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 diseases.
History
Patients with suspected or diagnosed TR should be asked about symptoms related to right heart failure in order to assess the clinical severity of TR. Pediatric patients should be assessed for growth and development in order to evaluate whether TR is associated with failure to thrive.[1]
Patients should also be asked about symptoms or known history of possible causes of primary TR:
- Rheumatic heart disease
- Myxomatous changes
- Endocarditis
- Presence of a pacemaker
- Recent endomyocardial biopsy
- Trauma to the chest[2]
- Carcinoid syndrome
- Radiation
- Congenital heart disease
- Connective tissue disorders
- Medications
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
- 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 Heart Failure
- Abdominal distention
- Peripheral edema
- Jugular venous distension
- Palpitations (atrial fibrillation occurs due to the dilatation of the right atrium)[3]
- Fatigue (from reduced 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
- ↑ Anyanwu AC, Adams DH (2010). "Functional tricuspid regurgitation in mitral valve disease: epidemiology and prognostic implications". Semin Thorac Cardiovasc Surg. 22 (1): 69–75. doi:10.1053/j.semtcvs.2010.05.006. PMID 20813320.
- ↑ Croxson MS, O'Brien KP, Lowe JB (1971). "Traumatic tricuspid regurgitation. Long-term survival". Br Heart J. 33 (5): 750–5. PMC 487246. PMID 5115020.
- ↑ 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.