|
|
| (11 intermediate revisions by one other user not shown) |
| Line 1: |
Line 1: |
| __NOTOC__
| | #Redirect [[Tricuspid regurgitation]] |
| {{Infobox_Disease |
| |
| Name = {{PAGENAME}} |
| |
| Image = |
| |
| Caption = |
| |
| DiseasesDB = 13348 |
| |
| ICD10 = {{ICD10|I|07|1|i|05}}, {{ICD10|I|36|1|i|30}} |
| |
| ICD9 = {{ICD9|397.0}} |
| |
| ICDO = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| MeshID = D014262 |
| |
| }}
| |
| {{Search infobox}}
| |
| {{CMG}}
| |
| | |
| ==Overview==
| |
| '''Tricuspid insufficiency''', a [[valvular heart disease]] also called '''Tricuspid regurgitation''', refers to the failure of the heart's [[tricuspid valve]] to close properly during [[systole]]. As a result, with each heart beat, blood is pumped out from the right side of the heart in the ''opposite'' direction to normal.
| |
| | |
| ==Causes==
| |
| Although congenital causes of tricuspid insufficiency exist, most cases are due to dilation of the [[right ventricle]]. Such dilation leads to derangement of the normal anatomy and mechanics of the tricuspid valve and the muscles governing its proper function. The result is incompetence of the [[tricuspid valve]]. Common causes of right ventricular dilation include left [[heart failure]], [[pulmonary hypertension]], and right ventricular [[infarction]].
| |
| | |
| One notable exception to right ventricular dilation as a cause of tricuspid insufficiency occurs in right-sided [[endocarditis]] (i.e. infection affecting the right side of the heart). In that case, there is direct damage to the [[tricuspid valve]] as a result of infection.
| |
| | |
| ==Symptoms and Signs==
| |
| | |
| Tricuspid insufficiency may be asymptomatic, especially if right ventricular function is well preserved. Conversely, [[edema]], vague upper abdominal discomfort (from a congested liver), and fatigue (due to diminished [[cardiac output]]) can all be present to some degree. On examination, the [[jugular venous pressure]] is usually elevated, and 'CV' waves can be seen. The liver may be enlarged and is often pulsatile (the latter finding being virtually diagnostic of tricuspid insufficiency). [[Peripheral edema]] is often found. In severe cases, there may be [[ascites]] and even [[cirrhosis]] (so-called 'cardiac cirrhosis).
| |
| | |
| Triscuspid insufficiency may lead to the presence of a pansystolic [[heart murmur]]. Such a murmur is usually of low frequency and best heard low on the left sternal border. It tends to increase with inspiration. However, the murmur may be inaudible reflecting the relatively low pressures in the right side of the heart. A third heart sound may also be present.
| |
| | |
| ==Physical Examination==
| |
| | |
| | |
| ==Diagnosis==
| |
| Diagnosis is usually made by [[echocardiography]] although the find of a pulsatile liver and/or the presence of prominent CV waves in the jugular pulse is also essentially diagnostic.
| |
| | |
| * Flail Tricuspid with Severe Tricuspid Regurgitation and Right Ventricular Overload 1
| |
| | |
| <googlevideo>-1747152855968122892&hl=en</googlevideo>
| |
| | |
| * Flail Tricuspid with Severe Tricuspid Regurgitation and Right Ventricular Overload 2
| |
| | |
| <googlevideo>-473547653338641591&hl=en</googlevideo>
| |
| | |
| * Flail Tricuspid with Severe Tricuspid Regurgitation and Right Ventricular Overload 3
| |
| | |
| <googlevideo>-467913193581382307&hl=en</googlevideo>
| |
| | |
| * Flail Tricuspid with Severe Tricuspid Regurgitation and Right Ventricular Overload 4
| |
| | |
| <googlevideo>-6781362651642487904&hl=en</googlevideo>
| |
| | |
| * Flail Tricuspid with Severe Tricuspid Regurgitation and Right Ventricular Overload 5
| |
| | |
| <googlevideo>-9158276529735175552&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation 1
| |
| | |
| <googlevideo>-7449754117470327127&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation 2
| |
| | |
| <googlevideo>182852850920439573&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation with dilated Right Ventricle and Severe Pulmonary Hypertension 1
| |
| | |
| <googlevideo>-6549522929946032312&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation with dilated Right Ventricle and Severe Pulmonary Hypertension 2
| |
| | |
| <googlevideo>-7995442420170502038&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation with dilated Right Ventricle and Severe Pulmonary Hypertension 3
| |
| | |
| <googlevideo>3265006624358008308&hl=en</googlevideo>
| |
| | |
| * Severe Tricuspid Regurgitation with dilated Right Ventricle and Severe Pulmonary Hypertension 4
| |
| | |
| <googlevideo>5717914351993402847&hl=en</googlevideo>
| |
| | |
| ===Cardiac MRI in Tricuspid insufficiency===
| |
| ====ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157 }} </ref> (DO NOT EDIT)====
| |
| {{cquote|
| |
| CMR may be used for assessing individuals with valvular heart disease in which evaluation of valvular stenosis, regurgitation, para- or perivalvular masses, perivalvular complications of infectious processes, or prosthetic valve disease are needed. CMR may be useful in identifying serial changes in LV volumes or mass in patients with valvular dysfunction.
| |
| }}
| |
| | |
| ==Therapy==
| |
| | |
| In most cases, surgery is not indicated since the root problem lies with a dilated or damaged [[right ventricle]]. Medical therapy with [[diuretics]] is the mainstay of treatment. Unfortunately, this can lead to [[volume depletion]] and decreased [[cardiac output]]. Indeed, one must often accept a certain degree of symptomatic tricuspid insufficiency in order to prevent a decrease in cardiac output. Treatment with medicines to reduce cardiac [[afterload]] may also be of benefit but a similar risk of depressed cardiac output applies.
| |
| | |
| {{Circulatory system pathology}}
| |
| | |
| [[Category: Valvular heart disease]]
| |
| | |
| [[Category:Cardiology]]
| |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |