From the Guidelines
Tricuspid regurgitation often presents with symptoms related to right-sided heart failure, including fatigue, weakness, and decreased exercise tolerance, as well as swelling, palpitations, and shortness of breath, which can worsen over time as the regurgitation becomes more severe or the heart's ability to compensate diminishes.
Symptoms of Tricuspid Regurgitation
The symptoms of tricuspid regurgitation can be attributed to the backward flow of blood from the right ventricle into the right atrium during contraction, leading to reduced forward blood flow and congestion in the venous system 1.
- Fatigue and weakness due to low cardiac output
- Decreased exercise tolerance
- Swelling (edema) in the legs, ankles, and abdomen (ascites)
- Distended neck veins (jugular venous distention)
- Palpitations or irregular heartbeats
- Shortness of breath, particularly during physical activity, and potentially at rest
- Liver enlargement (hepatomegaly) causing right upper quadrant discomfort
- Bluish discoloration of the skin (cyanosis) in severe cases due to poor oxygenation These symptoms are consistent with the stages of tricuspid regurgitation outlined in the guidelines, which categorize the condition based on its severity and the presence of symptoms 1.
Stages of Tricuspid Regurgitation
The stages of tricuspid regurgitation are defined as follows:
- Stage A: At risk of tricuspid regurgitation, with no or mild symptoms
- Stage B: Progressive tricuspid regurgitation, with mild symptoms
- Stage C: Asymptomatic severe tricuspid regurgitation
- Stage D: Symptomatic severe tricuspid regurgitation, with symptoms such as fatigue, palpitations, dyspnea, abdominal bloating, anorexia, and edema The management of tricuspid regurgitation depends on the stage and severity of the condition, as well as the presence of symptoms and other underlying health conditions 1.
Management of Tricuspid Regurgitation
The management of tricuspid regurgitation may involve medical therapies, such as diuretic agents and afterload reduction with pulmonary vasodilators, to provide symptomatic relief 1. In some cases, transcatheter tricuspid valve intervention (TTVI) or surgical intervention may be necessary to treat severe tricuspid regurgitation, particularly in patients with symptomatic disease or significant right ventricular dysfunction 1. Overall, the symptoms and management of tricuspid regurgitation are complex and require a comprehensive approach to diagnosis and treatment, taking into account the individual patient's underlying health conditions and the severity of the disease 1.
From the Research
Symptoms of Tricuspid Regurgitation
The symptoms of tricuspid regurgitation (TR) are not explicitly stated in the provided studies, but the conditions and consequences associated with TR can be inferred.
- TR is a complex condition of the right ventricle (RV) and tricuspid valve apparatus, frequently associated with symptomatic heart failure and significant morbidity and mortality 2.
- Significant TR is a common finding, affecting about one in twenty-five subjects among the elderly, and presents more frequently in women than in men 3.
- Functional TR (FTR) is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus, and base of the right ventricle, with pathological TV coaptation 3.
- Severe TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target 3.
- The five-year survival with severe TR and HFrEF is 34% 4.
Associated Conditions
TR is often associated with other conditions, including:
- Cardiomyopathies
- Left ventricle (LV) valve disease
- Pulmonary disease
- Pulmonary hypertension
- Atrial fibrillation
- Left heart pathologies
- Heart failure
Diagnosis and Treatment
The diagnosis and treatment of TR are discussed in the provided studies, including:
- Echocardiography to assess TR etiology and severity, measure right atrium (RA) and RV size and function, estimate pulmonary pressure, and characterize LV disease 4.
- Medical management with diuretics, ACE inhibitors, and aldosterone antagonists 4.
- Surgical annuloplasty or valve replacement for patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 4.
- Transcatheter repair or replacement for high-risk patients with TR 4, 3, 5.