Tricuspid Valve Regurgitation: Symptoms, Causes, and Treatment

Tricuspid valve regurgitation is also called tricuspid insufficiency. Tricuspid valve regurgitation is a type of valvular heart disease in which the tricuspid valve, situated between the right atrium and right ventricle, fails to close fully during the contraction of the right ventricle.

What is Tricuspid Valve Regurgitation?

It is a type of heart valve disease where the valve’s flaps (cusps or leaflets) do not close properly. The tricuspid valve regulates the blood flow from the heart’s right upper chamber (atrium) to the heart’s right lower chamber (right ventricle). When this does not function properly, blood can leak backwards into the atrium through the leaky tricuspid valve. As a result, your heart has to pump harder to move blood through the valve. With tricuspid valve regurgitation, reduced blood flow reaches your lungs.

Symptoms

Unless the condition is severe, symptoms of tricuspid regurgitation are normally not noticed. Symptoms could include:

• Fatigue: feeling unusually tired during physical activity
• Swelling: There may be a noticeable swelling in the abdomen, legs, neck, or veins.
• Abnormal heart rhythms: You might experience a sensation of your heart beating too slowly, too quickly, or irregularly.
• Pulsing in your neck: There may be pronounced throbbing in the veins in your neck
• Shortness of breath: You could have shortness of breath or feel unable to breathe fully while being active.

Causes

There could be various causes of tricuspid valve regurgitation.

• A congenital heart defect: You may be born with a defect that affects the shape and functioning of the tricuspid valve. In children, it can also be caused by a rare congenital heart condition known as Ebstein anomaly. The valve itself is not formed correctly. It is formed lower than usual in the lower ventricle.
• Marfan syndrome: Changes in the genes cause this condition. It affects the fibres that support and anchor the organs and other structures in the body.
• Rheumatic fever: It is an autoimmune disorder that can develop following a bacterial infection, such as strep throat or scarlet fever. It can cause enduring damage to the heart and valves. When this happens, it is called rheumatic heart valve disease.
• Infection of the heart valves and lining: This condition is also called infective endocarditis. The infection damages the tricuspid valve. Misuse of IV drugs can cause this.
• Carcinoid syndrome: Sometimes, a rare cancerous tumour releases certain chemicals into the bloodstream. This can lead to carcinoid heart disease. Mostly, the tricuspid valves and the pulmonary valves are commonly damaged.
• Chest injury: An injury from a car accident, for instance, can cause this condition.
• Pacemaker or other heart device wires: Sometimes, the wires from a pacemaker may cross the tricuspid valve. This may be a cause for the condition.
• Heart biopsy: Sometimes, a small part of the heart muscle tissue is removed for examination. This is called an endomyocardial biopsy, and it can damage the tricuspid valve.
• Radiation therapy: Rarely, radiation therapy for cancer, when focused on the chest area, may cause tricuspid valve regurgitation.

Stages

• Stage A: At Risk – Risk factors for developing heart valve disease are present.
• Stage B: Progressive – The valve disease is mild to moderate, but there will not be any noticeable symptoms.
• Stage C: Asymptomatic Severe – The Tricuspid Valve Regurgitation is severe, yet no proper symptoms are experienced.
• Stage D: Symptomatic Severe – The valve disease is severe, and symptoms are experienced.

Risk Factors

Certain factors can increase the risk of tricuspid valve regurgitation. An irregular heartbeat such as atrial fibrillation can affect how the valve works. People who are born with heart defects, including Ebstein’s anomaly, may also have a higher risk.

Heart muscle damage, heart attack, or heart failure can weaken the heart and lead to valve leakage. Pulmonary hypertension (high blood pressure in the lungs) can also put extra pressure on the tricuspid valve.

Other risk factors include heart infections (endocarditis), radiation therapy to the chest, and the use of certain weight-loss or migraine medications. In addition, conditions such as aortic stenosis, carcinoid syndrome, Marfan syndrome, mitral valve regurgitation, cardiac arrhythmias, and rheumatic fever may increase the risk.

Diagnosis and Treatment

Tricuspid valve regurgitations occur silently and is normally diagnosed when imaging tests are being done on the heart for other reasons. The cardiologist will inquire about your symptoms and your medical history. When the doctor listens to your heart using a stethoscope, they may hear a wooshing sound called a heart murmur.

Tests to diagnose tricuspid valve regurgitation may include:

Echocardiogram: This is the main test used in diagnosis. Using sound waves, it creates pictures of the beating heart. It demonstrates the blood flow through the heart and its valves, including the tricuspid valve. A standard echocardiogram captures images of the heart from outside the body. This is called a transthoracic echocardiogram (TTE). Sometimes, when more details are required, a test called transoesophageal cardiogram (TEE) is used to create pictures of the heart from inside the body.

Electrocardiogram: This records the electrical signals in the heart and shows how the heart is beating. Electrodes are stuck to the chest, hands, and legs. Wires connect the sensors to the computer, which displays and prints the results.

Chest X-ray: An X-ray showing the heart and lungs

Cardiac MRI: Detailed images of the heart are created using magnetic fields and radio waves. A cardiac MRI shows the severity of the tricuspid valve regurgitation and details about the lower right heart chamber.

Cardiac Catheterisation:  A flexible, narrow tube known as a catheter is gently introduced into a blood vessel in either the arm or the groin. The tube has a dye that makes the arteries of the heart show clearly on an X-ray, which is taken during the test. Pressure in the heart is also measured during this test.

Treatment depends on the cause of the tricuspid valve regurgitation. You may be advised:

• Medicines: Usually, medications to prevent water retention and control your heart rate are given.
• A heart procedure
• Surgery to repair or replace the valve: This surgery is done either as an open-heart surgery or a minimally invasive heart surgery. Cardiac catheterisation can help improve blood flow and reduce the symptoms of the disease. Surgery may be necessary if the condition is advanced, if your heart is becoming enlarged or weakened, or if you require heart surgery for another condition like mitral valve disease.

Living with Tricuspid Valve Regurgitation

Your prognosis will depend on your overall health and disease progression. You will have to manage your health and lifestyle based on the doctor’s advice. You will be advised based on the severity of your disease. Among many things, they may tell you:

• Have a healthy heart diet
• Avoid smoking
• Regular exercise routine. Those who have had heart failure will be advised to avoid strain on the heart
• Medication prescribed by the doctor
• Regular monitoring by the healthcare provider
• Visit your dentist on a regular basis and maintain good oral hygiene
• If you have strep throat, see the doctor immediately
• Avoid or limit alcohol consumption

What is the Life Expectancy of a Person with Tricuspid Valve Regurgitation

Understanding the prognosis of tricuspid valve regurgitation depends on its severity and timely treatment.

Mild Tricuspid Valve Regurgitation – It is a common condition that will not cause any problems or impact life expectancy.

Severe Tricuspid Valve Regurgitation – Without treatment,  40% of people may not survive beyond 4 years after diagnosis. The record says that only 34% of people with Severe Tricuspid Valve Regurgitation and heart failure live for 5 years.

Complications

The severity of Tricuspid Valve Regurgitation determines the possible complications. Atrial fibrillation (AFib) is a common complication, and it elevates the risk of blood clots and stroke.

In cases of severe tricuspid regurgitation, the heart has to put more effort into pumping blood efficiently throughout the body. Then, the extra strain causes the right lower heart chamber to enlarge. If it is left untreated, over time, the heart muscles weaken and cause heart failure.

Also, high blood pressure in the lungs causes pulmonary hypertension.

Taking Action for Heart Health

If you experience unusual fatigue or difficulty breathing during activity, consult a doctor right away. It is important to inform all your healthcare providers, including your dentist, that you have tricuspid valve regurgitation. Mild tricuspid valve regurgitation might not be serious, but severe conditions will require immediate attention from a cardiologist.

Frequently Asked Questions