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Abstract: A 74-year-old female patient with complaints of paroxysmal chest tightness and breath-holding with panic for 1 year, aggravated for more than 1 month, came to our hospital for further diagnosis and treatment. After echocardiographic examination in our hospital, the diagnosis of tricuspid valve insufficiency was clarified, and the patient was given anticoagulation, diuretic, vasodilator and antihypertensive drug treatment. 1 week later, the patient’s symptoms improved and her condition was stable.
Basic information】Female, 74 years old
Disease Type】Tricuspid valve insufficiency
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】November 2021
Treatment plan】Oral medications (warfarin sodium tablets, isosorbide mononitrate extended-release tablets, resulvastatin calcium tablets, candesartanate tablets) + intravenous injection (furosemide injection)
[Treatment period] Hospitalization for 1 week, regular review
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient is a 74-year-old female with a history of hypertension, thyroid and breast surgery. She complained of paroxysmal chest tightness and breath-holding with panic for 1 year, which was aggravated for more than 1 month, and came to our hospital for further diagnosis and treatment. On physical examination, T: 36.4℃, P: 64 beats/min, R: 19 beats/min, BP: 150/95 mm Hg. He was in clear consciousness, with coarse breath sounds in both lungs, and wet rales could be heard at the base of the lungs. Heart rate was 76 beats/min, with absolute arrhythmia. Grade 3/6 systolic murmurs could be heard in the apical region and tricuspid valve auscultation area; abdomen was soft, subxiphoid pressure pain, no rebound pain, liver was palpable under the ribs, spleen was not palpable under the ribs; edema of both lower limbs. Echocardiogram showed: large left heart and right atrium, dilated ascending aorta, widened main pulmonary artery, tricuspid regurgitation (moderate), and pericardial effusion. Combined with the relevant examinations, the initial diagnosis of tricuspid valve insufficiency was made and the patient was admitted to the hospital for treatment.
II. Treatment history
After communicating with the patient, a drug treatment plan of anticoagulation, diuretic, vasodilator and antihypertensive was determined. After the use of anticoagulant warfarin sodium tablets, the 5 coagulation tests were completed, and the results showed that the prothrombin time was 33.90S and the international standardized ratio was 2.82, both of which were higher than the normal range, and any bleeding manifestations were closely observed. The diuretic furosemide injection was also used to promote urine excretion and reduce cardiac load. Isosorbide mononitrate extended-release tablets were used to dilate blood vessels to reduce venous reflux and improve pulmonary stasis symptoms. Use of Rosuvastatin calcium tablets to inhibit the effect of LDL cholesterol and maintain normal blood lipids, and Candesartanate tablets to lower the patient’s blood pressure.
III. Treatment effect
The patient had paroxysmal chest tightness and breath-holding with panic before treatment. After drug treatment, she complained of smooth breathing and the symptoms of panic disappeared. No abnormal bleeding was seen during the administration of anticoagulant drugs. After using diuretics and antihypertensive drugs, the patient’s blood pressure of 135/85 mmHg was reduced to the normal range, and no electrolyte disturbance occurred during the period. After 1 week of treatment, the patient’s condition was stable and there was no other discomfort, so he was discharged from the hospital for convalescence and returned to the hospital for review after 1 month. Continue to take warfarin sodium tablets, isosorbide mononitrate extended-release tablets and resulvastatin calcium tablets out of hospital, and seek medical advice if there is any discomfort.
IV. Precautions
In addition to actively cooperate with the treatment in the hospital to improve the symptoms, patients should also strengthen their own management in life, which can effectively reduce the probability of recurrence of symptoms, usually to do the following.
1, after discharge from the hospital to adhere to the medication, family members give full play to the role of supervision, auxiliary, to avoid omission, more, so as not to affect the effectiveness of treatment.
2, diet pay attention to the choice of light and easily digestible food, avoid the intake of high salt, high sugar, high fat food, such as salty dishes, pastries, fatty meat, etc..
3, to develop good habits, regular rest and rest, to ensure sufficient sleep, avoid staying up late, overworked.
4, maintain a relaxed mood, do not overwork, and do not worry too much about tricuspid valve insufficiency, regular review is good.
V. Personal insight
Tricuspid valve insufficiency is usually secondary to other types of cardiac lesions, such as the patient in this case, with enlarged left heart and right atrium, which is an important risk factor for the development of the disease. Therefore, after discharge from the hospital, it is still necessary to pay close attention to changes in heart disease. Considering the patient’s age and insensitivity to self-monitoring, it is recommended that family members should strengthen their company and observation, and if abnormalities in heart rate and blood pressure occur, they should pay attention and go to the hospital for professional consultation and treatment in time to control further development of the disease.