**Question:** Which of the following is seen in a patient with tricuspid incompetence: September 2005

A. Pulmonary hypertension
B. Right ventricular dilation
C. Right atrial dilation
D. Congestive heart failure

**Core Concept:** Tricuspid incompetence, also known as tricuspid regurgitation, refers to a condition where the tricuspid valve does not close properly, leading to regurgitation of blood from the right ventricle into the right atrium. This can result in various clinical manifestations depending on the severity and underlying cause.

**Why the Correct Answer is Right:** Option B (Right ventricular dilation) is the correct answer because tricuspid regurgitation leads to increased right ventricular volume load. Over time, the right ventricle has to work harder to pump blood against the increased pressure in the right atrium, resulting in dilation of the right ventricle to compensate for the increased workload.

**Why Each Wrong Option is Incorrect:**

A. Pulmonary hypertension: Although pulmonary hypertension can coexist with tricuspid regurgitation, it is not directly caused by it. Pulmonary hypertension is a separate condition where the pulmonary vessels are narrowed or damaged, leading to increased pulmonary vascular resistance.

C. Right atrial dilation: While right atrial dilation can occur in severe tricuspid regurgitation, the correct answer is right ventricular dilation because the increased pressure in the right atrium is primarily transmitted to the right ventricle, causing dilation to accommodate the increased volume load.

D. Congestive heart failure: Though congestive heart failure can result from tricuspid regurgitation, it is not solely caused by it. Heart failure is a complex clinical syndrome resulting from various cardiac abnormalities, including tricuspid regurgitation.

**Clinical Pearl:** In assessing patients with suspected tricuspid regurgitation, it is essential to evaluate the right heart chambers and hemodynamics. Right ventricular dilation is the most direct consequence of tricuspid regurgitation, reflecting the increased workload on the right ventricle due to regurgitant blood returning to the right atrium.