Tricuspid regurgitation history and symptoms
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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 history of a patient with suspected or confirmed tricuspid regurgitation (TR) should include information about the possible etiologies of primary and secondary TR. TR occurs most commonly secondary to pulmonary hypertension and left heart failure; therefore, detailed information about these conditions should be obtained. The majority of TR are asymptomatic. Symptoms of TR include clinical manifestations related to right heart failure such as peripheral edema and abdominal distention. If left heart failure or pulmonary hypertension is the underlying etiology of TR, the patient might have symptoms related to these conditions.
History
Patients with suspected or diagnosed TR should be inquired about symptoms related to heart failure.
Patients should be asked about symptoms or known history of possible causes for primary TR:
- Rheumatic heart disease
- Myxomatous changes
- Endocarditis
- Presence of a pacemaker
- Recent endomyocardial biopsy
- Trauma to the chest
- Carcinoid syndrome
In addition, patients should be asked about symptoms and possible causes of left heart failure and pulmonary hypertension, which are the most common causes of secondary TR.
When the patient is asked about left heart failure, it is optimal to obtain details about the following:
- Arrhythmia
- Cardiomyopathies
- Cardiotoxins e.g., alcohol, cocaine
- Congenital heart disease
- Hypertension
- Ischemic heart disease
When the patient is asked about pulmonary hypertension, it is optimal to obtain details about the following:
- History of exposure to cocaine, methamphetamine, alcohol leading to cirrhosis, and smoking leading to emphysema
- Hepatic disease, congenital heart disease, thyroid diseases, and diseases that cause hypoxia
- Snoring and daytime sleepiness to rule out obstructive sleep apnea (OSA)
- Skin changes, Raynaud's phenomenon and joint pain suggestive of connective tissue disorder
- History of deep vein thrombosis or pulmonary embolism
- Over-the-counter medications and herbal supplements as well as illicit drug use
- High risk for HIV exposure
- Family history of pulmonary hypertension
Symptoms
Symptoms Related to Right Heart Failure
- Abdominal distention
- Peripheral edema
- Palpitations (atrial fibrillation occurs due to the dilatation of the right atrium)[1]
Symptoms Related to Left Heart Failure
- Fatigue (due to the decrease in cardiac output)
- Decreased exercise tolerance
Symptoms Related to Pulmonary Hypertension
- Dyspnea
- Fatigue
- Raynaud's phenomenon
- Syncope
- Chest pain
- Near Syncope
- Palpitations
- Leg swelling
- Cough (rare)
- Hemoptysis (rare)
- Hoarseness (rare)
References
- ↑ 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.