Aortic insufficiency ( aortic valve ) - Causes, Symptoms and Treatment .MF .
Causes and symptoms of aortic insufficiency
diagnosis, degree of aortic valve regurgitation
Lifestyle with vice
Complications and prognosis
aortic valve is a kind of connective tissue flap, consisting of three leaflets, and is located at the mouth of the large blood vessels of the body - the aorta.Its function is reduced to the delimitation of the cavities of the left ventricle and the aorta.After the rupture of blood from the ventricle into the aorta at the time of relaxation of the leaflets are closed tightly, facilitating the movement of blood in the direction of smaller caliber arteries and preventing reverse flow in the left ventricular cavity.When the pathological changes in the structure or the mobility of the leaflets of their function is impaired, which leads to the formation of defects of the aortic valve.
These defects include stenosis and aortic valve regurgitation, with isolated aortic regurgitation found only 4% of cases among heart disease.
Thus, aortic regurgitation -
Causes of aortic insufficiency
main cause of the disease, as well as other acquired defects, heart failure is the result of acute rheumatic fever (rheumatic fever).At the same time more often, than at mitral to aortic insufficiency can cause atherosclerosis, bacterial endocarditis, long-existing hypertension, aortic aneurysm, including acute her bundle, systemic lupus erythematosus, rheumatoid arthritis, especially if the valve structure predisposes to the developmentit changes, for example, congenital abnormality - bi-leaflet aortic valve.A very rare cause of valve failure may be due to syphilis.
Symptoms of valve insufficiency aortic
As with aortic valve stenosis, in its failure, or a combination of these vices clinical picture may not manifest themselves for decades, if the defect has arisen at a young age and is characterized by not very severe regurgitation (reverse blood flow in the leftventricle).
Under compensation (heart failure, there is no) symptoms bother the patient in connection with the development of compensatory mechanisms of the heart, for example, an increase in strength and frequency of left ventricular contractions, thereby long-term way to maintain adequate blood flow in the capillaries of the vital organs(brain, liver, kidneys, etc..)
under subcompensation (latent heart failure) patients concerned about complaints of palpitations, shortness of breath during exercise, a sense of strong beats of the heart, increasing in the left lateral position, dizziness, tendency tofaintness when changing body position, general weakness and fatigue.
decompensated (overt cardiac failure) above complaints appear in a state of normal household activity, and often alone.Also joined complaints pressing retrosternal pain radiating to the left arm and shoulder blade.This condition is called angina, which is caused by the fact that hypertrophied (enlarged and stretched high volume of blood returning back) left ventricle is not getting enough oxygen from the blood flowing through the coronary (own heart) arteries.Shortness of breath at this stage can be a symptom of cardiac formidable ( "heart") of asthma, which is the manifestation of pulmonary edema.
patient experiences shortness of edema, bubbling breath, inability to breathe when lying down;there choking cough with frothy, bloody sputum.All these symptoms indicate a developing left ventricular heart failure.
Under severe decompensation (severe heart failure) to left ventricular joins and right ventricular failure, because the right ventricle is experiencing certain difficulties for the expulsion of blood in the pulmonary artery overflowing.As a result, there is an overload right heart that clinically severe edema of the lower extremities, face, hands, full body, an accumulation of fluid in the abdominal cavity and the abdomen increases, the weight and pain in the right upper quadrant of the increased blood supply and increase in liver.
In the terminal stage of a patient as a result of pathological processes in all organs and associated complications are formed persistent irreversible metabolic disorders, and degenerative changes in organs and tissues, which leads to death.The human heart is so depleted that simply can not adequately ensure that the blood circulation throughout the body.
diagnosis of aortic insufficiency
Suspected diagnosis of aortic insufficiency your doctor may still at the stage of clinical examination.
attention is drawn to the following features:
- general pallor of the patient (compared to mitral, cyanosis, or blue coloration of the skin is not determined until the terminal stage);
- friendly with the pulse changes the color saturation of the throat and tonsils (Muller symptom) and nail bed - capillary pulse (Quincke's sign).These symptoms are associated with changes in blood supply to the smallest capillaries of the skin and mucous membranes in the process of systole and diastole cardiac contraction, when part of the blood ejected from the heart during systole and gives a rich color the skin and mucous, comes back during diastole, resulting in a reddish hue pharyngeal mucosa ornail bed pale, and with the next heartbeat again becomes tinged with red;
- «carotid dance" - the pulsating movement of the common carotid arteries in the neck;
- visible pulsations of the aortic arch in the hole at the top of the jugular notch of the sternum;
- symptom Musset - friendly with a pulse shake of the head;
- the measurement of the pulse is detected its high and fast rhythm;
- when the systolic blood pressure measurement ( "top"), the pressure may be raised, and the diastolic ( "lower") dramatically reduced;
- auscultation (listening) of the chest is determined by tender (not rude, unlike stenosis) noise during diastole - ventricular relaxation, as well as the weakening of the second heart sound (the sound is not muted or collapse of the aortic valve).Can auscultated wet or dry rales in the lungs;
- palpation (palpation) of the abdominal cavity can be defined by the edge of dense enlarged liver.
If the doctor during the examination and review complaints and a history of the patient's disease suspected diagnosis of aortic valve defect, he shall appoint additional methods of laboratory - instrumental diagnostics to confirm the diagnosis.These methods include:
- common blood and urine tests, biochemical and immunological blood test determines the presence of rheumatic process in the body, the liver and kidney function, autoimmune diseases - rheumatoid arthritis, systemic lupus erythematosus.
- the ECG revealed severe left ventricular hypertrophy, and later the right heart, myocardial ischemia, cardiac electrical axis deviation to the left, recorded atrial and ventricular premature beats.
- on a radiograph of the chest cavity can be seen the expansion of the left heart.
- echocardiography (ECHO - CG) - method of visualization of internal structures of the heart and major blood vessels by means of ultrasonic waves.It allows to specify anomaly valve structure, the structure and the mobility of its flaps, determine whether regurgitation (backward flow of blood into the left ventricle) to measure stroke volume and ejection fraction of the left ventricle and other important parameters.Depending on the severity of regurgitation, aortic insufficiency can be divided into degrees:
1 degree - the initial aortic insufficiency - back from the aorta back no more than 30% of the blood from the whole blood, ejected into the aorta from the left ventricle in a single heartbeat;regurgitant jet reaches not more than 5 mm away from the aortic valve into the left ventricle cavity;
grade 2 - moderate insufficiency - regurgitant volume 30 - 50%, the length of the blood stream - 5 10 mm;
grade 3 - severe failure - regurgitant volume more than 50%, the return of the blood stream in a length of 10 mm or more.
the arrow indicated a return of blood cast into the left ventricle (regurgitation)
- in diagnostically unclear cases, is shown holding a transesophageal ECHO - CG, stress ECHO - CG (ultrasound of the heart with physical activity), coronary angiography (CAG) -radiopaque study coronary vessels to ascertain their permeability for a decision on the carrying out of surgery at the same time the valve of the aorta and coronary arteries.
Treatment of aortic valve insufficiency
How to treat other heart diseases, in the treatment of this disease apply medication and surgical methods of treatment.
to medical methods include prescriptions following pharmacological groups: peripheral vasodilators (nitroglycerin and its analogs, apressin, Adelphanum and others), antihypertensives (ACE inhibitor - perindopril, captopril, etc.), calcium channel blockers (verapamil, diltiazem, nifedipine andetc.), on the testimony of diuretics (diuretics - Lasix, indapamide, and others).
to prevent hypotension (sharp decline in blood pressure) in acute aortic insufficiency (clinical pulmonary edema when dissecting aneurysm of the aorta, for example), these drugs are prescribed in combination with dopamine.
Drugs slows the heart rate (beta - blockers) are contraindicated, since the increase in heart rate is the heart of the compensatory mechanism in order to maintain systemic blood flow at the proper level.
From the surgical treatment of aortic valve prosthesis is used to replace it with a mechanical or biological implant.In the case of a patient of acute aortic insufficiency and aortic root aneurysm surgery is performed on the valve transplant and root, and as the implant may be a portion of the pulmonary artery of the patient.
Lifestyle in aortic insufficiency
addition to medical and surgical treatments, a very important role in maintaining the overall health of a given pathology plays a lifestyle.
1. Diet: The following can be isolated from the main recommendations.A patient with aortic defect is necessary to observe a rational mode of work and rest, plenty of rest, enough sleep are more likely to walk on air, to eliminate physical stress and limit stress.
2. Diet.It is necessary to organize a correct and clear of eating regime, eat more fruits, vegetables, lean meats and fish, dairy products;limit salt intake and fluid intake;eliminate the sharp, salty, fatty and fried foods, spices, chocolate, coffee, alcohol.In the Cardiology Hospital
used medical table №10.
3. Employability can be stored for a long time in the absence of symptoms of the heart, but the patient, who set the diagnosis, you must inform the doctor about the nature of work, in particular, the presence of significant physical and psycho-emotional stress.
4. The patient should regularly visit the clinic with the performance of the prescribing doctor, especially relating to the conduct of laboratory - instrumental examination methods.
5. In the event of termination of pregnancy is shown in the case of significant clinical manifestations of heart failure.In the absence of symptoms or minimal changes in hemodynamics by cardiac ultrasound pregnancy can be prolonged.the question of preservation of pregnancy is solved individually for each patient.
Complications of aortic insufficiency
In the absence of medical or surgical treatment of the patient may develop complications such as acute myocardial infarction, bacterial endocarditis (inflammation of the cardiac valvular apparatus caused by settling of microorganisms on the already modified, for example, rheumatism, or atherosclerosis, valves)pulmonary edema, cardiac arrhythmias (atrial fibrillation, atrial and ventricular premature beats, ventricular fibrillation), thromboembolic events (transfer of blood clots from the heart into the blood vessels of lungs, brain, intestines, with the development of heart attacks and strokes in these organs)
If a patient is referred for surgery, the physician should warn him about a certain degree of operational risk and operational lethality.In the case of operations on the aortic valve, these risks are relatively small, which allows to achieve a very high level of survival after cardiac surgery treatment.But there is still a small chance of postoperative complications such as thrombosis on artificial valve with a margin of blood clots, bacterial endocarditis, the melting of the biological implant.prevention of complications are life-long warfarin, chimes, clopidogrel and anticoagulants, the timely use of antibiotics, as well as the prevention of recurrent attacks of rheumatic fever.
Without treatment, while the prognosis for life and work in a favorable stage of compensation.But after the onset of clinical manifestations of the disease without treatment is progressing rapidly, and most patients die within the first two - four years from the onset of heart failure and angina.Surgical treatment combined with medication can extend the patient's life and improve quality of life, that is, after the treatment the forecast favorable.
therapists Sazykina OJ