Tricuspid valve disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 3, 2016

For some individuals who have tricuspid valve disease, symptoms may be completely absent. For this reason, these individuals may never realize they have the disease until they seek medical attention for a related issue and get an echocardiogram. For moderate to severe cases of tricuspid valve disease, some of the most commonly cited symptoms include:

• Irregular heartbeat (e.g. atrial fibrillation).
• Fatigue and/or weakness.
• An odd fluttering sensation in the neck area.
• Symptoms of heart failure that may include swelling in the extremities, shortness of breath, pain along the right side of the abdomen, or feelings of being cold.

Causes

Apart from taking a diet drug that contained Fen-Phen in any form, there are several other known factors that can cause the onset of tricuspid valve disease. Infection of the heart valve itself (infective endocarditis) or Marfan syndrome are common causes.

Rheumatic fever, caused by the same bacteria that cause strep throat, can also lead to the onset of tricuspid valve disease. When this is the cause, tricuspid valve disease often co-occurs with other valve diseases like aortic valve regurgitation, aortic valve stenosis, mitral valve regurgitation, mitral valve stenosis, and mitral valve prolapse.

In some cases, a congenital birth defect such as Ebstein's anomaly or a trauma to the chest area can trigger tricuspid valve disease. Lupus, tumors and carcinoid heart disease (caused by plaque build-up on the valves) can also cause tricuspid valve disease.

Diagnosis & Tests

A heart murmur is often the first warning sign that an individual may be experiencing the onset of tricuspid valve disease. The simplest way to detect a heart murmur is to listen to the heart through a stethoscope. If a murmur is detected, the doctor will usually take the patient's pulse next to look for an irregular heartbeat. Often the pulse is taken in the neck to see if the characteristic fluttering is present as well.

Further tests can include the following:

• Echocardiogram. This test creates a working image of the heart as it moves.
• Electrocardiogram (ECG). This test measures the electrical activity of the heart.
• Angiogram and cardiac catheterization. This test looks at heart muscle, the valves, the chambers and major blood vessels to identify any areas of narrowing or blockage.
• Magnetic resonance imaging (MRI)s. This test creates a real-time picture of the heart as it functions.
• Transesophageal echocardiogram. This test performs an echocardiogram from inside the body to get an up-close look at the heart system, including chambers and valves.
• Chest X-ray. This test looks at the whole structure of the heart and its components.
• Radionuclide angiography. This test uses a small amount of radioactive material as a contrast medium to assess the function of the heart.

Based on the results of each of these tests, there may be additional and more specific tests ordered to look for even more specific indications of tricuspid valve disease. 

Treatment & Therapy

Once a diagnosis of tricuspid valve disease is established, it is possible to begin treating any symptoms. For very mild cases where few if any symptoms are present, the physician may recommend watchful waiting. For moderate to more severe cases, treatments may involve either medications and/or surgery. Medications prescribed may include the following:

• Diuretics to prevent the body from retaining water.
• Heart regulation medications to provide for regular heartbeat.

Surgery is typically considered only after other means of treatment have failed to yield the desired results. Common surgical procedures used to treat tricuspid valve disease include these:

• Valve repair/replacement. When the heart valve becomes compromised, it may be necessary to surgically repair it or replace it with a new valve. 
• Catheter ablation. This surgical procedure creates a small amount of damaged tissue in the area where the heart arrhythmia is occurring so that the heartbeat can stabilize.
• Cox maze procedure. This surgical procedure creates a small series of cuts that will heal into scar tissue. The scar tissue will then block electronic signals that can cause heart arrhythmias.

Prevention & Prophylaxis