Tricuspid valve disease
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Tricuspid valve disease refers to a condition affecting the valve that separates the right atrium and right ventricle of the heart. The valve can be affected in several ways, such as leaking (known as regurgitation), becoming rigid or narrow (stenosis), or being malformed since birth (atresia). This leads to an increased workload on the heart in order to pump blood to both the lungs and the rest of the body.
The tricuspid valve is an important component of the four heart valves that help regulate the proper flow of blood in the heart. Its function is to ensure the steady and rhythmic pumping of blood between the right upper heart chamber (atrium) and the right lower heart chamber (ventricle). If the tricuspid valve fails to function properly, it can result in a condition known as tricuspid valve disease.
Tricuspid valve disease can manifest in several types, which include:
- Tricuspid valve regurgitation: The backflow of blood from the lower right chamber into the right atrium, due to the improper closure of the tricuspid valve, results in an increased amount of blood in the atrium. This can lead to the enlargement of the atrium and alterations in the pressure of both the heart and blood vessels, which may cause damage to the heart.
- Tricuspid valve stenosis: Tricuspid stenosis is a condition where the tricuspid valve opening is narrow or rigid, restricting blood flow between the two chambers. This can cause enlargement of the right atrium, which can affect blood flow and pressure. Consequently, the amount of blood that circulates through the lungs and the rest of the body may decrease due to tricuspid stenosis.
- Tricuspid atresia: This congenital heart defect is characterized by the absence of the tricuspid valve, leading to a blockage of blood flow between the right heart chambers due to the presence of a solid sheet of tissue.
- Ebstein anomaly: This is a rare congenital heart defect in which the tricuspid valve is improperly positioned and its flaps are abnormally shaped. As a result, there is a possibility of blood flowing back through the valve, which is known as tricuspid valve regurgitation.
Tricuspid valve disease can occur in conjunction with other cardiac valve disorders, such as abnormalities in the mitral or aortic valves. The symptoms and treatments may vary depending on the specific valve issue. However, tricuspid valve disease can lead to symptoms and heart damage over time. Treatment options may include regular monitoring, medication, and surgery.
Symptoms
While minor tricuspid valve disease may not cause any symptoms or complications, moderate to severe cases can lead to the expansion of the heart and potentially irreversible damage over time. People with this condition may experience various symptoms, such as:
- Constant tiredness or weakness
- Irregular heart rhythm, or arrhythmia
- Inflammation or swelling in the legs, ankles, feet or abdomen
- Increased liver size
- Fluttering or pounding sensation in the chest or neck
- Heart murmur
- Pulsing or fluttering feeling in the chest or neck.
- Breathing difficulties or dyspnea
- Skin that is unusually chilly
Causes
Tricuspid valve disease can be caused by various factors, which may include:
- Congenital heart defect: Certain condition such as Ebstein’s abnormality can cause tricuspid valve disease. Ebstein’s abnormality is a very rare birth condition. It affects the heart’s tricuspid valve, causing an enlarged heart, irregular heartbeats, and heart failure.
- Autoimmune disorders: Diseases that affect the immune system can lead to tricuspid valve disease, such as lupus, Marfan syndrome or rheumatoid arthritis.
- Injury: Trauma due to medical emergencies, diagnostic and treatment procedures, such as damage from heart attack, pacemaker, or myocardial biopsy can cause tricuspid valve disease.
- Medications and treatment: Medicines, particularly diet drug commonly known as fen-phen, or fenfluramine and phentermine can cause tricuspid valve disease. People who had cancer treatments such as radiation or tumor therapy to the chest can also acquire this disease.
Other causes include infection, such as rheumatic fever or endocarditis, enlarged right ventricle, and pulmonary hypertension.
Diagnosis
When diagnosing tricuspid valve disease, healthcare professionals typically begin by examining the patient’s symptoms, reviewing their personal and family medical history, and performing a variety of tests.
- Physical examination: The healthcare provider may perform a physical examination to diagnose tricuspid valve disease which involve listening to the heart using a stethoscope, getting a blood pressure reading, and touching the veins in the neck. This is to check for any irregularities in the heart.
The healthcare provider may order tests if the physical exam shows consistent symptoms with tricuspid valve disease. To confirm the diagnosis, the patient may undergo a blood test as well as one or several of the following tests:
- Cardiac catheterization: Also known as coronary angiography is an invasive imaging treatment that allows the doctor to assess the function of the heart. This procedure will help determine the location of the coronary artery constriction or blockage, examine the size and shape of heart chambers and/or blood vessels, and detect abnormal leaks or holes.
- Chest X-ray: This is a quick non-invasive diagnostic test that examines the heart, lungs, and bones. Chest X-rays provide a black-and-white image with a low dosage of radiation.
- Echocardiogram: This test provides a visual representation of the action of the heart. Using high-frequency sound waves, the doctor will be able to see the heart’s pumping action.
- Electrocardiography (EKG): This procedure measures the electrical activity of the heart using temporary electrodes attached in the chest and limbs. It generates images of the heart. The graph lines represent the heart rate and rhythm.
- Exercise stress test: A cardiac stress test begins by having the heartbeat faster and harder. For many people, this includes treadmill walking or riding a stationary bicycle and helps with the detection and evaluation of specific heart problems, such as problem with the muscles or valves, sufficient blood supply to the heart muscle and the heart’s electrical stability during rest and during exercise.
- Heart magnetic resonance imaging (MRI): This test can show the many elements of the heart, including chambers, valves, and muscles, and how well they perform, as well as how the blood flows. This is a scan of the heart in which radio waves and magnets generate images without anything visible or feel entering the body.
- Transesophageal echocardiography (TEE): TEE is a test that creates pictures of the heart using sound waves. A TEE differs from other types of echocardiograms or ultrasounds in a way that it obtains images from inside the body rather than outside of it.
Treatment
The appropriate treatment for tricuspid valve disease will depend on the severity of the condition and whether any additional issues are present. In most cases, medication, surgery, or a combination of the two may be utilized for treatment. Regular checkups and tests may be necessary to monitor the condition over a specific period of time.
- Medication: For mild cases with symptoms, the following drugs may be prescribed to alleviate symptoms or avoid complications:
- Anti-arrhythmic: This helps maintain a steady pulse pattern.
- Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors are medications that are commonly prescribed to reduce high blood pressure. These drugs work by inhibiting the conversion of angiotensin, which is a substance that can increase blood pressure in the body. ACE inhibitors are used to manage various cardiovascular conditions such as heart failure, kidney problems, and hypertension, among others.
- Anticoagulants: Anticoagulants are a class of drugs that reduce the capacity of the blood to clot. They either allow the body to break down existing clots or prevent new clots from developing. Anticoagulants are available in a variety of forms, including injections, intravenous (IV) treatments, and oral therapies.
- Digoxin: Digoxin is an oral medication that is effective in treating heart failure and a type of irregular heartbeat known as AFib, or atrial fibrillation. Its mechanism of action involves strengthening the heart’s contractions and stabilizing its rhythm, leading to improved heart function.
- Diuretics: Diuretics, commonly known as water pills, aid the kidneys in removing excess salt and water from the body through urine. By doing so, diuretics effectively reduce blood pressure by clearing out excess fluids. In addition, diuretics are useful in treating conditions where fluid accumulates in the body due to medical issues such as heart failure.
- Surgery: In severe cases of tricuspid valve disease, surgery may be the optimal option for recovery. Depending on the patient’s condition, the doctor may recommend either tricuspid valve repair or valve replacement surgery. Typically, a tricuspid valve repair utilizing the patient’s own heart tissue for healing is the preferred initial approach. However, if the valve and surrounding tissue are significantly damaged, the doctor may suggest replacing the valve with a prosthetic valve.
Valve repairs are generally less invasive than valve replacements. The doctor will typically repair damage to the valve, leaflets, or tissue-based flaps. Valve replacement surgery, on the other hand, involves the insertion of new valves into the heart. These replacement valves can be made from biological sources such as the patient’s own tissue or tissue from a donor, or they can be made from metal.
Replacement valves are classified into two types: biological and mechanical. A biological valve can be derived from either an animal or a deceased human donor. A mechanical valve is a medical equipment that has been manufactured.
The duration of recovery after tricuspid valve surgery or replacement depends on several factors, including the patient’s overall health. Generally, patients require several months to return to their normal activities following open-heart surgery.
