Tricuspid regurgitation medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Tricuspid regurgitation}}
{{Tricuspid regurgitation}}
{{CMG}} {{AE}} {{Rim}} {{FB}} {{VKG}}
{{CMG}} ; {{AE}} {{VKG}} {{Rim}} {{FB}}  


==Overview==
==Overview==
Line 21: Line 21:
**[[Ascites]]
**[[Ascites]]
* [[Loop diuretics]] are commonly used to relive some of the symptoms from the volume overload.
* [[Loop diuretics]] are commonly used to relive some of the symptoms from the volume overload.
*[[Aldosterone antagonist]]s can be beneficial among patients with [[hyperaldosteronism]] secondary to hepatic congestion.
*[[Aldosterone antagonist]]s 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.<ref name="pmid19470901">{{cite journal| author=Bruce CJ, Connolly HM| title=Right-sided valve disease deserves a little more respect. | journal=Circulation | year= 2009 | volume= 119 | issue= 20 | pages= 2726-34 | pmid=19470901 | doi=10.1161/CIRCULATIONAHA.108.776021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19470901  }} </ref>
* [[Diuretics]] should be administered [[intravenously]] whenever the patient has intestinal [[edema]] as oral treatment with [[diuretics]] is inefficacious.<ref name="pmid19470901">{{cite journal| author=Bruce CJ, Connolly HM| title=Right-sided valve disease deserves a little more respect. | journal=Circulation | year= 2009 | volume= 119 | issue= 20 | pages= 2726-34 | pmid=19470901 | doi=10.1161/CIRCULATIONAHA.108.776021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19470901  }} </ref>


===Left Heart Failure===
===Left Heart Failure===


* If [[left heart failure]] is present, the therapeutic strategy should be targeted towards the treatment of the underlying pathophysiological mechanism.
* If [[left heart failure]] is present, the therapeutic strategy should be targeted towards the treatment of the underlying pathophysiological mechanism.
*Pharmacologic medical therapy is recommended among patients with left ventricular systolic dysfunction with beta-blockers, renin-angiotensin-aldosterone system inhibitors and digitalis.
*Pharmacologic medical therapy is recommended among patients with left ventricular [[systolic dysfunction]] with [[Beta blockers|beta-blockers]], [[renin-angiotensin-aldosterone system]] inhibitors and [[digitalis]].


===Pulmonary Hypertension ===
===Pulmonary Hypertension ===


* The selective use of pulmonary vasodilators in patients with [[pulmonary hypertension|pulmonary artery hypertension]] may improve the valvular regurgitation.<ref name="pmidPMID: 27048553">{{cite journal| author=Rodés-Cabau J, Taramasso M, O'Gara PT| title=Diagnosis and treatment of tricuspid valve disease: current and future perspectives. | journal=Lancet | year= 2016 | volume= 388 | issue= 10058 | pages= 2431-2442 | pmid=PMID: 27048553 | doi=10.1016/S0140-6736(16)00740-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27048553  }} </ref><ref name="pmid23063102">{{cite journal| author=Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K et al.| title=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. | journal=J Cardiothorac Vasc Anesth | year= 2013 | volume= 27 | issue= 3 | pages= 459-66 | pmid=23063102 | doi=10.1053/j.jvca.2012.07.020 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23063102  }} </ref>
* The selective use of [[pulmonary]] [[Vasodilator|vasodilators]] in patients with [[pulmonary hypertension|pulmonary artery hypertension]] may improve the valvular [[regurgitation]].<ref name="pmidPMID: 27048553">{{cite journal| author=Rodés-Cabau J, Taramasso M, O'Gara PT| title=Diagnosis and treatment of tricuspid valve disease: current and future perspectives. | journal=Lancet | year= 2016 | volume= 388 | issue= 10058 | pages= 2431-2442 | pmid=PMID: 27048553 | doi=10.1016/S0140-6736(16)00740-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27048553  }} </ref><ref name="pmid23063102">{{cite journal| author=Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K et al.| title=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. | journal=J Cardiothorac Vasc Anesth | year= 2013 | volume= 27 | issue= 3 | pages= 459-66 | pmid=23063102 | doi=10.1053/j.jvca.2012.07.020 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23063102  }} </ref>


=== Pregnancy ===
=== Pregnancy ===
Line 38: Line 38:
** Timing
** Timing
** Preconception evaluation
** Preconception evaluation
***Which includes a detailed history, information on any prior [[valve]] interventions, a complete [[Physical examination|physical exam]] and a 12 lead [[electrocardiogram]] should be considered  
***Which includes a detailed history, information on any prior [[valve]] interventions, a complete [[Physical examination|physical exam]] and a 12 lead [[electrocardiogram]] should be considered
**[[Echocardiography|Echocardiographic]] assessment
**[[Echocardiography|Echocardiographic]] assessment
***Helps in determine the type and severity of [[Valvular heart disease|valvular]] lesions
***Helps in determine the type and severity of [[Valvular heart disease|valvular]] lesions
***Safer and less [[Invasive (medical)|invasive]]
***Safer and less [[Invasive (medical)|invasive]]
***Maternal [[Left ventricle|left ventricular]] [[Diastole|diastolic]] function and [[systolic]] function can be evaluated
***Maternal [[Left ventricle|left ventricular]] [[Diastole|diastolic]] function and [[systolic]] function can be evaluated
***Any cardiac [[Hemodynamics|hemodynamic]] changes or remodeling can be evaluated in pregnancy
***Any cardiac [[Hemodynamics|hemodynamic]] changes or remodeling can be evaluated in [[pregnancy]]
**[[Exercise testing]]
**[[Exercise testing]]
***Exercise testing which includes heart rate response should be considered to access the risk and can objectively estimate functional capacity
***Exercise testing which includes [[heart rate]] response should be considered to access the risk and can objectively estimate functional capacity
**[[Biomarkers]] can predict the cardiovascular complications in pregnancy and the following can be used to elevate:
**[[Biomarkers]] can predict the [[cardiovascular]] complications in [[pregnancy]] and the following can be used to elevate:
***N-terminal pro-B-type natriuretic peptide
***N-terminal pro-B-type [[Natriuretic peptides|natriuretic peptide]]
***B-type natriuretic peptide
***B-type [[Natriuretic peptides|natriuretic peptide]]
**[[Medication|Medications]]
**[[Medication|Medications]]
***Review of the patients current medications and should consider lowering or to stop some of medications that might be teratogenic.
***Review of the patients current medications and should consider lowering or to stop some of [[Medication|medications]] that might be [[teratogenic]].


<br />
<br />

Revision as of 04:10, 28 April 2020

Tricuspid Regurgitation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tricuspid Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Stages

History and Symptoms

Physical Examination

Laboratory Findings

Echocardiography

Chest X Ray

Electrocardiogram

Cardiac Stress Test

Cardiac MRI

Cardiac Catheterization

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Tricuspid regurgitation medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tricuspid regurgitation medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onTricuspid regurgitation medical therapy

CDC on Tricuspid regurgitation medical therapy

Tricuspid regurgitation medical therapy in the news

Blogs on Tricuspid regurgitation medical therapy

Directions to Hospitals Treating Tricuspid regurgitation

Risk calculators and risk factors for Tricuspid regurgitation medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2] Rim Halaby, M.D. [3] Fatimo Biobaku M.B.B.S [4]

Overview

The main therapy to tricuspid regurgitation is the treatment of the 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. Medical therapy with diuretics is given to reduce volume overload. Treatment with medications such as vasodilators to relieve pulmonary hypertension may also be of benefit.

Medical Therapy

Right Heart Failure

Left Heart Failure

Pulmonary Hypertension

Pregnancy


2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)[15][16][17]

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. Ingraham BS, Pislaru SV, Nkomo VT, Nishimura RA, Stulak JM, Dearani JA; et al. (2019). "Characteristics and treatment strategies for severe tricuspid regurgitation". Heart. 105 (16): 1244–1250. doi:10.1136/heartjnl-2019-314741. PMID 31092546.
  2. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease". Journal of the American College of Cardiology. 63 (22): e57–e185. doi:10.1016/j.jacc.2014.02.536. ISSN 0735-1097.
  3. 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.
  4. Rodés-Cabau J, Taramasso M, O'Gara PT (2016). "Diagnosis and treatment of tricuspid valve disease: current and future perspectives". Lancet. 388 (10058): 2431–2442. doi:10.1016/S0140-6736(16)00740-6. PMID 27048553 PMID: 27048553 Check |pmid= value (help).
  5. 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.
  6. Kovacs, Adrienne H.; Harrison, Jeanine L.; Colman, Jack M.; Sermer, Mathew; Siu, Samuel C.; Silversides, Candice K. (2008). "Pregnancy and Contraception in Congenital Heart Disease: What Women Are Not Told". Journal of the American College of Cardiology. 52 (7): 577–578. doi:10.1016/j.jacc.2008.05.013. ISSN 0735-1097.
  7. Bamfo JE, Kametas NA, Nicolaides KH, Chambers JB (2007). "Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy". Eur J Echocardiogr. 8 (5): 360–8. doi:10.1016/j.euje.2006.12.004. PMID 17321800.
  8. Jimenez-Juan L, Krieger EV, Valente AM, Geva T, Wintersperger BJ, Moshonov H; et al. (2014). "Cardiovascular magnetic resonance imaging predictors of pregnancy outcomes in women with coarctation of the aorta". Eur Heart J Cardiovasc Imaging. 15 (3): 299–306. doi:10.1093/ehjci/jet161. PMID 24037808.
  9. Waksmonski CA (2014). "Cardiac imaging and functional assessment in pregnancy". Semin Perinatol. 38 (5): 240–4. doi:10.1053/j.semperi.2014.04.012. PMID 25037513.
  10. Lui GK, Silversides CK, Khairy P, Fernandes SM, Valente AM, Nickolaus MJ; et al. (2011). "Heart rate response during exercise and pregnancy outcome in women with congenital heart disease". Circulation. 123 (3): 242–8. doi:10.1161/CIRCULATIONAHA.110.953380. PMID 21220738.
  11. Kampman MA, Balci A, van Veldhuisen DJ, van Dijk AP, Roos-Hesselink JW, Sollie-Szarynska KM; et al. (2014). "N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease". Eur Heart J. 35 (11): 708–15. doi:10.1093/eurheartj/eht526. PMID 24334717.
  12. Kampman MA, Balci A, van Veldhuisen DJ, van Dijk AP, Roos-Hesselink JW, Sollie-Szarynska KM; et al. (2014). "N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease". Eur Heart J. 35 (11): 708–15. doi:10.1093/eurheartj/eht526. PMID 24334717.
  13. Tanous D, Siu SC, Mason J, Greutmann M, Wald RM, Parker JD; et al. (2010). "B-type natriuretic peptide in pregnant women with heart disease". J Am Coll Cardiol. 56 (15): 1247–53. doi:10.1016/j.jacc.2010.02.076. PMID 20883932.
  14. Ducas RA, Elliott JE, Melnyk SF, Premecz S, daSilva M, Cleverley K; et al. (2014). "Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study". J Cardiovasc Magn Reson. 16: 1. doi:10.1186/1532-429X-16-1. PMC 3882291. PMID 24387349.
  15. Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita; Antunes, Manuel J.; Barón-Esquivias, Gonzalo; Baumgartner, Helmut; Borger, Michael Andrew; Carrel, Thierry P.; De Bonis, Michele; Evangelista, Arturo; Falk, Volkmar; Iung, Bernard; Lancellotti, Patrizio; Pierard, Luc; Price, Susanna; Schäfers, Hans-Joachim; Schuler, Gerhard; Stepinska, Janina; Swedberg, Karl; Takkenberg, Johanna; Von Oppell, Ulrich Otto; Windecker, Stephan; Zamorano, Jose Luis; Zembala, Marian; Bax, Jeroen J.; Baumgartner, Helmut; Ceconi, Claudio; Dean, Veronica; Deaton, Christi; Fagard, Robert; Funck-Brentano, Christian; Hasdai, David; Hoes, Arno; Kirchhof, Paulus; Knuuti, Juhani; Kolh, Philippe; McDonagh, Theresa; Moulin, Cyril; Popescu, Bogdan A.; Reiner, Željko; Sechtem, Udo; Sirnes, Per Anton; Tendera, Michal; Torbicki, Adam; Vahanian, Alec; Windecker, Stephan; Popescu, Bogdan A.; Von Segesser, Ludwig; Badano, Luigi P.; Bunc, Matjaž; Claeys, Marc J.; Drinkovic, Niksa; Filippatos, Gerasimos; Habib, Gilbert; Kappetein, A. Pieter; Kassab, Roland; Lip, Gregory Y.H.; Moat, Neil; Nickenig, Georg; Otto, Catherine M.; Pepper, John; Piazza, Nicolo; Pieper, Petronella G.; Rosenhek, Raphael; Shuka, Naltin; Schwammenthal, Ehud; Schwitter, Juerg; Mas, Pilar Tornos; Trindade, Pedro T.; Walther, Thomas (2012). "Guidelines on the management of valvular heart disease (version 2012)". European Heart Journal. 33 (19): 2451–2496. doi:10.1093/eurheartj/ehs109. ISSN 1522-9645.
  16. 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.
  17. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A (June 2017). "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 135 (25): e1159–e1195. doi:10.1161/CIR.0000000000000503. PMID 28298458.

Template:WH Template:WS