Tricuspid regurgitation history and symptoms: Difference between revisions
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==Overview== | ==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. | 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 | ==History and Symptoms== | ||
Patients should also be asked about symptoms or known history of possible causes of primary TR: | === History === | ||
* [[Rheumatic heart disease]] | Patients with [[tricuspid regurgitation]] ([[Tricuspid Regurgitation|TR]]) may have a positive history of the following: | ||
* [[Myxomatous]] | |||
* [[Endocarditis]] | |||
Patients with suspected or diagnosed [[Tricuspid Regurgitation|TR]] should be asked about symptoms related to [[right heart failure]] in order to assess the clinical severity of [[Tricuspid Regurgitation|TR]]. [[Pediatric]] patients should be assessed for growth and development in order to evaluate whether [[Tricuspid Regurgitation|TR]] is associated with [[failure to thrive]].<ref name="pmid20813320">{{cite journal| author=Anyanwu AC, Adams DH| title=Functional tricuspid regurgitation in mitral valve disease: epidemiology and prognostic implications. | journal=Semin Thorac Cardiovasc Surg | year= 2010 | volume= 22 | issue= 1 | pages= 69-75 | pmid=20813320 | doi=10.1053/j.semtcvs.2010.05.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20813320 }} </ref> | |||
Patients should also be asked about [[symptoms]] or known history of possible causes of primary [[Tricuspid Regurgitation|TR]]:<ref name="pmid5115020">{{cite journal| author=Croxson MS, O'Brien KP, Lowe JB| title=Traumatic tricuspid regurgitation. Long-term survival. | journal=Br Heart J | year= 1971 | volume= 33 | issue= 5 | pages= 750-5 | pmid=5115020 | doi= | pmc=PMC487246 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5115020 }} </ref><ref name="pmidPMID: 15277624">{{cite journal| author=Baseman DG, O'Suilleabhain PE, Reimold SC, Laskar SR, Baseman JG, Dewey RB| title=Pergolide use in Parkinson disease is associated with cardiac valve regurgitation. | journal=Neurology | year= 2004 | volume= 63 | issue= 2 | pages= 301-4 | pmid=PMID: 15277624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15277624 }} </ref> | |||
*[[Rheumatic heart disease]] | |||
*[[Myxomatous degeneration]] | |||
*[[Endocarditis]] | |||
* Presence of a [[pacemaker]] | * Presence of a [[pacemaker]] | ||
* Recent [[endomyocardial biopsy]] | * Recent [[endomyocardial biopsy]] | ||
* [[Trauma]] to the [[chest]] | *[[Trauma]] to the [[chest]] | ||
* [[Carcinoid syndrome]] | *[[Carcinoid syndrome]] | ||
* [[Radiation]] | *[[Radiation]] | ||
*[[Congenital heart disease]] | |||
*[[Connective tissue disorders]] | |||
*[[Medication|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: | 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 [[Tricuspid Regurgitation|TR]]. When the patient is asked about [[left heart failure]], it is optimal to obtain details about the following: | ||
* [[Arrhythmia]] | * [[Arrhythmia]] | ||
* [[Cardiomyopathies]] | * [[Cardiomyopathies]] | ||
* Cardiotoxins e.g., [[alcohol]], [[cocaine]] | * [[Cardiotoxicity|Cardiotoxins]] (e.g., [[alcohol]], [[cocaine]]) | ||
* [[Hypertension]] | * [[Hypertension]] | ||
* [[Ischemic heart disease]] | * [[Ischemic heart disease]] | ||
* [[Valvular heart disease]] | |||
When the patient is asked about [[pulmonary hypertension]], it is optimal to obtain details about the following: | 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]] | * 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]] | *[[Hepatic]] disease, [[congenital heart disease]], [[thyroid]] diseases, and diseases that cause [[hypoxia]] | ||
* [[Snoring]] and daytime sleepiness to rule out [[obstructive sleep apnea]] (OSA) | * [[Snoring]] and [[daytime sleepiness]] to rule out [[obstructive sleep apnea]] (OSA) | ||
* [[Skin changes]], [[Raynaud's phenomenon]] and [[joint pain]] suggestive of connective tissue disorder | * [[Skin changes]], [[Raynaud's phenomenon]] and [[joint pain]] suggestive of [[connective tissue disorder]] | ||
* History of [[deep vein thrombosis]] or [[pulmonary embolism]] | * History of [[deep vein thrombosis]] or [[pulmonary embolism]] | ||
* Over-the-counter medications and herbal supplements as well as illicit drug use | * Over-the-counter [[Medication|medications]] and [[herbal supplements]] as well as illicit [[drug use]] | ||
* High risk for [[HIV]] exposure | * High risk for [[HIV]] exposure | ||
* Family history of [[pulmonary hypertension]] | *[[Family history]] of [[pulmonary hypertension]] | ||
==Symptoms== | ==Symptoms== | ||
===Symptoms Related to | Common [[symptoms]] of [[tricuspid regurgitation]] include: | ||
=== '''Symptoms Related to Heart Failure''' === | |||
* [[Abdominal distention]] | * [[Abdominal distention]] | ||
* [[Peripheral edema]] | * [[Peripheral edema]] | ||
* [[Jugular venous distension]] | |||
* [[Palpitations]] ([[atrial fibrillation]] occurs due to the dilatation of the [[right atrium]])<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> | * [[Palpitations]] ([[atrial fibrillation]] occurs due to the dilatation of the [[right atrium]])<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> | ||
* [[Fatigue]] (from reduced [[cardiac output]]) | |||
* [[Exercise tolerance test|Decreased exercise tolerance]] | |||
===Symptoms Related to | === '''Symptoms Related to Pulmonary Hypertension''' === | ||
*[[Dyspnea]] | *[[Dyspnea]] | ||
*[[Fatigue]] | *[[Fatigue]] | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Cardiology]] | |||
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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 and Symptoms
History
Patients with tricuspid regurgitation (TR) may have a positive history of the following:
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:[2][3]
- Rheumatic heart disease
- Myxomatous degeneration
- Endocarditis
- Presence of a pacemaker
- Recent endomyocardial biopsy
- Trauma to the chest
- 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
- Valvular 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
Common symptoms of tricuspid regurgitation include:
Symptoms Related to Heart Failure
- Abdominal distention
- Peripheral edema
- Jugular venous distension
- Palpitations (atrial fibrillation occurs due to the dilatation of the right atrium)[4]
- 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.
- ↑ Baseman DG, O'Suilleabhain PE, Reimold SC, Laskar SR, Baseman JG, Dewey RB (2004). "Pergolide use in Parkinson disease is associated with cardiac valve regurgitation". Neurology. 63 (2): 301–4. PMID 15277624 PMID: 15277624 Check
|pmid=value (help). - ↑ 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.