Severe tricuspid regurgitation

DEfinition: heart's tricuspid valve does not close properly, causing blood to flow backward (leak) into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.

Causes : Hypertension

• Carcinoid tumors, which release a hormone that damages the valve
• Marfan syndrome
• Injury
• Rheumatoid arthritis
• Radiation therapy
• Rheumatic fever

Symptoms:

• Active pulsing in the neck veins
• Decreased urine output
• Fatigue, tiredness
• General swelling
• Swelling of the abdomen
• Swelling of the feet and ankles
• Weakness

  
  

  
  

  
  

  Signs and tests

  The health care provider may find abnormalities when gently pressing with the hand (palpating) on your chest. The doctor may also feel a pulse over your liver. The physical exam may show liver and spleen swelling.

  Listening to the heart with a stethoscope may reveal a murmur or other abnormal sounds. There may be signs of fluid collection in the abdomen.

  An ECG or echocardiogram may show enlargement of the right side of the heart. Doppler echocardiography or right-sided cardiac catheterization may be used to measure blood pressure inside the heart and lungs.

  Other tests, such as CT scan or MRI of the chest (heart), may reveal enlargement of the right side of the heart and other change

  
  

  Medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of CHF that is causing or contributing to the problem.

  Diuretics

  Class Summary

  Are used to control the fluid overload associated with the process.

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  Furosemide (Lasix)

   

  Increases excretion of water by interfering with chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. Dose must be individualized to the patient. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1 mg/kg/dose increments until a satisfactory effect is achieved.

  
  

  Cardiac glycosides

  Class Summary

  These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility.

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  Digoxin (Lanoxin)

   

  Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure

  Angiotensin-converting enzyme (ACE) inhibitors

  Class Summary

  Are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle.

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  Captopril (Capoten)

   

  Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion.

  Anticoagulants

  Class Summary

  Are used to prevent thrombosis and embolization from the prosthetic valve used in the treatment of tricuspid regurgitation.

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  Warfarin (Coumadin)

   

  Interferes with hepatic synthesis of vitamin K–dependent coagulation factors. Used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Tailor dose to maintain an international normalized ratio (INR) in the range of 2-3.