Think of your heart as a water pump. Inside this pump, there are small doors that help send blood in only one direction. We call these "valves." Sometimes one of these doors may not close properly and may be slightly open. Then, some of the blood that should have gone forward leaks back. Similarly, the door between the upper and lower chambers on the right side of our heart, the 'Tricuspid Valve', does not close properly and blood leaks back, which is what we call Tricuspid Valve Regurgitation .
Simply put, how does this happen?
To understand this situation better, let's take a look at how the tricuspid valve in our heart works.
The tricuspid valve controls the flow of blood from the upper chamber (Right Atrium) on the right side of our heart to the lower chamber (Right Ventricle). This valve has three flaps. When the heart contracts (systole), these flaps close tightly, preventing blood from flowing back into the upper chamber. When the heart relaxes again (diastole), these flaps open, allowing blood to flow into the lower chamber.
However, in someone with a leaky tricuspid valve, when the heart contracts, these flaps don't close completely. There's a little space left. So, some of the blood that should be going to the lungs leaks back into the upper chamber.
The important thing is that most people can have a very small leak (Trace/Trivial Regurgitation). This is normal, it does not cause any harm, and there are no symptoms. However, if this leak is moderate or severe, the heart has to work harder.
What are the main types of this condition?
Tricuspid valve regurgitation can be divided into three main types.
| Type | Meaning |
|---|---|
| Primary (Primary/Organic) | In this case, the problem lies with the valve itself. The valve itself may have been damaged due to a congenital defect (e.g., Ebstein's anomaly), an infection, or some other cause. |
| Secondary/Functional | Here, the valve is in good condition, but due to another heart condition, the valve is not working properly. This is the most common type. |
| Isolated | This is similar to the secondary type. However, the main cause here is a condition called atrial fibrillation, which causes the upper chamber of the heart to become enlarged. Sometimes this can also be caused by the insertion of a pacemaker. |
What are the symptoms of this condition?
As mentioned earlier, if you have mild regurgitation, you may not experience any symptoms. However, if the condition becomes moderate or severe, you may experience some symptoms.
Symptoms you may experience
- Feeling short of breath while exercising, walking, or doing work.
- Feeling very tired or weak for several days.
- Swelling in the abdomen, ankles, or legs (edema) . This occurs when the heart cannot pump blood properly, causing water to accumulate in the body.
Symptoms that the doctor can understand
- A heart murmur is an abnormal sound heard when you listen to your heart with a stethoscope.
- Feeling a change in the way your pulse beats in your neck or liver area.
Why is this happening? What are the main reasons?
In most cases, the main cause of this condition is structural changes that occur in the right side of the heart. Simply put, if there is continued high pressure or too much blood flowing into the right side of the heart, the chambers on that side (the atrium and ventricle) begin to enlarge.
Imagine if the opening of a door gets bigger, the door can't close properly. Similarly, as the chambers of the heart get bigger, the annulus that holds the valve leaflets in place also stretches and gets bigger. Then the three leaflets can't close together properly. This is what we call secondary regurgitation.
Causes of enlargement of the right side of the heart:
- Atrial Fibrillation
- Cardiomyopathy - weakness of the heart muscle
- Coronary Artery Disease
- Weakening of the function of the left side of the heart (Left Ventricle Failure)
- Pulmonary Hypertension
- Severe problems with the mitral or aortic valves of the heart
Very rarely, this leak can also be caused by damage to the valve stem itself. This is called a primary leak.
Possible causes of valve stem damage:
- Rheumatic Heart Disease
- Heart infection (Infective Endocarditis)
- Congenital defects (e.g. Ebstein's Anomaly)
- Complications of implanting devices like pacemakers
- Radiation therapy to the chest
- Severe chest injuries from a major accident
- Some medications
What complications can this cause?
If this condition is left untreated and becomes severe, it can affect other organs.
- Kidney Failure
- Liver Failure
- Right-sided Heart Failure
How does the doctor diagnose this disease exactly?
Your doctor will first examine you. He or she will listen to your heart with a stethoscope and check your pulse in your neck and abdomen.
Then, the main test to confirm the disease is an echocardiography test. This is like a scan of the heart. This can accurately determine many things, such as the degree of valve leakage, whether there is a change in the shape of the valve, and whether the heart chambers are enlarged.
In addition, the following tests can be done to find the cause:
- Blood Tests
- Chest X-ray
- ECG test
- Cardiac MRI
What are the treatments for this?
Treatment depends on the severity of your condition and the cause. Your doctor will provide you with a treatment plan that is best suited to you.
1. Controlling symptoms with medication: For example, diuretics can be given to reduce water retention in the body.
2. Treating the underlying cause: If the cause of the leak is high blood pressure, treat it, etc. If the cause is a heart attack, treat it.
3. Surgical repair or replacement of the valve: If the condition is severe, surgery may be required to repair the valve or replace it with a new artificial valve.
4. Transcatheter Therapies: These are modern methods that repair the valve without surgery, by going into the heart through a tube inserted through the leg or arm.
What can we do to reduce the risk?
Although this condition cannot always be prevented, maintaining good heart health can greatly reduce the risk.
- Follow a heart-healthy diet (e.g. Mediterranean Diet).
- Engage in at least 150 minutes of moderate exercise per week.
- Stop using tobacco products completely.
- Stop or limit alcohol use .
- See a doctor at least once a year for a medical checkup .
When should you see a doctor?
Follow your doctor's instructions exactly and go to the clinics on time. Also, be aware of the following:
| Opportunity | What to do |
|---|---|
| Call your doctor: | |
| If new symptoms appear or existing symptoms worsen. | For example, if you have difficulty breathing or swelling in your legs increases. |
| If your symptoms are interfering with your daily activities. | If you feel tired even after walking a little, or if you have difficulty climbing stairs. |
| Go to the Emergency Treatment Unit (ETU) immediately: | |
| If you experience symptoms of a heart attack or stroke. | Namely, sudden chest pain, severe difficulty breathing, and loss of consciousness on one side of the body. |
| If you have a fall (especially if you hit your head) while taking blood thinners. | There is an increased risk of internal bleeding when taking this type of medication. |
| After heart surgery, if the surgical wound shows signs of infection. | That is, the wound may swell, become red, or feel hot to the touch. |
In conclusion, tricuspid valve regurgitation can be a minor issue for some people, and a life-threatening one for others. The most important thing is to get proper medical advice. Your doctor will be monitoring your heart health closely. So, if there is a problem, it can be detected and treated before it becomes serious.
Take-Home Message
- Tricuspid valve regurgitation is when a door in the heart doesn't close properly, allowing blood to flow backward.
- A small leak (trace/mild) that most people have is usually not dangerous. It does not require treatment, but it is important to be under the supervision of a doctor.
- If you experience symptoms like difficulty breathing and swelling of your legs, it could be a moderate or severe condition. So see a doctor immediately.
- This is often caused by another heart condition, so it is very important to treat that cause.
- With the advancement of modern medicine, this condition can be well controlled through medications, surgery, and other methods. So don't be afraid, just follow the correct medical advice.
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