What is Tricuspid Valve Regurgitation – Symptoms and causes

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 bottom chamber (right ventricle). When this does not function properly, blood can leak backward 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 of Tricuspid Valve Regurgitation

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 might find it difficult to take deep breaths during physical activity.

Causes of Tricuspid Valve Regurgitation

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 tumor 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.

Diagnosis and Treatment

Tricuspid valve regurgitations occur silently and are 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 a tricuspid valve regurgitation may include:

Echocardiogram: This is the main test that is 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 transthoracic echocardiogram (TTE). Sometimes, when more details are required, then 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 catheterization:  A catheter, which is a thin, flexible tube, is inserted into a blood vessel in the arm or groin. It is slowly moved to the artery in the heart. 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 catheterization 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

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 to pump 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 get weakened and cause heart failure.

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

If you get tired very easily or feel short of breath with activity, see a doctor immediately. 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.

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