Causes

• right ventricular infarction
• pulmonary hypertension e.g. COPD
• rheumatic heart disease
• infective endocarditis (especially intravenous drug users)
• Ebstein's anomaly
• carcinoid syndrome

Signs

• pan-systolic murmur
• prominent/giant V waves in JVP
• pulsatile hepatomegaly
• left parasternal heave - due to associated right ventricular hypertrophy

Investigations

• ECG: usually nonspecific; they may show all peaked p waves or incomplete right bundle-branch block
• Echocardiography: to detect and quantify tricuspid regurgitation and heart function
• Cardiac MR is used for evaluating right ventricular size and function.
• Cardiac catheterisation: may be required prior to surgery to assess for coronary artery disease.