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Abstract: A 63-year-old female patient who presented to our hospital 2 months ago with chest tightness and breathlessness after activity. Combining the patient’s clinical symptoms and echocardiographic examination, she was initially diagnosed with tricuspid valve insufficiency, and was treated with anticoagulation, diuretic, and vasodilator drugs. 4 days later, her chest tightness and breathlessness disappeared and her condition was stabilized, and she was discharged from the hospital.
Basic information】Female, 63 years old
Disease Type】Tricuspid valve insufficiency
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Time of consultation】December 2021
Treatment plan】Intravenous infusion (furosemide injection) + oral medication (warfarin sodium tablets, isosorbide mononitrate extended-release tablets)
Treatment period】Inpatient treatment for 4 days, outpatient follow-up after 1 month
Treatment effect] The symptoms of chest tightness and breathlessness disappeared after activity, and the condition was stable.
I. Initial consultation
The patient is female, 63 years old. She has been suffering from chest tightness and wheezing for 2 months, all after activity, without palpitations, chest pain, nausea, vomiting, coughing, hemoptysis, tinnitus, deafness, foaming at the mouth, or physical dysfunction. He had been seen at a local hospital, and after cardiac ultrasound examination, he was found to have tricuspid less to moderate regurgitation and pulmonary hypertension, so he came to our hospital for treatment. On examination: normal facial appearance, no obstacle to limb movement, no enlarged lymph nodes on both clavicles, symmetrical thorax; normal respiratory movement, clear percussion, no dry or wet do sound in both lungs, no pleural friction sound, respiratory diseases could be excluded. After echocardiography, the results suggested moderate tricuspid regurgitation and mild regurgitation of mitral valve and aortic valve, and no abnormalities were found in coronary CTA examination.
II. Treatment history
After the patient was admitted to the hospital, the relevant examinations were completed. Considering that conservative treatment could relieve the symptoms, I told the patient that anticoagulation, diuretic and vasodilator drugs could effectively relieve the discomfort, and after obtaining understanding, I actively carried out the treatment. The anticoagulant warfarin sodium tablets were used to improve his hemodynamics and prevent the formation of thrombus. Use isosorbide mononitrate extended-release tablets to dilate blood vessels to reduce venous reflux and improve pulmonary stasis symptoms. The diuretic furosemide injection was used intravenously to promote urine excretion, reduce fluid retention, and reduce cardiac load. After 4 days of treatment, the patient’s condition was stable and he could be discharged from the hospital for convalescence.
III. Treatment effect
Before treatment, the patient presented with chest tightness and breathlessness after activity. After 4 days of anticoagulation, diuretic and vasodilator treatment, the patient no longer had symptoms of chest tightness and shortness of breath after activity, and was in good general condition, with no other palpitations, chest pain and other uncomfortable symptoms.
IV. Precautions
I was happy that the patient could be discharged home to recuperate from his symptoms. Considering that tricuspid valve insufficiency is not completely cured, the patient should avoid strenuous activities at home as much as possible to avoid increasing the burden on the heart and inducing aggravation of the disease. Daily life also requires a light diet with adequate vitamins, proteins and other nutrients, and reduced intake of spicy and stimulating foods, such as strong tea and coffee. Daily water intake should be limited to less than 1000mL to avoid fluid retention. It is also necessary to follow the doctor’s prescription for regular review and pay attention to the changes of the disease after the condition is stabilized, and it is recommended to review every 6 months.
V. Personal Insights
Tricuspid valve insufficiency is usually asymptomatic in the early stage and therefore not easily detected. As the disease progresses, it may manifest as fatigue, dyspnea, or even right heart failure, and in severe cases, surgery is required. The patient in this case, although not very early when he discovered his condition, was not at the point of needing surgery. After discharge from the hospital, it is still necessary to strengthen self-observation and to seek medical attention in case of reappearance of uncomfortable symptoms.