• Sean Beckman, Helen Lu, Peter Alsharif, Linda Qiu, Marwa Ali, Robert James Adrian, and Stephen Alerhand.
• Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA.
• Am J Emerg Med. 2024 Jun 1; 80: 227.e7227.e11227.e7-227.e11.

AbstractThe tricuspid regurgitation pressure gradient (TRPG) reflects the difference in pressure between the right ventricle and right atrium (ΔPRV-RA). Its estimation by echocardiography correlates well with that obtained using right-heart catheterization. An elevated TRPG is an important marker for identifying right ventricular dysfunction in both the acute and chronic settings. However, in the "wide-open" variant of TR, the TRPG counterintuitively falls. Failure to recognize this potential pitfall and underlying pathophysiology can cause underestimation of the severity of right ventricular dysfunction. This could lead to erroneous fluid tolerance assessments, and potentially harmful resuscitative and airway management strategies. In this manuscript, we illustrate the pathophysiology and potential pitfall of wide-open TR through a series of cases in which emergency physicians made the diagnosis using cardiac point-of-care ultrasound. To our knowledge, this clinical series is the first to demonstrate recognition of the paradoxically-low TRPG of wide-open TR, which guided appropriate management of critically ill patients in the emergency department.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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