Summary
Definition
History and exam
Key diagnostic factors
- história de febre reumática aguda na infância
- dispneia
- pressão venosa jugular elevada com onda A proeminente
- sopro pré-sistólico (diastólico) de baixa frequência na região paraesternal inferior esquerda
Other diagnostic factors
- idade: 20-39 anos
- intolerância ao exercício
- fadiga
- pulsações jugulares
- edema e desconforto abdominal
- edema
- cianose ou hipoxemia
- fibrilação atrial
- hepatomegalia
- ascite, edema, anasarca
- idade: primeira infância ou infância
- rubor facial episódico, diarreia aquosa ou broncoconstrição
- ausência de impulsão do ventrículo direito
- estalido de abertura
- estigmas de endocardite (por exemplo, hemorragias em estilhas, nódulos de Osler, lesões de Janeway)
Risk factors
- faringite por estreptococo do grupo A (GAS)
- tumores carcinoides metastáticos
- valva tricúspide artificial
- uso de substâncias por via intravenosa
- eletrodos de marca-passo/desfibrilador atravessando o orifício da valva tricúspide
- predisposição genética e fatores ambientais
Diagnostic tests
1st tests to order
- eletrocardiograma (ECG)
- radiografia torácica
- ecocardiograma transtorácico 2D
- ecocardiograma transtorácico com Doppler
- testes da função hepática
- bioquímica sérica
- Hemograma completo
- hemoculturas
- excreção urinária de ácido-5-hidroxi-indolacético (5-HIAA) em 24 horas
Tests to consider
- cateterismo cardíaco
- ressonância nuclear magnética (RNM) cardíaca
- ecocardiograma transtorácico 3D
- angiotomografia (ATG) cardíaca
- PET/TC com 18F-fluordesoxiglucose (FDG)
Treatment algorithm
congênito
com cardiopatia carcinoide
com sequelas de febre reumática
com endocardite infecciosa
Contributors
Authors
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
Disclosures
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
Disclosures
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, null
Assistant Professor
Pediatrics and Communicable Diseases
University of Michigan Congenital Heart Center
Ann Arbor
MI
Disclosures
ADM receives grant funding from the NIH.
Acknowledgements
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.
Disclosures
MLB declares that he has no competing interests.
Peer reviewers
Lokesh Tejwani, MD, FACC
Assistant Professor of Clinical Medicine
University of Missouri Hospitals and Clinics
Harry S. Truman VA Hospital
Columbia
MO
Disclosures
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
Disclosures
JC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease [Internet]. Geneva: World Health Organization; 2024.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tumores cardíacos
- Lúpus eritematoso sistêmico (LES)
- Pericardite constritiva (PC)
More DifferentialsGuidelines
- 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
More Guidelines
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