Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- history of acute rheumatic fever (ARF) during childhood
- dyspnea
- elevated jugular venous pressure with prominent a-wave
- low-frequency presystolic (diastolic) murmur at lower left sternal border
Otros factores de diagnóstico
- age: 20-39 years
- exercise intolerance
- fatigue
- jugular pulsations
- abdominal swelling and discomfort
- edema
- cyanosis or hypoxemia
- atrial fibrillation
- hepatomegaly
- ascites, edema, anasarca
- age: infancy or childhood
- episodic facial flushing, watery diarrhea, or bronchoconstriction
- absent right ventricular lift or heave
- opening snap
- endocarditis stigmata (e.g., splinter hemorrhages, Osler nodes, Janeway lesions)
Factores de riesgo
- group A streptococcal (GAS) pharyngitis
- metastatic carcinoid tumors
- artificial tricuspid valve
- intravenous drug use
- pacemaker/defibrillator leads crossing tricuspid valve orifice
- genetic predisposition and environmental factors
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- ECG
- chest x-ray
- 2D transthoracic echocardiogram
- Doppler transthoracic echocardiogram
- liver function tests
- blood biochemistry
- CBC
- blood cultures
- 24-hour urinary excretion of 5-hydroxy-indole acetic acid (5-HIAA)
Pruebas diagnósticas que deben considerarse
- cardiac catheterization
- cardiac MRI
- 3D transthoracic echocardiogram
- cardiac CT angiography (CTA)
- [18F] fluorodeoxyglucose (FDG)-PET/CT
Algoritmo de tratamiento
congenital
with carcinoid heart disease
with rheumatic fever sequelae
with infective endocarditis
Colaboradores
Autores
John R. Charpie, MD, PhD
Professor
Pediatrics and Communicable Diseases
Division Director
Pediatric Cardiology
Medical Director
Pediatric Cardiothoracic ICU
University of Michigan Congenital Heart Center
Ann Arbor
MI
Divulgaciones
JRC declares that he has no competing interests.
Jeffrey D. Zampi, MD
Associate Professor
Pediatrics and Communicable Diseases
Director, Interventional Pediatric Cardiology
University of Michigan Congenital Heart Center
Ann Arbor
MI
Divulgaciones
JZ is a consultant for Medtronic Inc and Gore Medical. JZ serves on the data safety monitoring board for a clinical trial sponsored by Encore Medical. JZ has served as medical expert for several legal cases.
Amanda D. McCormick MD,
Assistant Professor
Pediatrics and Communicable Diseases
University of Michigan Congenital Heart Center
Ann Arbor
MI
Divulgaciones
ADM receives grant funding from the NIH.
Agradecimientos
Dr John R. Charpie, Dr Jeffrey D. Zampi, and Dr Amanda D. McCormick would like to gratefully acknowledge Dr Martin L. Bocks, a previous contributor to this topic.
Divulgaciones
MLB declares that he has no competing interests.
Revisores por pares
Lokesh Tejwani, MD, FACC
Assistant Professor of Clinical Medicine
University of Missouri Hospitals and Clinics
Harry S. Truman VA Hospital
Columbia
MO
Divulgaciones
LT declares that he has no competing interests.
John Coltart, MD, FRCP, FACC, FESC, MRCS
Consultant Cardiologist
Cardio-thoracic Unit
Guy's and St Thomas' Hospital
London
UK
Divulgaciones
JC declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease [Internet]. Geneva: World Health Organization; 2024.Texto completo Resumen
Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention. 2022 Feb 4;17(14):e1126-96.Texto completo Resumen
Writing Committee Members., Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Cardiac tumors
- Systemic lupus erythematosus (SLE)
- Constrictive pericarditis (CP)
Más DiferencialesGuías de práctica clínica
- The tricuspid valve: a review of pathology, imaging and current treatment options: a scientific statement from the American Heart Association
- 2023 ESC guidelines for the management of endocarditis
Más Guías de práctica clínica
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