Dr. M.J. Bazos, Patient Handout

About Your Diagnosis
The tricuspid valve is between the right atrium and right ventricle in the heart. Stenosis is a narrowing in the opening of the valve. The valve opens when the atrium contracts to allow blood to flow into the ventricle. It closes to prevent back flow of blood into the atrium when the ventricle contracts. If the opening is narrow, blood does not flow easily. This makes the atrium work too hard. An abnormality in this valve is unusual; when present, it often exists with abnormalities of other valves, such as mitral stenosis. The damage may be congenital (present at birth) or from infections in the heart such as rheumatic fever (from previous streptococcal infection) or bacterial endocarditis.

Living With Your Diagnosis
There may be no symptoms of tricuspid stenosis. However, because the condition often exists with mitral stenosis, symptoms may develop. Symptoms that do occur usually begin many years after the bout with rheumatic fever and are associated with symptoms of right heart failure. Difficulty with breathing, especially when lying down, commonly occurs. Other, more severe symptoms include irregular heartbeat, coughing up blood, or swelling in the legs and abdomen. Atrial fibrillation may develop, and the atrium does not contract normally. Because blood pools in the atrium if the atrium is not contracting normally, clots may form. This may cause blood clots to travel out of the heart when normal contractions resume. Because of this possibility, some patients undergo an operation to have the valve widened or replaced. Heart valve disease is diagnosed on the basis of symptoms and findings at a physical examination. Blood moving abnormally through the valve makes an abnormal sound called a murmur. The timing of the murmur in the cardiac cycle and the location of the murmur help determine which valve is affected. An echocardiogram (ultrasound examination of the heart) shows the abnormal valve and is used to assess blood flow through the valve. Chest radiographs (x-rays) often show the right atrium and ventricle enlarged from overfilling and leakage of fluid into the lungs. An electrocardiogram (ECG) may show arrhythmias such as atrial fibrillation. These occur if the changes in the atrium affect the electrical system of the heart.

Treatment varies depending on the severity of the stenosis. If the condition is mild, attempts are made to prevent possible complications. Abnormally functioning valves may be a target for an infection in the heart called endocarditis. Antibiotics are routinely given to patients with known mitral regurgitation for dental or surgical procedures and for bacterial infections. Digitalis (digoxin) may be given for atrial fibrillation and heart failure. Some
patients with atrial fibrillation take anticoagulant medications to try to prevent a blood clot from forming in the atrium. If there is evidence of heart failure, diuretics reduce the fluid volume in the blood so the heart does not have to work as hard. Vasodilators such as nitrates, hydralazine, captopril, or enalapril may be used when heart failure becomes more prominent. If the heart failure becomes unmanageable with medication or the ability of the heart to keep working is threatened, heart valve replacement may be needed. Side effects of the medications include allergies to antibiotics or the other drugs listed. Digoxin levels in the blood have to be checked periodically. Diuretics cause frequent urination and can cause dehydration and electrolyte (salt) abnormalities in the blood. Extra potassium pills may have to be taken with the diuretics, and these can cause nausea, vomiting, or diarrhea. Nitrate medications may cause headaches or dizziness, and the other vasodilators may cause lightheadedness, fatigue, and intestinal problems.
The DOs
•Take your medications as prescribed.
•Restrict fluid and salt in your diet if you have symptoms of heart failure.
•Remember to take antibiotics as prescribed before and after dental or surgical treatments, including tooth cleanings.
•Exercise as tolerated.
The DON’Ts
•Do not overexert yourself. If easy exercise is becoming difficult, rest until examined by your doctor.
When to Call Your Doctor
•If you have side effects to your medications or have new or worsening symptoms such as chest pain, shortness of breath, palpitations or rapid heartbeat, or swelling in the legs or abdomen.
•If you are taking anticoagulants and have a cut that does not stop bleeding or sustain a head injury.