Tricuspid regurgitation

Secondary/Functional causes of TR (MOST COMMON)

annulus is stretched/compromised from RV enlargement (caused by L heart D, abnormal RV function or pul htn)

Most common cause of primary TR

myxomatous degeneration (loose and floppy TV leaflets)

other primary causes of TR

Tumor/mass, Pap Muscle dysfunction, Ruptured chordae or flail leaflet

Rheumatic TS characteristics

thick leaflets, scarring, calcification and chordae tendinae are fused to the leaflet commissure

TV Prolapse

20% occur with MVP and has excessive billowing leaflets

Carcinoid heart disease TV signs

thick and rigid leaflets with no change in position during the cardiac cycle

TR Murmur

Holosystolic murmur that inc with inspiration

Complications of TR

enlarged R heart and A fib

Symptoms of TR

Leg/abdominal swelling, Hepatomegaly (enlarged liver) and portal HTN (backflow into the portal V)

TR on echo

diastolic leaflet flutter, RVVO and paradoxical septal motion

Pulmonary Hypertension

Elevated PAP caused by another D (Not a D of the pul vessels)

elevated PAP is caused by (causes PH)

sleep apnea, lung D, L heart D or diastolic HF

Pulmonary Hypertension levels

Elevated PAP >25 (>30 with exercise) and elevated PVR

Pulmonary Arterial Hypertension (PAH)

Chronic incurable subgroup of PH from elevated PAP (from arteries stiffening and tightening)

wedge P (PCWP)

<15

PH is associated with

Atrial enlargement, Diastolic dysfunction and Dilated IVC with dec collapse

bubble study for PH

PFO or AD

RVSP

RVSP = SPAP and is used to estimate LAP