Clinical Features

Patients are usually asymptomatic unless right heart failure develops and the patient complains of oedema, ascites and abdominal pain from liver congestion. Intravenous drug abusers may present acutely unwell with a staphylococcal endocarditis.
What are the clinical, ECG and CXR findings associated with TR?

Table 1: The clinical, ECG and CXR findings associated with TR

Pulse
  • AF common
  • large C-V waves in JVP

Auscultation
  • Soft pansystolic murmur at LSE louder on inspiration
  • Third heart sound (S3) often heard

ECG

No specific changes

CXR

Cardiomegaly, pleural effusion

Other features

Tender enlarged pulsatile liver

How would you treat tricuspid endocarditis in a drug abuser?

A drug abuser needs blood cultures and aggressive antibiotic therapy covering staphylococcal infection. Early surgery may be needed.

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