Tricuspid Regurgitation.
Synonyms:—Tricuspid insufficiency; tricuspid incompetency.
Definition:—A condition of the tricuspid valve in which there is failure on its part to completely close the right auriculoventricular orifice, permitting a backward flow of the blood upon contraction of the right ventricle.
Etiology:—This condition is not of common occurrence. It is usually, however, due to chronic organic changes, more often on the left side of the heart, from which interference with free passage of the blood from the lung results in an increased strain upon the tricuspid valve. The condition may also result from chronic disease in the lungs, independent of any heart trouble. It is often the case that the valves themselves are not diseased, but that from heart strain, there is dilatation of the ventricle, resulting in an enlarged orifice. It has been observed that this condition quite frequently follows endocarditis, especially in children, although this statement is denied by some writers. The condition has been observed at birth, jmd also in the fetus. The evidences of pulmonary congestion are conspicuous at the onset of this condition, in some cases there is a typical bronchitis, or there will be found present a local hypostatic congestion at the base of the lung, and the sputum may have the appearance of that found in croupous pneumonia. It may be rusty colored—uniformly blood stained. The regurgant wave at each contraction of the heart, induces a pulsation in the veins, observable in the jugular vein especially, which becomes distended. It may extend to the subclavian and axillary veins" and may be detected in other of the organs. It is especially conspicuous when the patient is lying down. The entire venous system becomes engorged, and this results in a more or less permanent cyanosis, which is greatly increased upon holding the breath.
Diagnosis:—This depends largely upon the presence or absence of the venous pulsation.
Prognosis:—In those patients who are actively engaged in manual labor and in whom the changes have occurred slowly, the prognosis is bad. In young adults who will submit to the essential habits of life and auxiliary treatment the outlook is more favorable. In a few cases, where it depends upon temporary dilatation, a cure can be accomplished if it be undertaken promptly.
