Acquired valvular heart disease - Causes, Symptoms and Treatment .MF .
Causes Symptoms of heart disease
Diagnosis Treatment Prevention
acquired heart defects
The normal human heart consists of two atria and two ventricles, separated by valves that passed the blood from the atria to the ventricles.The valve is located between the right atrium and ventricle is called the tricuspid and consists of three leaflets, and between the left atrium and ventricle is called the mitral and consists of two wings.These valves are supported by the ventricles of tendon chords - threads, enabling the movement of the valves and the complete closure of the valve at the time of the expulsion of blood from the atria.This is important so that the blood was moving in one direction only, and do not throw back, as this can break the heart and cause a deterioration of the heart muscle (myocardium).There are also the aortic valve that separates the left ventricle and the aorta (the large blood vessel that provides blood of the whole body) and pulmonary artery valve that separates the r
If there are gross distortion of the internal structures of the heart, this leads to disruption of its functions, making the work of the whole body suffers.Such states are called heart defects that are congenital and acquired.This article deals with the basic aspects of acquired heart defects.
acquired defects - a group of diseases of the heart, which are caused by changes in the anatomy of valvular apparatus due to an organic lesion, which causes significant impairment of hemodynamics (blood flow within the heart and blood circulation throughout the body as a whole).
prevalence of these diseases according to different authors, from 20 to 25% of all heart diseases.
heart defects in 90% of cases in adults and children acquired defects are the result of the transferred acute rheumatic fever (rheumatic fever).This is a serious chronic disease that develops in response to the introduction into the body hemolytic streptococcus group A (due to a sore throat, scarlet fever, tonsillitis), and manifests itself affecting the heart, joints, skin, and nervous system.It is also the cause of defects can serve as bacterial endocarditis (inner lining of the heart failure due to the ingress of pathogens in the blood - sepsis, and their settling on the valves).
In other cases, rare causes in adults are autoimmune diseases (rheumatoid arthritis, systemic sclerosis, etc.), atherosclerosis, coronary heart disease, myocardial infarction, especially with the formation of a broad post-infarction scar.
Symptoms of acquired heart defects
clinical picture of heart disease depends on the stage of compensation hemodynamic disturbances.
Stage 1: compensation.It implies a lack of clinical symptoms due to the fact that the heart produces a compensatory (adaptive) mechanisms for the correction of functional disorders in the work, and the body is still can adapt to these violations.
Stage 2: subcompensation .It characterized by the appearance of symptoms during exercise, when the defense mechanisms are not enough to reverse the hemodynamic changes.At this stage, the patient concerned about shortness of breath, tachycardia (rapid heartbeat), chest pain left, cyanosis (blue or purple skin staining fingers, nose, lips, ears, the whole face), dizziness, predoobmorochnye state or loss of consciousness, lower limb edema.These symptoms appear usually under unusual stress for the patient, such as fast walking great distances.
3 stage: decompensation. mean depletion of the compensatory mechanisms of the heart and the whole body, which leads to the above symptoms with normal household activity or at rest.In severe decompensation due to an inability of the heart to pump blood occurs stagnation of blood in all the organs, it is clinically severe dyspnea at rest, especially in the supine position (so the patient can only be in a position half-sitting), cough, tachycardia, elevated or more frequently reduced pressure,edema of the lower extremities, abdomen and sometimes the whole body (anasarca).At this stage, disturbed blood flow to all organs and tissues from degenerative changes in them, the body is unable to cope with such severe pathological changes, and comes terminal stage (death) .
also acquired defects manifest themselves variously depending on their type and location.By the nature isolated defect failure (incomplete closure of the valve leaflets) and stenosis (narrowing) of the opening of the valve ring.Localization distinguish mitral, tricuspid, aortic valve and pulmonary valve stem.Observed as a combination thereof (lesions two or more valves), and combinations (stenosis and failure of the valve).Such defects are called combined or combined, respectively.The most common mitral and aortic valves.
Mitral stenosis (narrowing of the atrioventricular openings left). Characteristic for him are the patient complaints of pain in the chest and between the shoulder blades to the left, palpitations and shortness of breath, initially under a load, and then alone.Shortness of breath can be a symptom of lung edema (due to stagnation of blood in the lungs), which is a threat to the life of the patient.
mitral valve insufficiency.Clinically can does not manifest itself for decades from the beginning of the formation of defect, in the absence of active rheumatic heart disease (rheumatoid "inflammation" of the heart) and the defeat of the other valves.The main complaints in the development subcompensation are complaints of shortness of breath (also the same as in the stenosis, which might be a manifestation of pulmonary edema), disruptions in the heart, pain in the right upper quadrant (liver due to overfilling with blood), lower limb swelling.
aortic stenosis. If the patient had a minor narrowing of the valve ring, for decades, it can feel satisfactorily even at high physical exertion.In marked stenosis, there are complaints of general weakness, fainting, pale skin, coldness of extremities (due to decreased blood ejection into the aorta).Then join heart pain, shortness of breath, episodes of pulmonary edema.
aortic valve regurgitation. clinically for a long time can itself be only a sense of irregular heartbeats when expressed physical exertion.Later joined by a tendency to fainting, pressing pain in the chest, resembling angina and shortness of breath, which can be a formidable symptom in the rapid development of pulmonary edema.
Isolated stenosis of the right atrioventricular orifice and tricuspid valve insufficiency defects are very rare and usually occur on the background of mitral and / or aortic defects.The earliest signs - disruptions in heart and heart palpitations with a load, and then, with an increase in right ventricular failure appear lower limb swelling, heaviness and pain in the right upper quadrant (due to stagnation of blood in the liver), the increase in the abdomen (ascites - fluid accumulation in the abdominal cavity), dyspnea at rest.
Isolated pulmonary stenosis and insufficiency valve stem are also quite rare diseases, most of the defects of the valve combined with malformations of the tricuspid valve.Clinically manifested by frequent prolonged bronchitis, disruptions in heart with exertion, swelling of the lower limbs, enlarged liver.
acquired heart defects diagnosis of heart disease can be assumed in the course of a clinical examination of the patient with a mandatory auscultation of the chest, while listening to that detected abnormal tones and noises caused by the malfunction of the heart valves;as the doctor may hear crackles in the lungs due to the stagnation of blood in the vessels of the lungs.Attention is drawn to the pale skin, the presence of edema, determined by palpation (at a palpation of the abdomen), enlargement of the liver.
From laboratory and instrumental methods of investigation appointed by common blood and urine tests, biochemical blood tests to detect violations in the work of the kidneys and liver, ECG detects arrhythmias, hypertrophy (overgrowth) of the atria or ventricles, chest X-ray shows signs of stagnation of blood in the lungs, extending transverse size of the heart, angiography - the introduction of contrast medium through the vessels of the heart cavity, followed by X-ray, echocardiography (ultrasound of the heart).
example, looks with hypertrophy of the heart atria and ventricles with heart disease on chest radiograph.
Of these research methods reliably confirm or refute the diagnosis helps echocardiography, as it allows to visualize the heart and its internal structures.
When mitral stenosis by ultrasound of the heart is determined by the severity of the stenosis on the atrioventricular orifice area, seal the valve leaflets, hypertrophy (increase in weight) of the left atrium, turbulent (not unidirectional) flow of blood through the atrioventricular orifice, increasing the pressure in the left atrium.Mitral insufficiency is characterized by ultrasound echo cliff from the valves at the time of closing of the valve, as determined by the severity of regurgitation (backward throw blood into the left atrium) and the degree of hypertrophy of the left atrium.
When aortic stenosis by ultrasound to determine the degree of severity of stenosis, left ventricular hypertrophy, decreased ejection fraction and stroke volume (the indicators characterizing the blood flow into the aorta in one heartbeat).Aortic insufficiency deformation manifests aortic valve leaflet, by closing their incomplete, regurgitation of blood into the left ventricular cavity, left ventricular hypertrophy.
When defects of the tricuspid valve and the pulmonary trunk valve identifies and assesses the corresponding figures are only for the right heart.
Treatment of acquired heart disease Treatment
acquired defects continues to be a challenging and topical issue in modern cardiology and cardiac surgery, since for each individual patient is very important to determine the fine line when the operation is necessary, but not contraindicated.In other words, cardiologists should carefully monitor these patients to timely detect a situation where drug therapy is no longer capable of holding a fault in a compensated form, but marked decompensation not had time to develop, and the body is still able to move open-heart surgery.
There are medical and surgical treatments for heart disease. Drug therapy is used in the active phase of rheumatism, in step subcompensation (if possible to achieve the correction of hemodynamic disorders with drugs, or if surgery is contraindicated due to comorbidities - acute infectious disease, acute myocardial infarction, re-rheumatic fever, etc...)at the stage of severe decompensation.Because of drugs are appointed by the following groups:
- antibiotics and anti-inflammatory drugs for the relief of active rheumatic process in the heart, it is mainly used of the penicillin group (bitsillin injections, ampicillin, amoxicillin, amoxiclav, etc.), non-steroidal anti-inflammatory drugs (NSAIDs) - diclofenac,nimesulide, ibuprofen, aspirin, indomethacin;
- cardiac glycosides (digoxin, digitoxin) are assigned in certain cases, to improve the contractile activity of the myocardium (heart muscle);
- drugs that improve the trophism (nutrition) infarction - Pananginum, magnerot, Magne B6, etc .;
- diuretics (furosemide, indapamide, etc.) shown to reduce volume overload of the heart and blood vessels;
- ACE inhibitors (captopril, lisinopril, ramipril, and others) have cardioprotective properties, help to normalize blood pressure;
- B-adrenergic blockers (bisoprolol, carvedilol, etc.) are used to reduce the pressure and the deceleration rate if the patient develops heart rhythm disorders with increased heart rate;
- antiplatelet therapy (aspirin and its modifications - cardiomagnil, Cardio aspirin thrombotic Ass, etc.) and anticoagulants (heparin, fraxiparine) are assigned to prevent increased blood clotting with the formation of clots in blood vessels or the heart;
- nitrates (nitroglycerin and its analogues - Nitromintum, nitrosprey, nitrosorbid, monocinque) appointed, if a patient with heart disease develops angina (caused by insufficient blood supply to the heart muscle hypertrophy).
Cardiosurgical treatments are radical way the defect correction.Of these apply commissurotomy stenosis (ressechenie scar adhesions to the valve cusps), suturing nesmykayuschihsya flaps, expanding small area stenosis with the probe, supplied to the heart through blood vessels, valve replacement (excision of its valve and replacing it with artificial).
In addition to these treatments, the patient should maintain a certain lifestyle, for example:
- rational nutrition, diet with restriction of salt, the volume of fluid intake, foods with high cholesterol (fatty meats, fish, poultry and cheese, margarineeggs), with the exception of fried, spicy, savory, smoked.
- often walking in the fresh air;
- exclude sports;
- limit the physical and psycho-emotional stress (stress and feel less nervous);
- organize the mode of the day with a rational distribution of work and rest, and sufficient sleep duration;
- pregnant woman with acquired heart disease regularly attend antenatal clinic, the cardiologist or cardiac surgeon to decide on the possibility of continuing the pregnancy with the choice of the optimal method of delivery (usually by cesarean section).
Prevention of acquired heart defects
Since the main cause of these diseases is a rheumatic disease, prevention is aimed at timely cure diseases caused by streptococcus (angina, chronic tonsillitis, scarlet fever) with antibiotics, sanitation of chronic foci of infection in the body (chronic pharyngitis, cariousteeth, etc.).This primary prevention.Secondary prevention is used in patients with pre-existing rheumatic process and is carried out through the annual course of antibiotic injections bitsillina and taking anti-inflammatory drugs.
Despite the fact that the stage of compensation (without clinical signs) certain heart defects calculated for decades, the overall life expectancy may be reduced, as the heart of the inevitable "wear out", developed heart failure with impaired blood supply and nutrition of all organs and tissues,which leads to death.That is the life of a poor prognosis for.
also forecast by the possibility of life-threatening conditions (pulmonary edema, congestive heart failure) and associated complications (thromboembolic complications, cardiac arrhythmias, prolonged bronchitis and pneumonia).When the surgical correction of the defect favorable prognosis for life subject to acceptance of drugs prescribed by a doctor and the prevention of complications.
therapists Sazykina OJ