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Abstract: The patient had a history of atrial fibrillation and hypertension, and recently developed chest tightness and panic attacks, which were more pronounced during exertion and were accompanied by weakness. After systematic treatment, the patient’s symptoms improved significantly and the disease control was stable.
Basic information】Female, 70 years old
Disease Type】Tricuspid valve insufficiency
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】March 2021
Treatment plan】Oral medication (hydrochlorothiazide tablets, spironolactone tablets, nitroglycerin tablets)
Treatment Period】Regular review after 1 week of hospitalization
Treatment effect】The patient’s chest tightness and panic symptoms were relieved and the condition was relatively stable
I. Initial consultation
When we first saw the patient, he had a painful face and poor mental status. The patient reported that he had a history of atrial fibrillation and hypertension, and was taking antihypertensive drugs regularly, and his blood pressure was relatively stable, but the symptoms of atrial fibrillation were not treated systematically. The patient was asked about the pain in the precordial region, and there was no cough, sputum or dyspnea. On auscultation, the heart rate was 82 beats/minute, the heart rhythm was irregular, the heart sound was variable in intensity, and a systolic murmur could be heard between 3-4 ribs at the left edge of the sternum. After admission, the patient underwent a cardiac ultrasound examination, the results of which suggested the presence of large double atria, tricuspid regurgitation (severe), mitral regurgitation (moderate to severe), pulmonary hypertension (mild), and aortic regurgitation (mild), and the results of an electrocardiogram suggested the presence of an enlarged right atrium and hypertrophy of the right ventricle, and the results of an X-ray examination suggested an enlarged right atrium. He was admitted to the hospital with “tricuspid valve insufficiency”.
II. Treatment history
After examination, the patient could be diagnosed with tricuspid valve closure insufficiency and mitral valve closure insufficiency, so I communicated with the family and the patient and informed them that they could use drugs to control the symptoms caused by tricuspid valve closure insufficiency and mitral valve closure insufficiency, and the patient and his family agreed. I then applied hydrochlorothiazide tablets and spironolactone tablets for diuretic therapy, which helped to relieve the symptoms of leg edema, and combined with nitroglycerin tablets for vasodilator therapy, which could help to reduce venous reflux and improve pulmonary stasis due to tricuspid and mitral valve closure insufficiency.
III. Treatment effect
The patient’s discomfort symptoms such as chest tightness and panic were relieved after drug treatment. On the 3rd day of drug treatment, the patient’s edema in both legs disappeared, and the symptoms of chest tightness and panic were significantly relieved, while the symptoms of weakness were also improved. After 1 week of drug treatment, the patient’s symptoms of chest tightness, panic and weakness had basically disappeared, and the treatment effect was more satisfactory, so he was allowed to be discharged from the hospital, and there was no aggravation or recurrence of the disease at the time of review.
IV. Precautions
Seeing that the patient’s symptoms improved after treatment, I felt happy for the patient from the bottom of my heart, and suggested that the patient should pay attention to the following points.
1. Patients should take medication regularly during the treatment period and pay attention to regular review to clarify the recovery and development trend of the disease.
2. Patients should try to have a low-salt, low-fat diet and eat light meat, eggs, vegetables and fruits, avoiding pickled vegetables, which may lead to sodium retention and increase the burden on the heart.
3. Patients should take adequate rest and maintain a positive and optimistic attitude in life, avoid staying up late, exertion, anxiety, etc. They can also take appropriate physical exercise, such as tai chi, square dance, etc., which can help enhance their physical fitness and help their recovery.
V. Personal insight
Tricuspid valve insufficiency is a heart valve disease, usually secondary to right ventricular enlargement, tricuspid annulus dilatation and other diseases, like the 70-year-old grandmother Li in this case, is due to right ventricular enlargement, resulting in the diagnosis of tricuspid valve insufficiency, the good thing is that the grandmother Li’s condition was found in time, and active treatment, so that the discomfort symptoms are relieved, while the condition is also relatively stable control. However, if people with tricuspid valve insufficiency do not pay attention to treatment, the condition may worsen and serious complications such as heart failure may occur.