The Intern At Work: Internal Medicine Tired of Trying – An Approach to Tricuspid Regurgitation
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Feb 22, 2026 A concise walkthrough of tricuspid valve anatomy and how leaflet, chordae, and annular problems cause regurgitation. Clear guidance on clinical signs and bedside exam findings for right‑sided congestion. Differentiates primary, secondary, and device-related causes with echo staging and case examples. Reviews medical, interventional, and surgical treatment options and trial evidence for transcatheter repair.
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Tricuspid Valve Anatomy Shapes Dysfunction
- The tricuspid valve has three leaflets with distinct mobility that determine dysfunction patterns.
- The anterior leaflet is largest and most mobile while the septal leaflet is least mobile and attached to the annulus above the septum, affecting repair strategy.
Symptoms Often Subtle Despite Severe TR
- TR can be asymptomatic even when severe, so screen for edema, ascites, fatigue, and new diuretic needs.
- Exam clues include a pansystolic murmur at the left lower sternal border that increases with inspiration and signs of hepatic congestion.
Primary Versus Secondary Tricuspid Regurgitation
- TR is classified as primary (valve problem) or secondary (functional from RV/RA changes).
- Primary causes include endocarditis, carcinoid, trauma; secondary arises from RV dilation, leaflet tethering, or annular dilation.