Mild tricuspid insufficiency on echo?

[erica1991]

This will be a long story so bear with me.

Three years ago I was going through a battery of tests for a very bad arrhythmia, long story short I was finally sent to an electrophysiologist and had a successful ablation of SVT done when I was 20 and was told that if the SVT or another arrhythmia comes back, ablation is no longer an option because he ablated as much as he could without killing entire SA node. I had no symptoms and was seeing my doctor on an as needed basis. However, for the past year I have had swelling in my lower extremities, some days I can't get my shoes on (I wear wide shoes and they fit perfectly) because my feet are so swollen and I often get very deep indention's/ridges from my socks. My weight goes up and down like a yo-yo, I am assuming from water retention. I saw my doctor in December because of a new onset of arrhythmia symptoms (heart pounding and my heart would beat rapidly then have long drawn out pauses then repeat) The problem showed up on the EKG and he said that he could hear it with the stethoscope. He said this was a new issue then from what I had before the surgery and for the first time I have been put on a "no cardio" restriction and I have a follow up in a year. He said that over time the heart will slow down to where he will need to intervene (I am assuming with a pacemaker). Fast forward to currently, I found an old medical record of an echo I had done 3 years ago (I am now 23) that showed mild tricuspid insufficiency, which was complete news to me as this was never mentioned before, probably because it was not a cause of concern then. I called my electrophysiologist to move my appointment up from December to August (I am in AL for grad school right now and cannot go back to TX until then) because of the new discovery of the echo report and because my arrhythmia have gotten a thousand times worse (they keep me up ALL night pounding and when I fall asleep they wake me back up, when i get up to go to the bathroom on the nights its bad I am dizzy). And they wanted me to FAX MY REPORT! They should have had this, I had all of my tests I had done with another cardiologist sent over to them. My concern is, hypothetically, how much can a mild tricuspid valve deteriorate into something more serious over the course of three years? My symptoms seem to correlate with a worsening leaky tricuspid valve. Especially the swelling of the ankles and feet and the onset of a new arrhythmia. I have asked my vascular dr. about the swelling because I have venous insufficiency in the leg that I had the catheter in for my heart surgery, and he said that there was no way that it would cause swelling on the other leg, so the problems are unrelated to each other. I see my doctor in August and my mom is going to try and get me in with her cardiologist (she had an atrial septal defect repaired with open heart surgery) since my doctor deals solely with electrical problems

Any thoughts or ideas? Thanks for taking the time to read this, I know it is long!!

[Ger57]

Hi Erica,
many people have leaky valves, it is very common. As long as the leakage is trace or mild, there is no reason for concern. When it is moderate or severe, closer monitoring is required.

Hypothetically, a tricuspid valve can deteriorate in very short time. A bacterial infection for instance can cause great damage in a very short time.
Normally however, leakage remains stable for many, many years. So, not 3 years but decades.

It is very unlikely that mild tricuspid valve leakage causes any symptoms. I can not imagine that your swollen ankles are caused by it. There must be another reason for it.

[erica1991]

I don't mean to object by any means, but how come with a quick google search on "mild tricuspid insufficiency" every single site (including American Heart Association) say that it can cause swelling in the lower extremities? It just confuses me, nonetheless I am still going to see my doctor to have all of this checked out, especially with the rapid progression of this new arrhythmia

[Ger57]

The websites state that tricuspid regurgitation may not cause any symptoms if the regurgitation is not moderate or severe.

Mild regurgitation hardly ever gives problems, that is why I said that it is very unlikely that your edema is caused by it.

Good luck and please keep us informed on what your doctor's visit brings.

[ed34]

I would ask for a TEE which is a great way to look at your valves. It does mean swallowing a sensor, but your throat is numbed. At least it will satisfy you if Doctors are looking in the right area.

[Ger57]

TEE gives the best pictures but unless you are very overweight, a normal echo (TTE) will probably suffice at this stage to check if your tricuspid valve regurgitation has increased and if there are other issues with your heart.

Severe/moderate tricuspid regurgitation can be recognized with a stethoscope.
I assume worsening of the regurgitation would have been detected in december.

[erica1991]

I just wanted to give an update. I saw my electrophysiologist because I felt that my problem had gotten worse and I am home on break. He confirmed via EKG that because of my previous cardiac ablation I now have a wandering pacemaker and that medicine will not help nor can I have another ablation. We are monitoring the progress of it and I have a check up in 6 months. I saw a regular cardiologist regarding the previous echo that showed mild tricuspid insufficiency and I wanted to get the intermittent edema checked out that I have in my lower extremities. He is going to repeat the echo and he mentioned that he was curious to see if I have right sided heart enlargement, and I am having a vein mapping done on both of my legs. (Another doctor previously told me I had venous insufficiency in my right leg only, so they are going to do another diagnostic test to check). I will update if anything shows up!