Tricuspid valve insufficiency

The main muscle of the human body is the heart. This is a complex mechanism, the components of which are valves. In the right half is a tricuspid valve. He shares the atrium and ventricle.

When a failure occurs in his work, the blood flow in this part of the muscle is disrupted. The result is a life-threatening condition. In medical practice, it is also known as “tricuspid valve insufficiency.”

In today’s article, we will consider the main causes, symptoms and methods of treating this disease.

The human heart is a muscular organ. Its cavity is divided into 2 atria and 2 ventricles. Communication between these structures occurs through valves. They are responsible for the flow of blood in one direction.

On the right side of the heart, chambers are connected through a tricuspid valve. It consists of the following anatomical formations:

  • three wings (septal, anterior and posterior);
  • tendon course;
  • papillary muscles;
  • fibrous ring.

During the contraction of one atrium, the tricuspid valve opens. Gradually, blood fills the ventricle. After this, the myocardium begins to alternately contract, while the valve flaps slam shut under strong pressure.

Such a debugged mechanism prevents the return of blood (regurgitation). Under the influence of certain factors, sometimes his work fails. In this case, it is said that the tricuspid valve is experiencing insufficiency.

However, he can no longer fully perform his functions.

With this pathology, blood from the right ventricle returns to the atrium. A slight increase in the volume of fluid practically does not affect the functioning of the main muscle of the body. With severe insufficiency, the chambers of the heart undergo deformities, the pressure indicators sharply change in them. It can increase up to 8 times in comparison with natural values.

The main organ of the human circulatory system – the heart, needs the blood to move in one direction, otherwise it can become filled with the same blood that was previously pushed into the arteries.

Valves are responsible for the unidirectional flow of blood, the valves of which at the right time close and open, letting blood through or obstructing it. The valve between the right atrium and the right ventricle consists of three plates and is called a tricuspid (or tricuspid).

If the operation of this valve is impaired, the blood flow becomes difficult, and tricuspid insufficiency occurs. A defect is considered acquired, cases of congenital pathology are extremely rare.

Tricuspid valve insufficiency at the initial stage is not considered a serious life-threatening condition. A person may not experience any manifestations of an ailment. Deviations from the norm are detected by chance during a medical examination or medical manipulations. But you can not leave the problem unattended, this will lead to grave consequences requiring surgical intervention.

When the heart relaxes, the tricuspid valve opens, and venous blood passes from the right atrium into the ventricle. At the time of contraction of the heart, the leaflets close again.

Due to their loose closure, part of the blood enters the right atrium. The volume of blood dispensed is negligible and does not actually affect the functioning of the heart and blood vessels.

But if its amount increases, it will be detrimental to the cardiovascular system and is fraught with the development of serious complications.

Tricuspid insufficiency is divided by cardiologists into 4 degrees:

  • 1st degree: the amount of blood that is thrown back into the atrium is very small and poorly detectable.
  • 2nd degree: the fluid returns sparingly and is found two centimeters from the valves.
  • 3rd degree: the distance from the valve cusps to the blood returning to the right atrium is more than two centimeters.
  • 4th degree: blood already fills a significant volume of the atrial cavity.

Stage 1 insufficiency is diagnosed at the initial stage of the development of the disease. She does not manifest herself symptomatically. A person feels good, lives a full life. After a thorough cardiological examination, the patient is prescribed drug therapy in order to improve the valve apparatus and maintain the heart muscle.

The following 3 degrees of disease development require an individual approach to the choice of treatment.

Congenital tricuspid insufficiency, occurs even before the birth of a child – in the womb. It is due to the wrong size of the valves, their low density or too low valve position. It is quite rare.

Acquired form – arises due to the impact on the human body of various factors. Frequent culprits of the disease are chronic inflammatory processes.

  • Organic – with the sash changing in shape and size;
  • Functional – the valves do not close tightly due to changes in the heart, for example, due to an increase in the size of the right ventricle, changes in the muscle ring, etc.
  1. The systemic inflammatory process is rheumatism.
  2. Rheumatoid endocarditis contributes to the compaction and wrinkling of the valves.
  3. Myocarditis, heart attacks, cardiomyopathy and other diseases of the heart muscle.
  4. Chronic heart failure.
  5. Pulmonary hypertension.
  6. Rupture of valve flaps due to traumatic factors or mechanical damage to the valve apparatus.
  7. The consequences of surgery to restore mitral valve function.
  8. The development of tumors in the heart cavity, which impede normal blood flow.

The diseases transferred by a person throughout his life, their complications and severe injuries received contribute to the formation of a pathological condition.

Tricuspid insufficiency of the 2nd degree is characterized by the presence of the following symptoms:

  • Bloating and bulging of the vessels of the neck;
  • Irregular heartbeat;
  • Excessive fatigue and lack of vital energy;
  • The appearance of shortness of breath even with low physical activity;
  • Swelling and chilliness of the limbs;
  • A feeling of heaviness in the liver as a result of an increase in size;
  • Puffiness of the face and its yellowish-cyanotic shade;
  • Extraneous noise and rhythm disturbances when listening to the heart;
  • Impaired urination;
  • Vomiting, nausea, diarrhea.

If patients ignore the first symptoms: fatigue, swelling, false chilliness – the disease progresses. The right ventricle increases in volume, as does the right atrium. At this stage, secondary changes in the functioning of organs and systems appear. If the disease goes into grade 3, then surgery can not be avoided.

Tricuspid valve insufficiency of the 1st degree often does not carry any symptoms and is not determined using an electrocardiogram. But the 2nd degree of the disease is already easy to identify when conducting certain examination methods:

  1. Medical history: the doctor collects information about the patient’s chronic diseases, his lifestyle, complaints about well-being and the time of their occurrence.
  2. General examination of the patient, listening to the heartbeat.
  3. Electrocardiographic examination (ECG) – gives an expanded picture of functional changes. It determines malfunctions of the heart rhythm, overload of the right atrium and ventricle, their increase in volume.
  4. Echocardiography – prov >

Treatment is purely individual in nature and depends on the severity of the disease. It can be medical or surgical. With running 3 and 4 degrees, an integrated approach is used.

As a conservative treatment, doctors usually prescribe:

  • Diuretic drugs to remove excess fluid from the body;
  • Nitrates to stabilize the pressure in the pulmonary vessels;
  • Preparations containing potassium to improve the functioning of the heart muscle;
  • Medicines for the prevention of heart failure;
  • Glycosides to optimize heart rate.

Treatment is carried out against a background of salt-free nutrition (not more than 3 g per day) and a decrease in fluid intake. This prevents stagnation of blood in the heart vessels.

Surgical measures include:

  • Plastic change of the tricuspid valve to narrow the outlet.
  • Replacing the valve with a mechanical or bioprosthesis. The operation is performed when the valves are badly damaged or the plastic performed earlier did not lead to a noticeable improvement.

As the primary prevention of the onset of the disease, it is necessary:

  • Take measures to prevent the development of rheumatism;
  • Time to treat inflammatory processes in the body: tonsillitis, carious lesions, tonsil enlargement, etc.
  • Introduce a healthy lifestyle: to temper, eat right and be physically active.

As a secondary prevention in the presence of defects in the valve apparatus, physiotherapeutic procedures and strict adherence to medications prescribed by a doctor are added to the measures described above.

Self-medication is life threatening! Self-changing drug regimens or their dosage is unacceptable. Only a cardiologist can prescribe adequate therapy for this heart disease.

Deterioration of the patient’s condition may occur due to neglect of the prescribed treatment, the absence of which entails an increase in symptoms. Atrial-gastric blockade, pulmonary thromboembolism, atrial fibrillation, repeated infective endocarditis may occur.

Another type of complication is the consequences of surgery. Thrombi may form after the valve is installed, calcium salts can be deposited on the walls of the bioprosthesis, and the inner lining of the heart becomes inflamed.

Tricuspid valve insufficiency of any severity requires mandatory medical supervision and proper treatment in order to avoid dangerous consequences. In the process of the disease, the work of other organs and systems is disrupted. Therefore, do not let this unpleasant heart ailment to drift.

Symptoms

Signs of the disease are:

  • external manifestations:
    • complexion has a shade of yellowish blue,
    • the face looks puffy;
  • shortness of breath,
  • weakness,
  • hemoptysis,
  • vomiting,
  • flatulence,
  • pain in the area of ​​the heart,
  • prostration,
  • fatigue even with light loads,
  • in the area of ​​the right hypochondrium, a feeling of heaviness,
  • symptoms of congestion in a large circle:
    • detection of fluid in the pleural cavity,
    • edema,
    • the appearance of signs of ascites – fluid accumulates in different places of the body;
    • enlargement of the liver.

In infants, the pathology manifests itself with cyanosis of the skin and symptoms of severe heart failure. The following complaints are received from older children and adults:

  • severe fatigue;
  • dyspnea;
  • cyanosis of the skin.

With secondary valve insufficiency, additional symptoms appear associated with concomitant pathologies. For example, pain with right ventricular infarction or hemoptysis and arrhythmia with mitral valve defects may be present.

Tricuspid valve insufficiency in children

Newborn babies with severe regurgitation and the presence of concomitant cardiac abnormalities are prone to the rapid development of right ventricular failure. Very often, it ends in death.

The acquired form of the disease develops against the background of complications of other diseases. Most often we are talking about an infection of streptococcus, which entails a rheumatic lesion.

Among other causes of childhood deficiency are:

  • acute form of hypertension;
  • myocardial disease;
  • traumatic injuries;
  • malignant neoplasms.

At the initial stage, tricuspid valve insufficiency in children is considered as an anatomical feature. The first degree of the pathological process does not require treatment. With age, the disease usually goes away on its own.

Pathology is dangerous with severe regurgitation in the case of formed abnormalities of a vital organ. Newborns quickly begin to suffer from insufficiency of the right ventricle. This is manifested by respiratory disorders and a change in the skin with a blue tint. In the absence of timely treatment, the child dies.

If the pathology is acquired, then it is a complication of a disease. Often there is a streptococcal infection that leads to rheumatic lesions.

The main causes of anatomical and functional abnormalities in children also include various myocardial lesions and severe hypertension. Rarely, the reasons lie in injuries and malignant tumors.

If a child has stagnation in a small or large circle, this can cause dysfunction of various internal organs.

When diagnosing a tricuspid valve insufficiency of the 1st degree in a baby, doctors do not sound the alarm, because this moderate pathology is regarded as a congenital anomaly that can pass with age.

It is important to timely diagnose the pathologies under consideration, since with adequate treatment the baby will lead a fully-fledged lifestyle.

Diagnostics

Early detection of the disease plays a direct role in the success of treatment, and also affects the life expectancy of the patient. Since insufficiency of the tricuspid valve of the 1st degree is almost asymptomatic, pathology is detected only after its transition to the next stage of development.

Diagnosis begins with a survey of the patient, a study of his medical history and physical examination. By asking various questions to the patient, the doctor determines the clinical picture, the time of the onset of the first symptoms.

He also needs to know which diseases were preceded by failure. An external examination usually reveals cyanosis of the skin and swelling, and when listening, a violation of the heart rhythm.

As part of the diagnosis, several laboratory tests are mandatory. Among them, the most informative are the blood test and the study of the immunological status of the patient. According to the results of laboratory tests, one can judge the presence of inflammatory processes in the body, parallel ailments.

To clarify the diagnosis, the doctor can use hardware examination methods. These include:

  1. ECG. It is carried out in order to detect an increase in atrial volumes.
  2. Phonocardiogram. Demonstrates the presence of systolic murmur.
  3. Spiral CT. Provides an informative image of the main muscle of the body.
  4. Roentgenogram. It gives an idea of ​​the size of the heart, reveals congestion.
  5. Coronocardiography It is used before surgery and allows you to evaluate blood flow.
  6. Echocardiography. Shows the deformation of the valves, the presence of new formations on them.

The specialist listens for the presence of noise in the chest area. After analyzing the patient’s symptoms and complaints, instrumental diagnostic methods are selected for a detailed study of the problem.

  • Electrocardiogram. This method can detect enlargement and deformation of the heart chambers.
  • Phonocardiography. The device records on paper the noise associated with the work of the heart. The device clarifies the patient examination data with a stethoscope.
  • Coronarocardiography It makes it possible to assess the movement of blood flow.
  • Roentgenography. It is possible to detect changes in the size of the atrium and vena cava. The configuration of the heart is determined.
  • Echocardiography. One of the main methods for examining a patient with problems associated with defective valve operation. The method shows the presence of regurgitation, the condition of the valve and whether there are other violations.
  • CT scan. Shows accurate images of the heart in the required perspective. It is possible to obtain an image in the context of any plane.
  • Catheterization. A method for diagnosing valve insufficiency is rarely used. Equipment that enters the heart with a catheter can provide detailed information about its internal abnormalities. Allows you to measure the pressure in the chambers of the heart.

Often tricuspid insufficiency is accompanied by pathologies of the mitral valve, stenosis, which complicates the diagnosis. Therefore, an extensive examination of the patient is carried out using a variety of methods – from taking an anamnesis to blood tests, ECG and X-rays.

During an oral questioning of the patient, the doctor examines his complaints, lifestyle, finds out what his close relatives were sick with. It is also important to establish the profession of the patient, since, perhaps, by the nature of his activity, he has encountered pathogens of infectious diseases.

  • During the examination, the doctor establishes the presence of blueness of the skin, swelling of the veins on the neck and abdomen (occurs with ascites due to accumulation of excess flu >

As part of the diagnosis, several laboratory tests are performed:

  • general blood and urine tests;
  • biochemistry of blood;
  • immunological analysis.

Thanks to these studies, the presence of inflammation and concurrent diseases is established.

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Hardware Methods

To clarify the diagnosis, you may need:

  1. ECG (detection of blockages, increased volumes of the atrium and ventricle).
  2. Phonocardiogram (demonstrates systolic murmur).
  3. Echocardiography (the main method, shows the deformation and thinning of the valves, the formation of new structures on them, etc.).
  4. Spiral computed tomography (provides an informative image of the heart).
  5. X-ray (reveals heart parameters, blood stasis).
  6. Cardiac catheterization (confirms that atrial pressure has reached ventricular level).
  7. Coronarocardiography (performed before surgery; by introducing contrast into the vessels, a clear image is obtained, blood flow is estimated).

Signs of tricuspid valve insufficiency

At the initial stage, heart disease does not practically manifest itself. Sometimes after physical exertion, patients note the appearance of a strong pulsation of veins on the neck. Detect the pathological process is possible only with the help of Dopplerography. Normal ECG does not show significant changes in the work of the heart.

Tricuspid valve insufficiency of the 2nd degree is accompanied by an increase in the volume of reverse blood flow. Right ventricular disorder leads to an increase in heart size. As a result, the clinical picture is supplemented by the following symptoms:

  • loss of strength, decreased physical and mental activity;
  • frequent urination at night;
  • severe swelling of the lower extremities;
  • dyspnea;
  • a feeling of heaviness under the ribs;
  • dyspeptic disorders.

When listening to the heart, pansystolic murmurs and atrial fibrillation are determined.

Complications

The lack of timely treatment can lead to the progression of the disease. The pathological process in this case affects not only the tricuspid valve.

Insufficiency gradually leads to the fact that the body begins to look for new compensatory mechanisms. Thus, he tries to cope with the existing violations.

Depending on the neglect of the disease, the following disorders may occur:

  • pneumonia;
  • enlargement of the liver, cirrhosis;
  • pulmonary embolism;
  • ascites.

Complications are also divided by specialists into two categories – those that follow due to the lack of treatment, and caused by the operation.

Pulmonary embolismThe formation and complete overlap of the lumen of the artery with a thrombus and its subsequent separation.
Atrial fibrillationAs well as other cardiac arrhythmias due to impaired movement of the electrical impulse.
Atrial Ventricular BlockIt is characterized by a deterioration in the movement of the electrical impulse.
Infectious endocarditisSecondary development.
Pulmonary embolismA blood clot forms in the area of ​​the operation.
Inflammation of the inner lining of a vital organIt is indicated by infectious endocarditis.
Thrombosis of a biological or artificial prosthesisA blood clot forms near the installed valve, which leads to impaired normal blood flow.
The characteristic destruction of the biological prosthesisOften requires repeated surgical intervention.
Calcification in the presence of a biological prosthesisProvokes deterioration in mobility.

Treatment of tricuspid valve insufficiency depends on the degree of damage, the severity of blood stasis and other factors that should be considered comprehensively.

If pathology is not treated, it will progress, leading to serious complications. Among them:

  1. Pulmonary embolism. The resulting thrombus will gradually block the lumen of the artery, and ultimately it will come off.
  2. Atrial fibrillation and other forms of abnormalities of the heart rhythm.
  3. Atrioventricular block with impulse movement.
  4. Atresia of the aorta (overlapping of the mouth of its ascending part).
  5. Secondary development of infectious endocarditis.

So, in the operated areas blood clots are often formed. If the patient has had a biological prosthesis installed, he can provoke calcification, which causes a decrease in patient mobility. It is also possible thrombosis or destruction of the installed valve, which often requires reoperation.

Prevention of tricuspid insufficiency

Primary preventionIt is characterized by preventing the development of tricuspid valve insufficiency, where each person must carry out the following actions:
  • Monitor your health and prevent diseases-causes that entail the development of the presented pathology, for example, rheumatism or infectious endocarditis.
  • If the disease, which entails the described sad consequences, is already diagnosed, it is necessary to quickly begin treatment to eliminate it.
  • People should resort to hardening procedures, which is carried out since childhood.
  • It is necessary to carefully treat the treatment of foci of chronic infection. For example, chronic tonsillitis accepts only surgical removal of the tonsils, and tooth decay – timely filling.
Secondary preventionIncludes actions to prevent the further spread of pathology in the form of organ damage.

Here, experts appoint patients:

  • Conservative treatment in the form of the use of medicines – diuretics, ACE inhibitors, nitrates, drugs containing potassium and cardiac glycosides to increase heart rate.
  • Methods for preventing the recurrence of rheumatism in the form of antibiotics, hardening procedures and timely treatment of chronic infections.
  • It is necessary to carefully treat diseases that initiated cardiac dysfunction.
  • If valve failure has caused rheumatism, efforts should be made to prevent relapse.
  • Must be observed by a cardiologist.

The following section briefly describes what mitral-tricuspid insufficiency of the 1st, 2nd, 3rd degree is described.

The best way to protect yourself from this ailment is to regularly see a cardiologist and treat diseases that affect the heart’s work in time. Since the most common cause of pathology is rheumatism, it is important to prevent recurrence of this disease.

Doctors also give their patients some tips that help maintain the functionality of the heart and all its departments:

  • Maintain a healthy diet rich in vitamins and minerals.
  • Monitor salt and fluid intake to prevent swelling.
  • Stop smoking and alcohol.
  • Avoid dynamic and excessive physical exertion.
  • Do not allow hypothermia.
  • Fight stress.

Operative intervention

Grade 3 tricuspid insufficiency is considered the main indication for surgical intervention. Also, surgery is recommended for patients with severe deformations of the cusps or severe malfunctions in their work.

If the intervention is ineffective, there are obvious structural changes, the patient is given an artificial trap. After implantation of the prosthesis, anticoagulant therapy is required.

When implanting a biological prosthesis, it is of a short-term nature. If it is made of medical alloys, the treatment of tricuspid valve insufficiency takes a little longer.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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