Tricuspid regurgitation medical therapy: Difference between revisions
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===Right Heart Failure=== | ===Right Heart Failure=== | ||
* Patients with severe [[tricuspid regurgitation]] and symptoms of [[right heart failure]] should receive [[diuretics]] in order to reduce the following: | * Patients with severe [[tricuspid regurgitation]] and symptoms of [[right heart failure]] should receive [[diuretics]] in order to reduce the following:<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease|journal=Journal of the American College of Cardiology|volume=63|issue=22|year=2014|pages=e57–e185|issn=07351097|doi=10.1016/j.jacc.2014.02.536}}</ref> | ||
**Volume overload | **Volume overload | ||
**Peripheral edema | **Peripheral edema | ||
Revision as of 14:15, 23 April 2020
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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] Fatimo Biobaku M.B.B.S [3]
Overview
The main therapy to tricuspid regurgitation 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. 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
- Patients with severe tricuspid regurgitation and symptoms of right heart failure should receive diuretics in order to reduce the following:[1]
- Volume overload
- Peripheral edema
- Ascites
- Loop diuretics are commonly used to relive some of the symptoms from the volume overload.
- 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.
Pulmonary Hypertension
- The selective use of pulmonary vasodilators in patients with pulmonary artery hypertension may improve the valvular regurgitation.[3][4]
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)[5][6][7]
| 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
- ↑ 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.
- ↑ 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.
- ↑ 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). - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.