However, the murmur may be inaudible due to the  relatively low pressures in the right side of the heart. A third heart sound may also be present, also heard at the lower sternal border, and increasing in intensity with inspiration.On examination of the neck, there may be giant C-V waves in the jugular pulse. With severe TR, there may be an enlarged liver detected on palpation of the right upper quadrant of the abdomen; the liver may be pulsatile on palpation and even on inspection. Causes
The causes of TR may be classified as  congenital or acquired; another classification divides the causes into primary or secondary. Congenital abnormalities are much less common than acquired. The most common acquired TR is due to right ventricular dilatation. Such dilatation is most often due left heart failure or pulmonary hypertension. Other causes of right ventricular dilatation include right ventricular infarction, inferior myocardial infarction, and cor pulmonale.In regards to primary and secondary causes they are:

Mechanism
In terms of the mechanism of tricuspid insufficiency, it involves the expansion of the tricuspid annulus (fibrous rings of heart). Tricuspid insufficiency is linked to geometric changes of the tricuspid annulus (decreased tricuspid annular release). The leaflets shape are normal but prevented from normal working mechanism due to a distortion of spatial relationships of leaflets and chords. It is also contemplated that the process via which tricuspid regurgitation emerges, is a decrease of contraction of the myocardium around the annulus. Diagnosis
The diagnosis of TR may be suspected if the typical murmur of TR is heard.
Because the changes in the condition of the gums from one day to another are minimal, patients get used to the gums appearance and tend not to notice the recession visually. Receding gums may remain unnoticed until the condition starts to cause symptoms. The following signs and symptoms may indicate gum recession:

Tooth mobility
Dentin hypersensitivity (over-sensitive teeth) - short, sharp pain is triggered by hot, cold, sweet, sour, or spicy food and drink. If the cementum covering the root is not protected anymore by the gums, it is easily abraded exposing the dentin tubules to external stimuli. Teeth may also appear longer than normal (a larger part of the crown is visible if gums are receding)
The roots of the tooth are exposed and visible
The tooth feels notched at the gum line
Change in the tooth’s color (due to the color difference between enamel and cementum)
Spaces between teeth seem to grow (the space is the same, but it seems larger because the gums do not fill it any more)
Cavities below the gum lineIf the gum recession is caused by gingivitis, the following symptoms may also be present:

Puffy, red, or swollen (inflamed) gums
Gum bleeding while brushing or flossing
Bad breath (halitosis)In some cases, it is the treatment of gingivitis that reveals a gum recession problem, that was previously masked by the gums swelling.