tricuspid

Tricuspid regurgitation: Causes, symptoms, diagnosis, and treatment

If someone is suffering from severe tricuspid regurgitation, they will likely experience symptoms that will require specific treatment. It helps to understand exactly how the heart works to fully comprehend what tricuspid regurgitation is.

Let’s look at the heart before we address the question? The heart is divided into four chambers. The upper chamber is called the left atrium and right atrium, while the lower chambers are the left and right ventricles. A muscle called the septum divides the left and right sides of the heart. Openings or valves regulate blood flow in and out of the heart between chambers. They open up, allowing blood to flow freely and they close and stop the flowing of blood.

Tricuspid regurgitation occurs when the valve does not properly close. This malfunctioning allows blood to flow back into the heart’s right chamber (atrium). This condition, which is also referred to as tricuspid valve insufficiency, can weaken the heart over time.

What causes tricuspid valve insufficiency?

There isn’t a single reason for tricuspid valve regurgitation. In fact, there is a long list of potential causes, the most common being right ventricle dilation. When the right ventricle is forced to work harder, it can grow in size to compensate. Additionally, a ring of tissue that supports the tricuspid valve and its ability to open and close can get larger.

There are several conditions that impact the tricuspid valve and can cause it to malfunction. Heart failure, conditions that cause high blood pressure in arteries in the lungs, and the abnormal heart muscle condition known as cardiomyopathy can cause tricuspid regurgitation.

Most of the tricuspid regurgitation causes are due to complications from other conditions, including those summarized in the list below:

  • Emphysema: A condition in which air sacs in the lungs are damaged
  • Pulmonary hypertension: High blood pressure in arteries
  • Left-side heart disorders: Includes left-sided heart failure
  • Pulmonic stenosis: Obstruction of blood flow from the right ventricle to the pulmonary artery.
  • Infection: Can injure the tricuspid valve. This happens most often with infective endocarditis.
  • Ebstein’s anomaly: A rare condition where the valve sits lower than normal in the right ventricle and the valve’s leaflets form abnormally.
  • Carcinoid syndrome: A rare condition that causes tumors to form in the digestive system and spread to the liver or lymph nodes. It produces a substance that can damage the heart valve.
  • Implantable device wires: During placement or removal, pacemaker or implantable cardioverter-defibrillator wires can sometimes injure the tricuspid valve.
  • Endomyocardial biopsy: This heart muscle tissue test can sometimes damage the tricuspid valve.
  • Trauma: Blunt chest trauma, such as in a car accident.

Risk factors and complications of tricuspid regurgitation

There are a number of factors that can put a person in a higher risk category for tricuspid regurgitation, including those listed here.

  • Infections such as infective endocarditis or rheumatic fever.
  • Heart attack, which can damage the heart, but also affect the right ventricle and functioning of the tricuspid valve.
  • Chronic high blood pressure, especially hypertension that is not well managed.
  • Heart disease, as research shows several forms of heart disease are linked to valve malfunction.
  • Medication use, including some that treat Parkinson’s disease and migraines
  • Radiation, particularly to the chest has the potential to damage the tricuspid valve

Regardless of the initial cause, there can be complications associated with tricuspid valve insufficiency. When tricuspid valve regurgitation lasts, it can lead to heart failure or atrial fibrillation. Atrial fibrillation is a common heart rhythm disorder.

What are the symptoms of tricuspid regurgitation?

Some people can suffer from valve malfunction but not experience tricuspid regurgitation symptoms. Evidence tells us that in most cases, tricuspid valve insufficiency symptoms tend to appear when the condition is severe. In some cases, people are diagnosed with the condition when they are undergoing tests for other health complaints.

Here are some symptoms of tricuspid valve regurgitation when the condition does progress to a more severe stage:

  • Fatigue
  • Swelling in abdomen, legs, or veins in the neck
  • Pulsing in the neck
  • Abnormal heart rhythms
  • Shortness of breath with activities
  • Decreased urine output
  • General weakness

How to diagnose tricuspid valve insufficiency

If you are experiencing any of the symptoms above, your doctor just might suspect you have tricuspid regurgitation, especially if you have other conditions or risk factors associated with the disorder.

Tricuspid regurgitation diagnosis will involve a full physical exam, which includes the doctor listening to your heart. Abnormal sound may indicate that blood is flowing backward. The following diagnostic tests will also be considered:

  • Electrocardiogram: Measures the electrical impulses of the heart
  • Chest X-ray: To study the size and shape of the heart as well as condition of the lungs.
  • Echocardiogram: Sound waves produce images of the heart
  • Transesophageal echocardiogram: This is the insertion of a tiny tube with a sound device into the digestive tract that runs from the throat to the stomach (close to the heart), thus providing detailed images of the heart.
  • Cardiac catheterization: Used more often to determine the cause of tricuspid regurgitation. A catheter (small tube) is inserted in the groin, arm, or neck and guided to the heart using X-ray imaging. Dye injected through the catheter allows the doctor to see the blood flow through the heart, vessels, and valves.
  • Radionuclide scan: Uses a small amount of radioactive material to see structures inside the body.
  • MRI: Magnetic fields and radio waves create detailed images of the heart
  • Exercise or stress tests: These help determine activity tolerance as well as measure the heart’s response to exertion.

How is tricuspid regurgitation treated?

There are cases where tricuspid regurgitation treatment is not needed. The doctor may suggest monitoring your heart regularly to make sure the condition is not progressing. People who have severe symptoms will need some sort of treatment for tricuspid regurgitation though. That treatment will largely depend on the cause and on any underlying conditions that you might have.

Aside from regular heart monitoring, a doctor may prescribe medications, especially if you have an irregular heartbeat. There are also specific medications for heart failure patients. Any swelling can be treated with diuretics, which promote fluid loss. If someone has an underlying condition, such as high blood pressure, medications to reduce that pressure will be considered.

Catheter ablation is a procedure that is used if you have a fast heart rhythm. The doctor threads one or more catheters through the blood vessels of the heart that have electrodes on the tips. Heat, cold or radiofrequency energy can then create an electrical shock along that pathway causing the arrhythmia.

Unfortunately, there are circumstances where a more invasive action is required. Below, we outline possible surgical treatment options, which are used in severe cases:

Maze procedure

The surgeon makes small incisions in the upper heart chambers to create a pattern of scar tissue. Scar tissue doesn’t conduct electricity and can interfere with the electrical impulses that cause fast heart rhythms.

Heart valve repair:

Surgeons can perform a valve repair by separating valve leaflets, closing holes in leaflets, or reshaping valve leaflets so that they can make contact with each other and prevent blood from flowing backward.

Heart valve replacement

Doctors can remove the damaged valve and replace it with a mechanical valve or a valve made from cow, pig, or human heart tissue.

Sometimes valve replacement with a human heart tissue stops working, so doctors conduct a less invasive catheter procedure. They insert a catheter with a balloon on the end into a blood vessel in the neck or leg and thread it to the heart using imaging. A replacement valve is inserted through the catheter and guided towards the heart.

Home remedies for tricuspid regurgitation

In many cases, doctors suggest lifestyle changes to improve heart health. This also applies to those who are suffering from tricuspid valve regurgitation.

Eating a heart-healthy diet that includes a variety of fresh fruits and vegetables as well as whole grains and lean proteins is advisable. Avoiding saturated and trans fats, sugar, salt and refined grains is also recommended.
Exercise is a big part of maintaining good heart health. It is important to check with a doctor before beginning any exercise program if you have heart issues. The amount and type of exercise will depend on your condition.

If you are planning to have a family and you have been diagnosed with tricuspid valve regurgitation, talk to your doctor first. In severe cases, a woman with tricuspid valve regurgitation must be closely monitored during pregnancy.

Prevention and prognosis of tricuspid regurgitation

If you have been diagnosed with tricuspid valve regurgitation, you should be taking steps to reduce the risk of endocarditis. You can prevent this health complication by taking good care of your teeth and gums, telling your doctors and dentist that you have a valve problem, considering taking antibiotics before any invasive medical or dental procedure, and informing your doctor about symptoms of infection, fever, sore throat, or body aches that you experience.

Tricuspid regurgitation prognosis is usually good. If the cause is an infection, removal of the valve often cures the problem if the source of the infection is eliminated. Those who have high blood pressure will find that the prognosis is directly related to the prognosis for the underlying cause.

Receiving a tricuspid regurgitation diagnosis can be frightening. Keeping on top of it can keep you in control and
active, which means you have to maintain a healthy lifestyle and report all signs and symptoms to your doctor.

While we don’t have exact numbers when it comes to how many people are currently suffering from tricuspid valve insufficiency, we do know that about five million Americans are diagnosed with some sort of heart valve disease each year. This not only puts a huge strain on patients, but on the healthcare system.

Related: Common causes of aortic regurgitation: Symptoms, diagnosis, treatment, lifestyle changes, and prognosis


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https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/symptoms-causes/syc-20350168
https://www.healthline.com/health/tricuspid-regurgitation
https://emedicine.medscape.com/article/158484-overview#a8

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