Tuesday, September 02, 2014

Tricuspid Valve Disease

Definition

Tricuspid Valve Disease can occur when the heart valve between the right atrium and the right ventricle, which normally has three flaps or cusps, becomes narrowed. This lessens the amount of blood flowing into the right ventricle and can reduce the efficiency of the heart.

Description

The tricuspid valve is one of four valves that control the flow and direction of blood in and out of the heart. Blood enters the right atrium (upper heart chamber) and passes through the tricuspid valve into the right ventricle (lower pumping chamber) from where it is pumped out through the pulmonary artery in the lungs.

If the valve is narrowed (stenosed), it becomes difficult for a sufficient amount of blood to move through the right heart chambers with each beat. If the valve does not close properly, some blood flowing into the ventricle leaks back into the atrium with each beat. This condition is known as regurgitation or insufficiency. In both cases, the heart must work harder to pump an adequate amount of blood. In tricuspid stenosis, the right atrium becomes enlarged, while the right ventricle does not fill completely and remains small. In tricuspid regurgitation, both right chambers enlarge substantially.

Tricuspid valve disorders, which are rare, often occur in conjunction with other heart valve problems, particularly with mitral valve disorders.

Individuals with tricuspid valve disease are at risk for heart failure and atrial fibrillation (which increases the risk of blood clot formation). As in other types of valve disease, tricuspid disorders also increase the risk of endocarditis.

Causes

Tricuspid valve stenosis is usually caused by rheumatic heart disease, although it is occasionally due to a congenital condition. Tricuspid valve regurgitation is often secondary to high pressure within the heart's chambers, usually caused by pulmonary hypertension.

Symptoms

Tricuspid regurgitation and stenosis may be present for years without symptoms. When symptoms do occur, they may include an uncomfortable fluttering sensation in the neck or chest because of heart rhythm irregularities. Both conditions can produce the symptoms of right-sided heart failure, including discomfort in the upper abdomen because of an enlarged liver, fatigue and swelling.

Diagnosis

Signs of tricuspid valve disease, such as a heart murmur and an abnormal pulse in the jugular vein in the neck, may be detectable during a physical examination.

A chest x-ray, an electrocardiogram (EKG), and an echocardiogram (ultrasound study of the heart muscle and valves) may be helpful in reaching the diagnosis.

Cardiac catheterization may be performed if surgery is being considered.

Treatment

These valve disorders may require no treatment, although related heart valve problems may require specific treatment. If atrial fibrillation is present, it can be treated with oral antiarrhythmic drugs. In the case of severe tricuspid stenosis or regurgitation, surgery to repair or replace the defective valve may be recommended.

Questions

Questions to ask your health care provider

What caused this problem?

Will I need to have surgery to correct this problem?

What about medications for my heart rhythm?

With this condition do I need to limit my activity in any way?

Do I need to take antibiotics prior to dental surgery?

Prevention

Limiting the risk of rheumatic fever, particularly by prompt treatment of strep throat, is the major preventive measure for tricuspid disease. Prophylactic use of antibiotics before dental extractions and surgery can help prevent the development of infective endocarditis (see Health Profile: Endocarditis).