Fast Five Quiz: Heart Valve Disease

Yasmine S. Ali, MD, MSCI


April 22, 2020

Tricuspid valve dysfunction can result from morphological alterations in the valve or from functional aberrations of the myocardium. Tricuspid stenosis is almost always rheumatic in origin and is generally accompanied by mitral and aortic valve involvement.

Fatigue, due to limited cardiac output, may be present. Systemic venous congestion leads to abdominal discomfort and swelling. The onset is usually gradual, but it may be rapid if atrial fibrillation or flutter develops. Dyspnea may be present but is not severe unless concomitant mitral valve disease is present. Patients may describe prominent pulsations in the neck. When tricuspid stenosis occurs concomitantly with mitral stenosis, the decrease in cardiac output to the pulmonary bed may paradoxically diminish the dyspnea, hemoptysis, and orthopnea typically seen with mitral stenosis.

Tricuspid stenosis remains a surgical disease and requires either commissurotomy or replacement of the valve if right heart failure or low cardiac output has resulted. Surgery is rarely performed solely on the tricuspid valve; it is usually performed in combination with mitral and/or aortic valve disease repair.

Tricuspid regurgitation may result from structural alterations of any or all of the components of the tricuspid valve apparatus. The lesion may be classified as primary when it is caused by an intrinsic abnormality of the valve apparatus or as secondary when it is caused by right ventricular dilatation or other conditions (eg, LV dysfunction). Patients with tricuspid regurgitation present with the signs and symptoms of right-sided heart failure. Rarely, patients report angina, which may result from right ventricle overload and strain, even in the absence of coronary artery disease. The spectrum of presenting symptoms depends on whether the condition is secondary to right ventricular dilatation or other conditions (eg, LV dysfunction). Common presenting symptoms in patients with RV dysfunction include the following:

  • Dyspnea on exertion

  • Orthopnea

  • Paroxysmal nocturnal dyspnea

  • Ascites

  • Peripheral edema

The choice of treatment for tricuspid regurgitation depends on the etiology and severity of the condition. With mild tricuspid regurgitation associated with mitral valve disease and pulmonary hypertension, the tricuspid regurgitation itself does not require intervention. As pulmonary vascular pressures fall with successful mitral valve therapy, the tricuspid regurgitation tends to disappear.

Medical therapy may be used in tricuspid regurgitation secondary to left-sided heart failure. For patients in whom tricuspid regurgitation is secondary to left-sided heart failure, treatment centers on adequate control of fluid overload and failure symptoms (eg, diuretic therapy). Patients should be instructed to reduce their intake of salt. Elevation of the head of the bed may improve symptoms of shortness of breath. Digitalis, diuretics (including potassium-sparing agents), angiotensin-converting enzyme inhibitors, and anticoagulants are all indicated in the care of these patients. Antiarrhythmics are added as needed to control atrial fibrillation.

Read more about tricuspid regurgitation.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Aortic Stenosis, Mitral Stenosis, Aortic Regurgitation, Mitral Regurgitation, Tricuspid Stenosis, and Tricuspid Regurgitation.

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