Tricuspid Regurgitation Symptoms and Diagnosis

Cardinal Symptoms and Signs

Patients with severe tricuspid regurgitation commonly present with fatigue from low cardiac output, abdominal fullness, edema, and palpitations, according to the American College of Cardiology 1, 2
Fatigue and reduced exercise capacity due to decreased cardiac output, which is often the earliest symptom, as noted by the American College of Cardiology 1, 3
Abdominal bloating and fullness resulting from hepatic congestion and ascites, as reported by the American College of Cardiology 1, 3
Peripheral edema, often bilateral lower extremity, due to elevated systemic venous pressure, according to the American College of Cardiology 1, 3
Palpitations, particularly in patients with concomitant atrial fibrillation, which occurs in approximately 70-88% of patients with severe TR, as noted by the American Heart Association 1
Anorexia in advanced cases due to splanchnic congestion, as reported by the American College of Cardiology 3
Dyspnea, both with exertion and at rest in advanced cases, according to the American College of Cardiology 3

Elevated jugular venous pressure with prominent "c-V" waves, which may be the only clue to severe TR in some patients, as noted by the American Heart Association 1, 4
Systolic murmur at the lower sternal border that increases with inspiration, although this may be absent even in severe TR, according to the American College of Cardiology 1, 4
Pulsatile liver edge due to systolic hepatic congestion, as reported by the American Heart Association 1, 4
Positive hepatojugular reflux, a sustained increase in jugular venous pressure when pressure is applied to the abdomen, indicating right-sided volume overload, as noted by the American College of Cardiology 5

Progressive hepatic dysfunction due to chronic elevated right atrial pressure, which can lead to abnormal liver function tests, according to the American College of Cardiology 1, 3

The presence of symptoms, particularly right heart failure, places patients in Stage D of TR severity classification, as noted by the American College of Cardiology 3, 6
A murmur may be inaudible even with severe TR, making jugular venous findings crucial for diagnosis, according to the American Heart Association 1, 4