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Tricuspid Regurgitation

WHAT YOU NEED TO KNOW:

What is tricuspid regurgitation (TR)?

TR is a condition that causes blood to leak backwards through the tricuspid valve to the right atrium. This happens because the tricuspid valve does not close properly. The tricuspid valve is between the right atrium and the right ventricle of your heart. The right atrium pumps blood into your right ventricle. The tricuspid valve opens to allow blood from your right atrium into your right ventricle. Normally, it closes when your right ventricle pumps blood to the lungs.

Heart Chambers

What increases my risk for TR?

TR often happens when your ventricle is enlarged. The following can increase your risk for damage:

  • Rheumatic fever or an infection of your tricuspid valve
  • A heart tumor or congenital heart problems
  • An injury to your tricuspid valve from chest trauma, a heart procedure, or radiation
  • Blunt chest trauma, such as your chest hitting the steering wheel in an accident
  • Use of certain medicines that help you lose weight
  • Rheumatoid arthritis or Marfan syndrome

What are the signs and symptoms of TR?

You may not have symptoms, or you may have any of the following:

  • Being able to see your neck veins move or pulse
  • Weakness or fatigue
  • Shortness of breath that gets worse during activity or when you lie down
  • Enlarged liver
  • Swelling in your abdomen, legs, ankle, or feet

How is TR diagnosed?

Your healthcare provider will examine you. Tell him or her if you have any heart or lung conditions, or have a family history of these. Also tell him or her if you take medicine to help you lose weight. You may also need any of the following:

  • An echocardiogram is a type of ultrasound. It is used to show problems with your tricuspid valve and how blood flows through your heart. It may also show how well your heart is pumping. You may need a transthoracic or transesophageal echocardiogram. Ask your healthcare provider about these types of echocardiogram.
  • X-ray or MRI pictures may show an enlarged heart or problems with your valve or lungs. You may be given contrast liquid to help the heart and lungs show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
  • A stress test helps healthcare providers see how well your tricuspid valve works under stress. Healthcare providers may place stress on your heart with exercise or medicine.
  • Cardiac catheterization is a procedure to check how well your heart is pumping blood. It is also used to measure pressure in different parts of your heart. A catheter (long thin tube) is inserted into your arm, neck, or groin and moved into your heart. An x-ray may be used to guide the tube to the right place. Contrast liquid may be used to help your heart show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.

How is TR treated?

Treatment may not be needed if your condition does not cause symptoms.

  • Medicines may be given to remove extra fluid, treat an infection, or lower lung pressure.
  • Surgery may be used to repair or replace the valve if you have severe symptoms.

What can I do to manage TR?

  • Maintain a healthy weight. Being overweight can increase your risk for high blood pressure and coronary artery disease. These conditions can make your heart work harder. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Limit or do not drink alcohol. Ask your healthcare provider if it is okay for you to drink alcohol. Alcohol can increase your risk for high blood pressure, liver problems, and coronary artery disease. Your provider will tell you how many drinks are okay to have within 24 hours or within 1 week. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
  • Eat heart-healthy foods. Heart-healthy foods include salmon, tuna, walnuts, whole-grain breads, low-fat dairy products, beans, and oils such as olive or canola oil. A dietitian or your provider can give you more information on meal plans such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. The DASH plan is low in sodium, processed sugar, unhealthy fats, and total fat. It is high in potassium, calcium, and fiber. These can be found in vegetables, fruit, and whole-grain foods.

  • Limit sodium (salt) as directed. Too much sodium can affect your fluid balance. Check labels to find low-sodium or no-salt-added foods. You can also make small changes to get less salt. For example, if you add salt while you cook, do not add more salt at the table. Ask your healthcare provider or dietitian for more ways to cut down on salt.

  • Exercise as directed. Exercise can help keep your heart healthy. Ask your healthcare provider what activities are safe for you to do. The amount and type of exercise that is safe may depend on your symptoms. It may also depend on how severe your condition is.
  • Talk to your healthcare provider about pregnancy. If you are a woman and want to get pregnant, talk to your healthcare provider. You and your baby may need to be monitored by specialists during your pregnancy.
  • Ask your healthcare provider if you should take antibiotics before certain procedures. Some procedures may allow bacteria to get into your blood and travel to your heart. This can make your condition worse.
  • Ask about vaccines you may need. Certain diseases are dangerous for a person who has TR. Vaccines help lower your risk for infections that can lead to disease. Get a flu vaccine as soon as recommended each year, usually in September or October. Your healthcare provider can tell you if you also need other vaccines, and when to get them.

What can I do to prevent TR?

  • Manage health conditions that can lead to TR. Your healthcare provider or a specialist can help you manage a condition such as rheumatoid arthritis or Marfan syndrome.
  • Get treatment for strep throat. Strep throat can lead to rheumatic fever, a cause of TR.
  • Talk to your healthcare provider before you take any new medicine. Some medicines can increase your risk for TR.

Call your local emergency number (911 in the US) or have someone else call if:

You have any of the following signs of a heart attack:

  • Squeezing, pressure, or pain in your chest
  • You may also have any of the following:
    • Discomfort or pain in your back, neck, jaw, stomach, or arm
    • Shortness of breath
    • Nausea or vomiting
    • Lightheadedness or a sudden cold sweat

When should I seek immediate care?

  • You have new or worse swelling in your abdomen, legs, ankles, or feet.
  • Your heart is beating slower or faster than usual.
  • Your symptoms increase.

When should I call my doctor?

  • You have a fever.
  • Your appetite decreases.
  • You lose weight or gain 3 pounds or more in one day.
  • Your skin or eyes look yellow.
  • You have a new cough that does not go away within 3 days.
  • You are pregnant or think you are pregnant.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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