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Tricuspid Regurgitation

Alternate Names

  • tricuspid insufficiency
  • tricuspid incompetence

Definition

Tricuspid regurgitation occurs when the tricuspid valve within the heart fails to close tightly. This causes blood to flow backward.

What is going on in the body?

There are four chambers in the heart, two on the left side and two on the right. The tricuspid valve separates the upper and lower chambers on the right side of the heart. Failure of this valve to close properly may lead to circulation problems and damage to the heart over time.

Risks

What are the causes and risks of the disease?

This condition has many causes, including:
  • congenital heart disease, in which the infant is born with an defective tricuspid valve
  • congestive heart failure
  • a heart attack
  • pulmonary hypertension, or high blood pressure in the arteries that carry blood through the lungs
  • chronic obstructive pulmonary disease (COPD), usually a consequence of smoking
  • infection of the heart valves, called endocarditis. A person who uses intravenous drugs, such as heroin, is at a high risk for this cause of tricuspid valve damage.
  • old age. Tricuspid regurgitation due to aging is often minimal and usually causes no harm.
  • trauma to the heart, such as from a stab wound to the chest
  • a tumor known as carinoid
Other causes are also possible.

Prevention

What can be done to prevent the disease?

Prevention of tricuspid regurgitation is related to the cause. For example, avoiding the use of intravenous drugs can prevent many cases due to heart valve infection. Avoiding smoking could help prevent many cases due to pulmonary hypertension, congestive heart failure, and heart attacks. Some cases cannot be prevented.

Diagnosed

How is the disease diagnosed?

Tricuspid regurgitation may be suspected after the history and physical exam. The healthcare provider may hear an abnormal heart sound, called a heart murmur, when listening to the heart with a stethoscope.
A heart tracing, called an electrocardiogram or ECG, may reveal certain problems that suggest this condition or one of its causes. A chest x-ray may show certain abnormalities as well. . If an infection of the heart valve is suspected, a blood culture may be done to try to identify bacteria that may be causing the infection.
Echocardiography is the test usually used to confirm the diagnosis. This is an imaging test that uses ultrasound waves to view the heart. This test can show the blood flowing backward through the valve.
A special procedure called a cardiac catheterization may be needed. This procedure involves inserting a tube though the skin and into a blood vessel, usually in the groin. The tube can then be advanced through the blood vessel into the heart. A contrast agent can be injected through the tube and X-ray pictures taken of the contrast agent while it is inside the heart and main blood vessels. This can help better define the defects in the heart. This test is most useful after a heart attack or when complex birth defects of the heart are suspected.

Long Term Effects

What are the long-term effects of the disease?

In severe untreated tricuspid regurgitation, the long-term effects may include congestive heart failure, heart and liver damage, and dangerous arrhythmias. Tricuspid regurgitation is often a long-term condition with symptoms that appear slowly over many years. If there are no other heart problems, the person may have no long-term effects.

Other Risks

What are the risks to others?

There are no risks to others, since tricuspid regurgitation is not contagious.

Treatments

What are the treatments for the disease?

Treatment of the underlying cause of the tricuspid regurgitation may help restore the normal function of the valve. For example, congestive heart failure can be treated with heart medications. Heart valve infections often go away with antibiotics.
If there is no underlying disease, treatment may not be needed. This is common in the elderly, who often get mildly leaky valves.
In severe cases, the valve can be repaired or replaced surgically. This is an open heart procedure that requires the use of heart-lung bypass for several hours.

Side Effects

What are the side effects of the treatments?

Side effects depend on the treatments used. For example, antibiotics may cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, heart arrhythmias, or an allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the disease?

If the cause of the tricuspid regurgitation can be treated, the function of the tricuspid valve may return to normal. If there is permanent damage to the valve, closer monitoring is usually needed. Those who have surgery to replace the valve are often "cured" once they recover from surgery.

Monitor

How is the disease monitored?

Regular visits to the healthcare provider are often advised. Repeat ECGs or echocardiograms may be used to monitor the function of the heart and its valves. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

Merck Manual, 1999

Harrison's Principles of Internal Medicine, 1991

Current Medical Diagnosis and Treatment 1996

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