Tricuspid valve insufficiency
Introduction
Introduction to tricuspid atresia Tricuspidinsufficiency or tricuspid regurgitation, most of which are functional tricuspid regurgitation secondary to mitral valve disease, and a few are caused by organic disease of the tricuspid valve itself. basic knowledge The proportion of illness: the incidence rate is about 0.003% - 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: congestive heart failure, arrhythmia, pulmonary embolism, infective endocarditis
Cause
Cause of tricuspid atresia
(1) Causes of the disease
Rheumatic tricuspid regurgitation is caused by recurrent episodes of rheumatic tricuspiditis, thickening of the valve leaflets, contracture and chordae tendine adhesion, thickening, shortening of the valve leaflet closure, more with tricuspid stenosis and mitral valve, the main Arterial valve disease.
(two) pathogenesis
In the case of organic tricuspid regurgitation, the right ventricular systolic phase can cause some blood to flow back into the right atrium. The reverse flow determines the severity of tricuspid regurgitation, the right atrial pressure and pulmonary hypertension, and the right atrial wall is thin. Can be enlarged due to increased right atrial volume load; diastolic right ventricle in addition to normal upper and lower vena cava into the right atrial blood, still need to accept the last cardiac cycle back into the right atrial blood, gradually causing right ventricular diastolic The volume of the period is too heavy and expands. The relative tricuspid regurgitation has hemodynamic abnormalities caused by mitral valve, aortic valve disease and pulmonary hypertension. Because of the poor compensatory function of the right atrial wall, it is early. Systemic venous congestion can occur. As the reflux volume increases, the right ventricle expands more, and the right ventricular end-diastolic pressure rises. The right atrial mean pressure and systemic venous pressure increase sequentially, eventually producing right heart failure.
Prevention
Tricuspid insufficiency prevention
Rheumatic heart disease can be effectively prevented. The main measures include:
1. Effective primary and secondary prevention
(1) Effective primary prevention: refers to the prevention of the first episode of rheumatic fever, the key is early diagnosis and treatment of methyl chain tonsillitis, the preferred drug for penicillin, Huang Zhendong scholars to carry out group rheumatic fever level and prevention research, early discovery Chain-type tonsil pharyngitis and early drug intervention, the results show that the intervention of half a year can reduce the number of cases of methyl-chain tonsil pharyngitis in the population by as much as 95.4% to 100%, reaching the primary prevention effect of group rheumatic fever.
(2) Active secondary prevention: refers to prevention of recurrence of rheumatic fever, which is essential for patients who have suffered from heart-warming or existing rheumatism. Rheumatic fever recurrence is most common in the first 5 years after the first episode, and recurrence after 5 years. Only 5%, the prevention target mainly refers to patients with rheumatic fever with a clear history of rheumatic fever and/or diagnosis. For patients with initial rheumatic fever without carditis, prevent 5 years after the last episode of rheumatic fever, at least To 18 to 20 years old; if there is carditis, it should be extended or even life. For patients with chronic rheumatic valvular disease, the prevention time should be long, usually until 50 years old or even for life; even PBMV (percutaneous mitral balloon) Surgery is still necessary to prevent rheumatism after surgery.
2. Prevention measures
(1) Prevention of rheumatic fever: It is the key. Individual use should be used when using drugs. Injection of penicillin should be especially alert to the occurrence of anaphylactic shock. When the clinic is injected, there should be corresponding first aid facilities.
(2) Avoid crowding: especially in the family bedroom and school classroom, keep well ventilated, not suitable for crowded places, because of the rapid spread of streptococcus between people, may increase the chance of infection.
(3) Reasonable arrangement of life and work: pay attention to work and rest, avoid mental and physical overwork and bad stimulation, emotional agitation, lack of sleep, etc., quit smoking and alcohol, avoid overeating and overweight, heart dysfunction should avoid severe Exercise and sudden exertion, such as running, swimming, lifting weights, driving, etc., heart function level I can basically live a normal life, but should not participate in competitive physical activity; heart function level II should avoid medium and heavy physical labor, such as There is no time to rest and treatment, female patients with heart function I ~ II can consider pregnancy, but need to be closely observed during pregnancy, heart function level III or above should not be pregnant.
(4) Regular examination: The main target is the cardiac function compensator, and patients with grade II or above should actively undergo interventional and surgical treatment.
(5) Master the self-care ability of rheumatic fever and rheumatic heart disease: Patients with rheumatic heart disease should learn some simple prevention knowledge and skills, such as measuring body temperature, counting pulse, listening to heart rate, measuring blood pressure, measuring urine volume, weighing body, low-salt diet. Etc. And familiar with major clinical manifestations such as rheumatic activity, heart failure, arterial embolism and infective endocarditis.
(6) Prevention of complications and comorbidities: the focus is on prevention of heart failure, low-salt diet in patients with rheumatic heart disease, avoiding excessive exertion, work fatigue, secondary infection, arrhythmia are important, for aortic valve disease or prosthetic valve replacement Patients, if necessary, often use antibiotics to prevent infective endocarditis.
Complication
Tricuspid atresia Complications congestive heart failure arrhythmia pulmonary embolism infective endocarditis
There may be complications such as congestive heart failure, arrhythmia, pulmonary embolism and infective endocarditis.
Symptom
Tricuspid atresia symptoms Common symptoms Abdominal lifted pulsating heart discharge reduced systolic murmur body circulation congestion appetite loss of gastrointestinal congestion dyspepsia
Clinically, tricuspid regurgitation alone is rare, most of which are secondary to mitral and/or aortic valve disease, or primary, secondary pulmonary hypertension with right ventricular enlargement, so the primary symptoms Mainly.
Symptom
Tricuspid regurgitation itself produces symptoms:
(1) fatigue: caused by a decrease in cardiac output.
(2) head, jugular vein pulsation: the blood that flows back into the right atrium from the systolic phase causes the pulsation to be reversed to the head and caused by the jugular vein.
(3) Liver, bloating caused by gastrointestinal congestion, poor appetite, and indigestion.
2. Signs
(1) enlargement of the right ventricle can shift the apex of the apex and the heart of the heart to the left. There is an uplifting pulsation in the anterior region, and the right atrium is enlarged in the right edge of the sternum.
(2) Auscultation:
1 Tricuspid systolic murmur: The tone can be heard at the 4th, 5th intercostal or xiphoid of the left sternal border, and the systolic murmur is heard in the full systolic period. The murmur is enhanced at the end of deep inhalation, called Carvallo sign. When exhaling and doing Valsalva movement, the noise is weakened. If the right ventricle is obviously hypertrophy, and the enlargement is made and the clockwise position is turned, the noise can be transmitted to the apical region, which needs to be differentiated from chronic mitral insufficiency (see 2 If the mitral insufficiency is incomplete), if the functional tricuspid atresia is caused by heart failure, the noise can be significantly reduced after the heart failure is corrected.
2 The first heart sound is often weakened: P2 can be enhanced with pulmonary hypertension, and S3 can be heard in the tricuspid region due to increased passive filling through the tricuspid valve in early diastole, and S3 galloping when the right ventricular dysfunction occurs. For example, combined with mitral valve disease often has atrial fibrillation.
3 Tricuspid valve diastolic murmur: patients with severe severe tricuspid regurgitation, due to increased diastolic blood flow through the tricuspid valve and rate of increase in the diastolic valve, can be softened in the tricuspid valve area, short diastolic mid-stage rumbling Noise.
(3) jugular vein pulsation and hepatic dilatation pulsation: the characteristic of tricuspid regurgitation. In severe tricuspid regurgitation, the patient can see the dilated jugular vein moving up and down with the heart beat like a water column in the sitting or semi-recumbent position. The CV wave of the jugular vein is increased. When the liver beats, the patient pauses to breathe. The two hands are placed in front of and behind the liver, which can be used to expand the late systolic pulsation, which is caused by the increase of hepatic blood volume caused by tricuspid regurgitation.
(4) systemic congestion: large liver, positive jugular vein return, ascites and lower extremity edema.
According to clinical manifestations and laboratory tests, especially in combination with echocardiography, the diagnosis can be established.
Examine
Tricuspid insufficiency examination
1. X-ray examination : visible right atrium, right ventricle is obviously enlarged, and the superior vena cava has systolic pulsation. If it is secondary to pulmonary hypertension or left heart lesion, there may be a corresponding X-ray sign change.
2. Electrocardiogram : right atrium, right ventricular hypertrophy, often accompanied by atrial fibrillation; may have right bundle branch block.
3. Echocardiography (UCG):
(1) M-type and two-dimensional UCG: abnormal tricuspid valve structure, valve leaf prolapse, chordae rupture, etc., systolic tricuspid valve malposition, tricuspid EF slope increased, right atrium, right ventricular enlargement, etc. .
(2) Doppler UCG: sampling on the right atrial side of the tricuspid valve, which can detect the systolic turbulent spectrum; color Doppler can display the colorful mosaic retrograde beam, and the right ventricle can be calculated by using the tricuspid regurgitation spectrum Pressure or pulmonary artery pressure.
There are quite a few normal people who use Doppler to detect tricuspid regurgitation, which is physiological reflux and should be differentiated from pathological reflux.
4. Right heart catheterization : The right atrium and right ventricular pressure curve are recorded at the same time. It can be seen that the "S" peak of the tricuspid regurgitation wave gradually increases with the increase of the reflux degree, and is connected with the "V" peak of the normal filling wave. Form a pressure curve similar to the right ventricle (right chamber pressure curve right ventricular), right ventricular angiography can estimate the degree of tricuspid regurgitation, right ventricular systolic pressure or pulmonary systolic pressure <5.33kPa (40mmHg), suggesting organic The possibility of tricuspid regurgitation; and right ventricular or pulmonary systolic pressure > 8.0 kPa (60 mmHg), indicating right ventricular decompensation, that is, functional tricuspid regurgitation.
Diagnosis
Diagnosis and diagnosis of tricuspid atresia
diagnosis
According to clinical manifestations and laboratory tests, especially in combination with echocardiography, the diagnosis can be established.
Differential diagnosis
Clinical attention should be paid to the following conditions:
1. Functional and organic tricuspid regurgitation.
2. Identification with mitral regurgitation.
