Tricuspid insufficiency 1 2 3 degrees all about cardiac pathology

A genetic kind of pathology is very unusual; it establishes in the fetus if the mom comes across damaging elements throughout pregnancy. It can be transmittable illness, radiation, x-ray direct exposure.

In most cases, the pathology is obtained, and its causes can be really various – from rheumatism to growths and heart surgical treatment.

Changes in the valves, identifying the natural kind of tricuspid insufficiency, take place under the impact of the list below elements:

  1. Rheumatism is a systemic swelling that impacts different organs and systems. The most typical reason for pathology.
  2. Closed heart injury with rupture of the valve leaves.
  3. Carcinoid syndrome – damage to different organs triggered by a carcinoid. This is a little digestive tract growth. From it, active compounds go into the blood stream and attack the endocardium. Then they go into the lung vessels and are ruined. Under such conditions, the tricuspid valve cannot close entirely.
  4. Infectious endocarditis, defined by an irritated endocardium.
  5. Mitral commissurotomy is an operation to separate the mitral valve cusps that are merged together. According to the outcomes of such treatment, blood circulation boosts, which can manifest signs of formerly concealed tricuspid insufficiency.

A reduction in the performance of the valve with its relative insufficiency takes place when the papillary muscles are harmed or the fibrous ring expands.

The papillary muscles lie inside the ventricles and support the motor capability of the valves. With myocardial infarction, they are harmed, which causes a decline in the effectiveness of the tricuspid valve.

Valve flaps are linked to the fibrous ring situated in the heart walls. Various pathologies can trigger its growth:

  1. Myocarditis is an inflammatory illness of the heart muscle.
  2. Dilated cardiomyopathy is an illness with expansion of cardiac cavities and thinning of the myocardium.
  3. Congenital malformations that provoke the development of the best ventricle. For example, with a hole in the interventricular septum, blood is ejected from delegated right.
  4. Chord tears. Due to these tendon threads, the myocardium and papillary muscles in the heart are linked, supporting the motor capability of the valves.
  5. Complicated lung high blood pressure is a substantial boost in high blood pressure.
  6. Tumors and other developments that disrupt the totally free circulation of blood from the ventricle.


Acquired conditions can take place due to illness:

  • rheumatism
  • transmittable swelling of the inner membranes of the heart,
  • carcinoid growths,
  • illness that hinder blood flow and provoke a boost in the best ventricle;
  • distressing injuries of the heart,
  • issues triggered by the repercussions of mitral valve surgical treatment.

Violations in the operation of the valve can start:

  • an abnormality in the structure of the valve or an offense in its structure due to illness,
  • damage to some parts of the system associated with managing the valve.

If hereditary tricuspid insufficiency is rather unusual and its event is connected with impaired fetal advancement, then obtained is defined by external direct exposure or human illness throughout life.

The 2nd location is divided into distressing ruptures of the capillary muscles, carcinoid syndrome due to the existence of malignant growths and other oncological symptoms in a client, in addition to transmittable endocarditis that impacts druggie.

The factors for the development of secondary insufficiency depend on the list below elements:

  • the existence of lung high blood pressure in an individual;
  • adjustment of the fibrous ring;
  • myocardial weakening;
  • myocardial dystrophy;
  • rupture of capillary muscles after myocardial infarction and other pathologies.

The provided pathology takes place in babies due to ischemic dysfunction of the best ventricle due to intrauterine hypoxia of the fetus, in addition to hypoglycemia.

Congenital insufficiency of the tricuspid valve is really unusual – frequently this flaw is obtained, and negative external elements or illness can provoke it.

The natural kind of this pathology, which is connected with modifications in valve flaps, can establish for the following factors:

  • closed chest injuries accompanied by rupture of the heart valves;
  • a carcinoid growth, which is frequently localized in the digestive tract area. It can producing toxic substances that are brought into the heart by the blood stream, harming its inner lining;
  • rheumatism is among the most typical reasons for a flaw, in which case it is accompanied by sores of other valves;
  • transmittable endocarditis – a severe inflammatory illness of the intracardiac membrane;
  • surgical intervention, which is performed in order to deal with mitral stenosis (blend of the valve cusps) – throughout the operation to separate the cusps of one valve, the advancement of insufficiency of the other is possible.

Functional failure, or a flaw in which the valve flaps do not go through modifications, takes place in the following cases:

  • in severe myocardial infarction, when the pathological procedure impacts the internal muscles of the ventricles;
  • with the growth of the ring inside the heart walls to which the valve flaps are connected, this takes place due to myocarditis, ruptures of the chords, extreme lung high blood pressure and other illness or problems.

The primary reason for impaired blood circulation through the tricuspid valve is dilatation of the best ventricle together with valvular insufficiency. Pulmonary high blood pressure, cardiac arrest, blockage (blockage) of the lung arteries provoke this abnormality. Less typically, the reasons for reverse blood reflux are transmittable endocarditis, rheumatism, medication, etc.

The elements that trigger the look of this cardiovascular disease are generally divided into 2 big groups depending upon the kind of pathology itself:

  1. Causes of main tricuspid regurgitation:
    • rheumatism (systemic swelling of the connective tissue);
    • transmittable endocarditis (swelling of the endocardium, frequently discovered in injecting druggie);
    • valve prolapse (sashes flex a number of millimeters);
    • Marfan syndrome (genetic connective tissue illness);
    • Ebstein’s abnormalities (hereditary malformation in which the valve leaves are displaced or missing);
    • chest injuries;
    • long-lasting usage of drugs (Ergotamine, Phentermine, etc.).
  2. Causes of secondary tricuspid regurgitation:
    • increased pressure in the lung arteries (high blood pressure);
    • growth or hypertrophy of the best ventricle;
    • best ventricular dysfunction;
    • mitral valve stenosis;
    • failure of the right and extreme failure of the left ventricle;
    • different kinds of cardiopathy;
    • atrial septal flaw (hereditary malformation);
    • blockage of the lung artery (and its efferent system).

In moderate types of impaired blood circulation in between the heart chambers, there are no particular signs.

Tricuspid regurgitation of 1 degree can state itself just one indication – an increased pulsation of veins on the neck.


This result takes place due to high pressure in the jugular veins, and it is simple to feel the pulsation merely by putting your hand to the neck on the right.

At later stages, you can feel not only a beating pulse, but also a clear trembling of the cervical veins. The following symptoms will also tell about problems with blood flow in the right ventricle:

  • The jugular veins not only tremble, but also noticeably swell;
  • bluish skin color (primarily on the nasolabial triangle, under the nails, on the lips and tip of the nose);
  • swelling of the legs;
  • atrial fibrillation;
  • splitting of heart tones;
  • vocalistic murmur in the heart (increased by inspiration);
  • shortness of breath and fatigue;
  • pain and heaviness in the right hypochondrium;
  • enlarged liver, etc.

Most of these signs can signal a wide variety of problems of the cardiovascular system. Therefore, the most visible symptom of tricuspid regurgitation is called swelling and trembling of the jugular vein.

The concept of insufficiency of the heart valve, including tricuspid or tricuspid, is understood to impair its functioning, which consists in incomplete closure of the valves due to their destruction, damage, deformation, as a result of which, when the heart contracts, blood is refluxed in the direction from the right ventricle to right atrium.

In the form of an isolated, pure valvular defect is found only in extremely rare cases, as usual, it is combined with mitral and/or aortic malformations, with symptoms of stenosis.

Among the causes of acquired tricuspid valve insufficiency are:

  • Rheumatism. a systemic disease of an inflammatory nature – as the most common defect factor
  • Infectious endocarditis, an inflammatory process that affects the inner lining of the heart
  • Damage to the myocardium of the right ventricle as a result of myocarditis, heart attack. cardiosclerosis
  • The consequences of carcinoid tumors
  • Traumatic damage to the heart, rupture of valve cusps
  • The presence of chronic heart failure. pulmonary hypertension
  • Congenital heart defects, accompanied by a change in the direction of increasing the size of the right ventricle, defects in the septum between the ventricles, impaired blood circulation
  • Lesions of the apparatus of the tricuspid valve, manifested in the expansion of the fibrous ring; in deformation, separation of chords, papillary, or papillary muscles
  • The consequences of surgical treatment of mitral valve stenosis

Various pathologies and diseases that occur throughout the patient’s life can lead to tricuspid insufficiency.

Learn about the causes of heart disease from the proposed video.

Generally speaking, the reason for the development of this problem in 2/3 cases is precisely the rheumatic lesion of the valves. More rarely, the disease causes infective endocarditis. Also, scientists identify two groups of causes, which are divided into chronic and acutely occurring.


Tricuspid valve insufficiency proceeds differently, and it is important to determine the form of the pathology to make the correct diagnosis. For this, a number of criteria are distinguished: the period of occurrence, the valve section in which violations are detected, the severity of regurgitation.

According to the period of occurrence, the pathology under consideration is of two types. Almost always, it is acquired and develops due to past inflammation. Congenital malformation is extremely rare. It is characterized by:

  • valve displacement below normal position;
  • irregular structure of the valves (congenital clefts, etc.);
  • degeneration (thickening of the valves, a decrease in their density).

Two forms of pathology are also distinguished based on which part of the valve is affected. Organic deficiency is accompanied by a change in the valves. They are deformed, wrinkled, covered with limescale.

The degrees are determined by the severity of regurgitation – reverse blood flow directed from the ventricle to the atrium:

  • with 1 degree of hemodynamic impairment;
  • at 2 degrees, regurgitation is detected 2 cm from the valve;
  • at 3 degrees, reverse blood flow passes more than 2 cm from the valve;
  • at 4 degrees, pronounced regurgitation is revealed in an extended section.

The pathology under consideration has its own classification, which is expressed in the following forms.

Congenital insufficiencyIt is rare, the cause of the occurrence is called various adverse effects on the fetus during its intrauterine development, Ebstein’s anomaly, congenital cleft and myxomatous degeneration are referred to possible lesions.
AcquiredIt develops in connection with possible inflammatory processes of the inner membrane of a vital organ.
OrganicIt is characterized by a change in the shape or size of the valves of the tricuspid valve.
FunctionalIt has a second name, as relative, characterized by a lack of ability to close an enlarged opening due to an enlarged right ventricle and anomalies in the stretching of the fibrous ring.
1 degree insufficiencyThe movement of blood is practically not expressed.
2 degreeTricuspid valve insufficiency of the 2nd degree is characterized by the definition of reverse movement at a distance of up to 2 cm from the valves.
3 degreeDetection of backward movement more than 2 cm from the valve.
4 degreeThe reverse movement of blood is diagnosed in a large area of ​​the cavity of the right atrium.
Primary or organic failureIt is diagnosed in the case of determining deformation or other structural changes in the valves.
Secondary or functionalDiagnosed as a result of dysfunction of the components of the valve apparatus.

By the time of occurrence, tricuspid valve insufficiency is divided into congenital and acquired:

  • a birth defect develops as a result of exposure to an organism of the future mother of adverse factors and can have three options: Ebstein’s anomaly, congenital cleft and myxomatous degeneration;
  • acquired insufficiency takes place due to internal pathological processes that affect the inner lining of the heart.

Based on the assessment of the severity of the reverse blood flow to the right atrium, four degrees are distinguished in the clinical course of the disease:

  • I degree at which the reverse movement is practically not determined;
  • II degree, when the reverse movement of blood is detected at a distance of two centimeters from the valve;
  • III degree, characterized by a reverse blood flow, which is determined at a distance of more than two centimeters;
  • IV degree – the reverse flow of blood is determined on a vast area of ​​the right atrium.

There are 2 main classifications of this pathology – by the time of occurrence and by the causes of occurrence.

  • By the time of appearance: congenital and acquired.

Congenital is recorded during intrauterine development of the child or in the first months after birth. In this case, the heart valve may return to normal over time. In addition, a congenital anomaly is much easier to control if you take care of your heart and follow preventative measures for cardiovascular diseases.

Acquired appears in adults already during life. Such a pathology almost never occurs in isolation, a variety of diseases can become its cause – from dilatation (expansion) of the ventricle to obstruction of the pulmonary arteries.

  • For a reason: primary and secondary.

The primary tricuspid anomaly is diagnosed against a background of heart disease. With this diagnosis, the patient has no problems with the respiratory system. The main cause of secondary blood flow disturbance in the tricuspid valve is pulmonary hypertension, that is, too much pressure in the pulmonary artery system.

Tricuspid valve regurgitation traditionally goes hand in hand with valve insufficiency. Therefore, some classifications share the types of blood reflux based on the form of tricuspid insufficiency, that is, directly valve disease:

  1. Organic (absolute) failure, when the cause is in the defeat of the valve cusps due to congenital illness.
  2. Functional (relative) when the valve is stretched due to problems with the pulmonary vessels or diffuse damage to the heart tissue.

There are a number of criteria according to which various forms of tricuspid valve insufficiency can be distinguished.

Depending on the period during which the occurrence of valvular defect occurs, they say:

  • About congenital insufficiency, which is extremely rare as a result of exposure to harmful factors on the fetus during pregnancy; detected with hereditary anomalies of Ebstein, Marfan, Ehlers-Danlos; manifested in an underdevelopment or anomaly in the number of valves; characterized by an abnormal, lower location of the tricuspid valve; expressed in violation of the structure of the valves, for example in the form of congenital clefts; manifested in degenerative changes of the valves themselves, an increase in their thickness, a decrease in their density.
  • About the acquired form of pathology that develops during the patient’s life due to various reasons, most often in the form of complications of inflammatory diseases.
  • According to what part of the valve apparatus is affected, we can distinguish: the organic form of failure, in which there are changes in the valves; relative or functional insufficiency, when the valves themselves are not changed, however the ability to close the valve is impaired; there are anomalies of other structures of the valvular apparatus, muscle ring, cords of the chords, papillary muscles, expansion of the right ventricle.
  • By how strongly regurgitation is expressed, the reverse movement of blood in the direction from the ventricle to the atrium, it is customary to distinguish the degree of defect: the first is the difficult definition of regurgitation; the second is the determination of the reverse movement of blood at a distance of two centimeters from the tricuspid valve; the third – the definition of regurgitation at a distance of more than two centimeters from the location of the valve; the fourth is the detection of regurgitation in a considerable area.

The determination of this or that form of tricuspid valve insufficiency is essential when choosing treatment tactics.

Second degree

Valve insufficiency can be expressed in varying degrees. A measure to determine the depth of the problem is the amount of blood return (regurgitation) to the atrium.

  • 1st. The backflow of blood in the direction of the atrium touches the valve cusps. The first degree of the disease is considered non-hazardous and no treatment is prescribed.
  • 2nd. Pathology of the second degree expresses itself by advancing the reverse jet further than the valve to a distance of two centimeters.
  • 3rd. If the return jet moves into the atrium more than two centimeters from the surface of the valve, then this violation is referred to the third degree.
  • 4th. Blood at the time of regurgitation in the upper zone of the atrium, that is, the stream passes through the entire chamber, indicates the fourth degree of the disease.

We will explain further why tricuspid valve insufficiency of the 1st, 2nd, 3rd and 4th degrees occurs.

A quantitative assessment of the severity of tricuspid insufficiency is carried out taking into account the depth of distribution of the regurgitant volume:

  • in case of insufficiency of the 1st degree, the depth of propagation of the regurgitant circulation does not exceed 20 mm from the point of closure of the valves;
  • with insufficiency of the 2nd degree – it is at a depth of 21-40 mm from the point of closure of the valves;
  • with insufficiency of the 3rd degree – at a depth of more than 40 mm from the point of closure of the valves.

The approaches to assessing the degree (intensity) of tricuspid insufficiency, performed according to the results of the CDC and taking into account the ratio of the width of the regurgitation stream to the diameter of the tricuspid valve, are similar to those given above for assessing the degree (intensity) of mitral regurgitation.

Slight regurgitation represents the worth of the defined ratio

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.