to reduce the valve opening, a repair, or a replacement valve. If surgery is not an option and right heart failure develops, doctors may use diuretic medicines such as furosemide and spironolactone.

The NHS adds that people with severe heart valve disease usually need surgery to repair or replace a valve, and that medicines may be used to reduce fluid, slow the heart rate or reduce the risk of clots.

MSD says people may tolerate tricuspid regurgitation for years, but the outlook is poor when it is severe, because the extra blood in the ventricle eventually causes heart failure. That is why follow-up matters.

The NHS lists heart failure, atrial fibrillation, stroke and endocarditis as possible complications of heart valve disease. If you have a valve condition and are pregnant or planning pregnancy, the NHS advises getting advice from a heart specialist.

Lifestyle matters. The NHS says causes include smoking, high blood pressure and high cholesterol over time. The care team may advise changes, including avoiding strenuous exercise in some cases.

The NHS says to call 999 or go to A&E if you are struggling to breathe, have sudden chest pain spreading to the arms, back, neck or jaw or lasting more than 15 minutes, or have chest pain with breathlessness or palpitations. Do not drive yourself.

See a GP if you are regularly short of breath, tired or dizzy during normal activity, have palpitations that keep returning, swollen ankles or feet, or chest pain that comes and goes. BHF also advises an urgent appointment for new or worsening symptoms, an unexplained temperature, night sweats or weight loss.

On the NHS, a GP listens to the heart and may arrange an echocardiogram or refer to cardiology. Specialist valve services usually manage moderate and severe disease, and a nurse specialist is often the contact.

Private cardiologists can offer an earlier echocardiogram and review, and some people use that to speed up the diagnosis before continuing on the NHS. Surgery and transcatheter procedures for the tricuspid valve are delivered in specialist cardiac centres in either sector.