Tricuspid Valve Insufficiency After Heart Procedures

Tricuspid valve insufficiency?

Hello, doctor: Last July, I underwent catheter ablation for paroxysmal supraventricular tachycardia, and the procedure was successful.
At that time, a cardiac ultrasound was performed, and everything was normal.
Although this past year, my heart rate occasionally exceeded 100 beats per minute, it did not last long.
The doctor prescribed antiarrhythmic medication for me, advising that I could take it if I felt uncomfortable with the rapid heart rate, but I have never taken it.
This year, after quitting smoking, I have felt my heart rate to be very unstable, fluctuating between 90 and over 100 beats per minute, and then dropping to the 60s, especially at night when it can go down to 58-60 beats per minute.
Due to this, I returned to a large hospital for a follow-up, where I underwent a 24-hour Holter monitor and another ultrasound.
The Holter monitor showed no significant issues, and the doctor said it was normal, although my heart rate during sleep was not slow enough.
However, the ultrasound surprisingly revealed moderate tricuspid regurgitation, which even the doctor found unusual.
All my other tests were normal, and I had no significant symptoms, only experiencing chest tightness when my heart rate was slow.
The doctor advised that I could just follow up in a year.
Still feeling uneasy, I sought a second opinion.
This doctor only performed an electrocardiogram and stated that my tricuspid regurgitation was likely caused by the ablation, as it was not present before the procedure.
He prescribed Carvedilol 10 mg and Clonazepam for me, but I find that when I sit or at night, my heart rate remains in the 60s.
It only increases slightly when I get up and move around.
I am concerned that taking the medication might slow my heart rate further.
The doctor suggested trying half the dose of Carvedilol, but I still feel a bit worried!

mimi, 50~59 year old female. Ask Date: 2022/07/23

Dr. He Dongjin reply Cardiology

Hello, the cause of tricuspid valve insufficiency is unknown, so let's just monitor it.
As for whether to take medication, it's up to you; if you feel more comfortable taking it, then go ahead.
Otherwise, simple observation should suffice.
I believe the medication is intended for stabilizing autonomic nervous system during menopause.
Changhua Hospital cares about you.

Reply Date: 2022/07/23

More Info

Tricuspid valve insufficiency, also known as tricuspid regurgitation, occurs when the tricuspid valve does not close properly, allowing blood to flow backward into the right atrium when the right ventricle contracts. This condition can arise from various causes, including structural heart changes, previous heart surgeries, or other underlying heart conditions. In your case, it appears that the tricuspid valve insufficiency was identified following your cardiac procedures, specifically after the catheter ablation for paroxysmal supraventricular tachycardia.

The relationship between heart procedures and tricuspid valve insufficiency can be multifactorial. During cardiac surgery or catheter-based interventions, the anatomy of the heart can be altered, which may affect the function of the heart valves. In your situation, the ablation procedure may have inadvertently impacted the tricuspid valve or the surrounding structures, leading to the observed insufficiency. It's also worth noting that the heart's electrical system and mechanical function can be interrelated; thus, changes in heart rhythm can sometimes lead to alterations in valve function.

Your recent echocardiogram indicating moderate tricuspid regurgitation, despite having normal findings prior to your procedure, raises some concerns. However, the absence of significant symptoms such as shortness of breath, fatigue, or swelling in the legs is a positive sign. The fact that your doctor has recommended a follow-up in a year suggests that they believe the condition is stable and not currently causing significant hemodynamic compromise.

Regarding your fluctuating heart rate, it is not uncommon for individuals with a history of arrhythmias to experience variations in heart rate, especially during periods of stress, anxiety, or even changes in physical activity. The medications prescribed, including heart rhythm control medications, are intended to help stabilize your heart rate and reduce episodes of tachycardia. It is understandable to be concerned about the potential side effects of these medications, particularly if you are experiencing bradycardia (slow heart rate) at times.
It is essential to communicate openly with your healthcare provider about your concerns regarding medication side effects and your heart rate fluctuations. They may consider adjusting your medication dosage or exploring alternative treatments if necessary. Additionally, lifestyle modifications, such as regular exercise, a heart-healthy diet, and stress management techniques, can also contribute to better heart health and may help stabilize your heart rhythm.

In summary, while moderate tricuspid valve insufficiency can be a concern, especially following cardiac procedures, the absence of significant symptoms and the recommendation for follow-up indicate that your healthcare team is monitoring your condition appropriately. It is crucial to maintain regular follow-up appointments, adhere to prescribed medications, and discuss any new or worsening symptoms with your doctor. If you continue to feel uneasy about your diagnosis or treatment plan, seeking a second opinion from a cardiologist can provide additional reassurance and guidance tailored to your specific situation.

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Hello, is mild tricuspid regurgitation congenital or acquired? I'm sorry, but I also don't know. Can I ask your attending physician if there is any evidence from imaging that can provide more information? Changhua Hospital cares about you.