Tricuspid valve disease comprises signs of tricuspid regurgitation and tricuspid stenosis. Often, other valves are also involved, therefore patients have even more symptoms and sometimes the tricuspid pathology is masked by left-sided abnormalities [1], especially if a rheumatic valvular process involving both the mitral and the tricuspid valve caused the disease [2]. Symptoms of tricuspid stenosis include fatigability, weight loss due to anorexia, pain located in the right hypochondrium due to liver distension, hepatic pulsations, ascites, edema, and dyspnea. The lesion itself produces a low rumbling diastolic murmur, often accompanied by that of a tricuspid regurgitation, which is high-pitched and pansystolic. The first heart sound is widely split, while the pulmonary component of the second sound is absent.

Symptoms of tricuspid regurgitation are often minimal, and when they exist, they overlap with those of right heart failure: dyspnea, fatigability, ascites, peripheral cyanosis, and edema. The liver is tender and pulsatile. If pulmonary hypertension is absent, auscultation reveals a mild presystolic murmur that becomes more audible during inspiration (Carvallo’s sign) and when liver compression or leg raising test are performed. If pulmonary hypertension is present, the pulmonary component of the second heart sound is loud.

Regarding jugular pulse, tricuspid stenosis induces a prominent "a" wave and a diminished rate of "y" descent, while tricuspid regurgitation causes abnormal "v" and systolic waves [3]. Other rare signs consist of systolic propulsion of the eyeballs [4], pulsations of varicose veins [5] and a venous jugular murmur [6].

Angina may occur in tricuspid valve disease even if coronary arteries are not affected, due to right ventricular overload [7].

• Fatigue

  Tricuspid regurgitation may not have any symptoms or the symptoms be vague, such as weakness and fatigue, which develop because the heart is not pumping enough blood to allow the body to receive the needed oxygen. [heart.org]

  […] of feeling our heartbeat) Neck discomfort Fatigue Cold skin Abdominal discomfort Treating Tricuspid Valve Disease Symptoms of tricuspid regurgitation can generally be managed with diuretics (also known as water pills, medicines that produce urine). [houstonmethodist.org]

  Most patients are asymptomatic, but those who do experience symptoms complain of fatigue and/or liver pain. [ihimontanafoundation.org]

  The symptoms of advanced-stage tricuspid valve disease can include: Reduced urine output due to fluid retention Swelling of the feet or legs Unexplained fatigue Visible pulsing of the neck veins, even while you are at rest Causes of Tricuspid Valve Disease [dignityhealth.org]

  Tricuspid Valve Disease Heart Throat pain Difficulty swallowing Red and swollen tonsils Tiny red spots on the soft or hard palate Swollen, tender lymph glands Fever Headache Rash Stomach ache Fatigue Shortness of breath Palpitations Chest pain Vomitting [nm.org]

• Regurgitation

  Most operations for tricuspid regurgitation are done at the time of left-sided heart valve surgery. [ncbi.nlm.nih.gov]

  Tricuspid valve disease comprises signs of tricuspid regurgitation and tricuspid stenosis. [symptoma.com]

• Abdominal Pain

  Symptoms may include: Edwards MC 3 Annuloplasty System Irregular heart rhythm (atrial fibrillation) Easily tired (fatigue) A fluttering discomfort in the neck With severe disease, heart failure symptoms (right abdominal pain, shortness of breath, swelling [my.clevelandclinic.org]

  These symptoms may include an uncomfortable feeling of an unusual pulsation in the neck, or abdominal pain and edema (swelling). If right-sided heart failure develops, pronounced dyspnea (shortness of breath), weakness and dizziness may occur. [verywell.com]

  The following are the most common symptoms of heart valve disease: Chest pain Palpitations caused by irregular heartbeats Fatigue Dizziness Low blood pressure Shortness of breath Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction [brighamandwomens.org]

• Heart Disease

  We prospectively studied the echocardiographic profile of tricuspid valve disease in 788 consecutive patients with rheumatic heart disease. [ncbi.nlm.nih.gov]

  […] in adults with congenital heart disease. [books.google.com]

• Heart Murmur

  A heart murmur is the sound of blood flowing across an abnormal heart valve. A heart murmur may be the first clinical sign of valve disease if you have no symptoms. [uwhealth.org]

  Changes in skin color How We Diagnose Tricuspid Valve Disease Your doctor may be alerted to tricuspid valve disease if you have a heart murmur. [heart.uvahealth.com]

  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. [healthcentral.com]

  Heart sounds and murmurs: High-pitched pansystolic murmur, most prominent in the fourth intercostal space in the left parasternal region. In the absence of pulmonary hypertension, the murmur is usually low-intensity and early systolic. [patient.info]

  (inactive) (rheumatic) (valve) (with chorea) I07.9 Lesion (s) (nontraumatic) tricuspid (valve) I07.9 Murmur (cardiac) (heart) (organic) R01.1 ICD-10-CM Diagnosis Code R01.1 Cardiac murmur, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable [icd10data.com]

• Diastolic Murmur

  The lesion itself produces a low rumbling diastolic murmur, often accompanied by that of a tricuspid regurgitation, which is high-pitched and pansystolic. [symptoma.com]

  A low rumbling diastolic murmur along the left sternal border, which increases with inspiration. Tricuspid regurgitation is often also present, causing a pansystolic murmur in a similar location. [patient.info]

  murmur 拡張期心雑音 DVR double valve replacement 2弁置換 DVT deep venous thrombosis 深部静脈血栓症 E ECC extracorpreal circulation 体外循環 ECG electrocardiography 心電図法 EF ejection fraction 駆出率 ESV end-systolic volume 収縮末期容量 ET ejection time 駆出時間 H HBE his bundle electrocardiography [nurseful.jp]

• Pansystolic Murmur

  Cardiac murmurs are often present: A pansystolic murmur, which may signify blood flow through the ventricular septal defect. [patient.info]

• Stroke

  Untreated heart valve disease can lead to congestive heart failure, cardiomyopathy, stroke, arrhythmia, or blood clots. [ihimontanafoundation.org]

  Critical Care Our emergency medicine physicians and nurses who are dedicated to the care of patients with broken arms and “broken” hearts to stroke or sudden pain and more. [excelahealth.org]

  […] the total right ventricular stroke volume (obtained from SSFP images) 9,12,13. [radiopaedia.org]

  If a clot breaks loose (becoming an embolus), it is pumped out of the heart and may block an artery, possibly causing a stroke or other damage Unlike other heart valve disorders, tricuspid regurgitation usually occurs in a normal valve that has been affected [merckmanuals.com]

  SE MRI may be the preferred technique for accurate assessment of RV function, such as measurement of RV end-diastolic, end-systolic, and stroke volumes, as well as the ejection fraction. [emedicine.medscape.com]

• Asthenia

  When symptoms appear, patients may complain of asthenia, fatigue or decreased exercise tolerance as a result of lower cardiac output. [heart.bmj.com]

Blood workup is noncontributory in chronic tricuspid valve disease, whereas in acute endocarditis causing the valvular abnormality, leukocytosis is observed. Polycythemia indicates pulmonary under-circulation.

A thoracic radiography shows a dilated right atrium in tricuspid stenosis and right or global heart enlargement in tricuspid regurgitation.

The electrocardiogram reveals right atrium hypertrophy and atrial arrhythmias, as well as incomplete right bundle branch block.

Echocardiography describes the presence and severity of the disease, both stenosis and regurgitation components, etiology [8] [9] and the consequences of the illness: chamber dimensions, pulmonary hypertension. This method also identifies associated abnormalities like rheumatic degeneration of other valves or congenital heart disease, like Ebstein's anomaly or tricuspid atresia [10] and assesses systolic and diastolic function of both ventricles. In short, the parameters that should be quantified by echocardiography are: tricuspid annular systolic plane excursion (TAPSE) [11], tricuspid annulus systolic velocity, right ventricular end-systolic area, annular dilatation [12], coaptation distance, pulmonary systolic pressure [13], mean transvalvular gradient [2], degree of commissural fusion in tricuspid stenosis and morphology of the subvalvular apparatus.

If the disease is severe enough to necessitate surgical intervention, a coronarography is indicated, in order to assess coronary status and the need for a concomitant by-pass. Also, cardiac catheterization allows direct measurement of pulmonary artery pressure and resistance, which is useful when clinical and echocardiography data conflict.

If available, a magnetic resonance imaging evaluation could prove useful in determining chamber dimensions and function.

Exercise testing is indicated in order to assess effort capacity when echocardiography shows severe disease, but clinical status is good.

• Hypercholesterolemia

  It causes high cholesterol and high blood triglycerides. high blood triglycerides Diseases & Conditions Familial hypercholesterolemia Familial hypercholesterolemia is a disorder that is passed down through families. [mountsinai.org]

Treatment & Prevention for Tricuspid Valve Disease Our expert treatment of tricuspid valve disease generally aims to reduce symptoms and restore heart valve function. Mild to moderate tricuspid valve disease may not require any treatment. [dignityhealth.org]

World Class Care for Tricuspid Valve Treatment The expert team at Piedmont’s Marcus Heart Valve Center provides comprehensive tricuspid valve treatment ranging from advanced imaging to surgical repair or replacement to new minimally invasive treatment [piedmont.org]

In the last few years, several percutaneous alternatives have been developed for the treatment of functional tricuspid regurgitation. Imaging techniques play an indispensable role in patient selection, procedural guidance and follow-up. [ncbi.nlm.nih.gov]

Images may need to be taken to examine your heart with: Echocardiogram Chest x-ray MRI scan Cardiac catheterization Treatment Options for Valve Disease Medications You may not need immediate treatment if you have mild tricuspid valve disease. [heart.uvahealth.com]

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. [healthcentral.com]

Prognosis of Tricuspid Valvular Disease The prognosis of tricuspid valve disorders is good. Right heart failure should be treated with standard measures. [myvmc.com]

Prognosis Prognosis is generally good but dependent on the prognosis of the underlying disease, associated other heart abnormalities and associated arrhythmias. Tricuspid regurgitation [ 1 ] The incidence of TR is less than 1%. [patient.info]

Surgical valve repair or valve replacement usually cures the condition, but those with untreated, severe tricuspid regurgitation may face a poor prognosis, either from the valve disease itself or because of the complications from the underlying condition [heart.org]

In these cases, one finds that surgery predicts outliving non-surgery cases initially matched in health ~60% of the time (HR = .74). [13] Prognosis [ edit ] The prognosis of TR is less favorable for males than females. [en.wikipedia.org]

Treatment and prognosis The decision to treat tricuspid regurgitation is based on the etiology and severity 1,2,4,14. Management involves pharmacotherapy measures (especially diuretics) and consideration of surgery 1,2,4,14. [radiopaedia.org]

The treatment of tricuspid valve disease is guided by underlying etiology and pathology. [ncbi.nlm.nih.gov]

Echocardiography describes the presence and severity of the disease, both stenosis and regurgitation components, etiology and the consequences of the illness: chamber dimensions, pulmonary hypertension. [symptoma.com]

The echocardiography offers a complete positive, etiologic (congenital, rheumatic, carcinoid syndrome, infectious, or tumor that mimicks the TS), severity and functional diagnosis. [tmj.ro]

Treatment and prognosis The decision to treat tricuspid regurgitation is based on the etiology and severity 1,2,4,14. Management involves pharmacotherapy measures (especially diuretics) and consideration of surgery 1,2,4,14. [radiopaedia.org]

Regardless of the underlying etiology, ventricular dilatation exacerbates tricuspid insufficiency through annular dilatation. These changes in compliance are easily seen in tracings of the RA and RV end-diastolic pressures. [ispub.com]

An evidence-based systematic overview was carried out to assess the epidemiology, diagnosis and management of organic rheumatic tricuspid valve disease (RTVD) over the past half century. [ncbi.nlm.nih.gov]

Features of MyAccess include: Remote Access Favorites Save figures into PowerPoint Download tables as PDFs Go to My Dashboard Close Epidemiology Although as many as 70 percent of Americans may have a small amount of tricuspid regurgitation (TR) on echocardiogram [accesssurgery.mhmedical.com]

This article reviews the pathophysiology and current management of patients with tricuspid valve disease. [ncbi.nlm.nih.gov]

Tricuspid valve anomalies are part of the pathological spectrum in various congenital heart diseases, including Ebstein anomaly and tricuspid valve dysplasia, with different pathophysiology and clinical implications. [books.google.com]

Pathophysiology The primary mechanism causing regurgitation is transmission of pressure overload to the valve in the form of pulmonary hypertension; this assumption underpins medical and surgical management. [thoracickey.com]

Pathophysiology In most cases, tricuspid valve disease presents as functional regurgitation secondary to left-sided valvular disease or heart failure (particularly in the setting of pulmonary hypertension). [accesssurgery.mhmedical.com]

The pathophysiology of secondary TR is related to RV and annular dilatation or tethering (even with little annular dilatation) 12 in connection to pulmonary hypertension. [heart.bmj.com]

Tricuspid valve stenosis can be prevented with the adequate treatment of strep ( Streptococcus ) throat infections. [nm.org]

Is Valve Disease Preventable? Tricuspid valve disease can't be prevented. [heart.uvahealth.com]

You can prevent tricuspid stenosis by promptly treating strep infections so they do not progress to rheumatic fever. [dignityhealth.org]

Find more information about Bacterial Endocarditis prevention. [my.clevelandclinic.org]

Limiting the risk of rheumatic fever, particularly by prompt treatment of strep throat, is the major preventive measure for tricuspid disease. [healthcentral.com]

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2. Baumgartner H, Hung J, Bermejo J, et al; Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25.
3. Wooley C, Fontana M, Kilman J, et al.Tricuspid stenosis: atrial systolic murmur, tricuspid opening snap, and right atrial pressure pulse. Am J Med 1985;78:375–384.
4. Naylor C. Systolic propulsion of the eyeballs in tricuspid regurgitation. Lancet 1995;346:1706.
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8. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and by the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009;30:2369 –2413.
9. Baumgartner H, Bonhoeffer P, De Groot NMS, et al. Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010;31: 2915 –2957.
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12. Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of 2494 ESC/EACTS Guidelines tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg 2011;141:1431 –1439.
13. Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010;11:307 –332.