Tricuspid regurgitation medical therapy: Difference between revisions
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Revision as of 16:29, 15 December 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The main therapy is treatment of underlying cause. The aim of medical therapy among patients with tricuspid regurgitation is to treat right heart failure, left heart failure, and/or pulmonary hypertension in case they are present.[1] Medical therapy with diuretics is the mainstay of treatment. Unfortunately, this can lead to volume depletion and decreased cardiac output. Indeed, one must often accept a certain degree of symptomatic tricuspid regurgitation in order to prevent a decrease in cardiac output. Treatment with medicines to reduce cardiac afterload may also be of benefit but a similar risk of depressed cardiac output applies.
Medical Therapy
Right Heart Failure
Patients with trucspid regurgitation and symptoms of right heart failure should receive diuretics in order to reduce their volume overload. Loop diuretics are commonly used. Aldosterone antagonists can be beneficial among patients with hyperaldosteronism secondary to hepatic congestion. Diuretics should be administered intravenously whenever the patient has intestinal edema as oral treatment with diuretics is inefficacious.[2]
Left Heart Failure
If left heart failure is present, the therapeutic strategy should be targeted towards the treatment of the underlying pathophysiological mechanism. Beta blockers and angiotensin converting enzyme inhibitors are used among patients with left ventricular systolic dysfunction.
Pulmonary Hypertension
As pulmonary hypertension is one of the causes of functional tricuspid regurgitation, treatment of pulmonary hypertension with vasodilators might improve the valvular regurgitation.[3]
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[1]
| Class IIa |
| "1. Diuretics can be useful for patients with severe TR and signs of right-sided HF (stage D). (Level of Evidence: C)" |
| Class IIb |
| "1. Medical therapies to reduce elevated pulmonary artery pressures and/or pulmonary vascular resistance might be considered in patients with severe functional TR (stages C and D). (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ Bruce CJ, Connolly HM (2009). "Right-sided valve disease deserves a little more respect". Circulation. 119 (20): 2726–34. doi:10.1161/CIRCULATIONAHA.108.776021. PMID 19470901.
- ↑ Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K; et al. (2013). "Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery". J Cardiothorac Vasc Anesth. 27 (3): 459–66. doi:10.1053/j.jvca.2012.07.020. PMID 23063102.