The Curious Clinicians [Archive] More Right Than Left
Feb 26, 2026
A lively dive into why tricuspid valve infections are common in people who inject drugs. They explore hemodynamics, endothelial injury, and how turbulent flow and particulates damage the tricuspid valve. Experiments and animal studies that prove injury precedes infection are discussed. The lung’s filtering role and why pulmonic and left‑sided valves are usually spared are highlighted.
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Clinical Experience Matches Epidemiology
- Avi Cooper and Hannah Abrams note tricuspid endocarditis often appears in people who inject drugs and in patients with intracardiac devices like pacemaker leads.
- Clinical experience matches cohort studies showing right-sided disease in IV drug users.
Epidemiology Shows Right Sided Predilection In IVDU
- Cohort data show tricuspid involvement in 56–68% of endocarditis among people who inject drugs versus ~12–18% in non‑IVDU cohorts.
- Pulmonic valve involvement remains rare (~1%) across cohorts.
High Pressure Flow Causes Valve Injury
- Endothelial injury is the first required step for infective endocarditis and typically results from high-velocity, turbulent flow across narrowed orifices.
- Simon Robert's venturi tube experiments showed bacteria colonize low-pressure sinks created by flow from high to low pressure, explaining typical lesion locations on valve sides.