Acquired aortic stenosis ( aortic stenosis ) - Causes, Symptoms and Treatment .MF .
Causes and symptoms of acquired aortic stenosis
Features lifestyle with stenosis
Complications and prognosis
Malformations of the aortic valve are second in frequency after the defeat of the mitral valve of any acquired heart defects.In most cases there is a combination of aortic stenosis with aortic valve insufficiency, while in the isolated aortic stenosis as much rarer.
aortic valve is formed by connective tissue, and consists of three leaflets, drop-down at the moment of the movement of blood from the left ventricle into the aorta (one of the major blood vessels of the body, providing the entire body with oxygen-rich blood).Normally, the aortic valve opening area is three to four square centimeters.When any disease process in the mouth the aorta (aortic location output from the left ventricle) affects the leaflet, it leads to the development of scars and changes therein to the formation of narrowing (stenosis) of the valve opening.
Thus, aortic stenosis - a disease rela
There are congenital and acquired aortic stenosis.In turn, congenital stenosis is supravalvular, valve and subvalvular and gained almost always localized in the wings (valve stenosis).Below we describe the main features and treatment of acquired stenosis of the aortic valve.
Causes of acquired aortic stenosis
In most cases (about 70 - 80%), aortic stenosis cause rheumatic fever and bacterial endocarditis transferred (usually in younger people).Older people to aortic stenosis may result in the development of atherosclerotic plaques on the walls of the aorta, as well as the deposition of calcium salts in the valve leaflets affected by atherosclerosis.
Symptoms of aortic stenosis
The basis of clinical signs is a violation of hemodynamics (blood flow) within the heart and throughout the body.In the aorta, and, consequently, all the internal organs, blood flows is much smaller than in the normally working heart.This is manifested by symptoms such as frequent dizziness, pale skin, presyncopal state, deep fainting, muscle weakness, pronounced fatigue, feeling of strong heart beats.
Due to the fact that the muscle mass of the left ventricle increases to overcome the resistance to blood flow (going left ventricular hypertrophy), and coronary (own heart) blood vessels are not able to provide the heart muscle with oxygen, developed angina.In this case the patient concerned about attacks of chest pain radiating to the left arm or shoulder blade occurring during exercise or at rest.
As the proliferation of the cardiac muscle of other chambers of the heart (left atrium, right ventricle) due to its inability to cope with the resistance there are signs of stagnation of blood in the vessels of the lungs, liver, muscle, kidney and other organs.The patient in this case concerned shortness of breath when walking or at rest, bouts of "heart" of asthma with episodes of pulmonary edema (severe breathlessness at rest and in supine position with choking difficulty breathing), pain in the right upper quadrant, the increase in the abdomen due to accumulation of abdominal fluid, lower limb edema.Arrhythmias are much less common than in the mitral defects, and are more likely to be registered ventricular arrythmia.
All these symptoms are different depending on the current stage of the process.
Thus, in the stage of compensation heart to cope with the increased load on it, and the symptoms do not appear for a certain period of time (for example, for decades, if fault developed at a young age and the degree of constriction is not very pronounced).
In stage subcompensation (latent heart failure) symptoms appear when the significant physical exertion, especially not familiar to the patient.
In stages decompensation - severe heart failure, severe heart failure and terminal - the above symptoms bother the patient, not only when the minimum load of home, but also at rest.
In end-stage death comes as a result of complications and irreversible changes in the cells of the heart and the vital organs.
Diagnosing aortic valve stenosis
Sometimes the absence of complaints aortic stenosis can be diagnosed by chance during a routine examination of the patient.If there are complaints from the heart diagnosis is made in accordance with the following methods:
- clinical examination : estimated complaints, history of the disease and the appearance of the patient species, as well as conducted auscultation (listening) of the chest, where the doctor caught the rough systolic murmurat the point of projection of the aortic valve - in the second intercostal space to the right of the sternum, crackles in the lungs due to the stagnation of blood in them, if any;
- laboratory methods: during common blood and urine tests, biochemical and immunological blood tests revealed signs of inflammation, such as repeated attacks of rheumatic or bacterial endocarditis sluggish;signs of abnormalities in the liver and kidneys;Dyslipidemia signs atherosclerosis - an increase in cholesterol, triglycerides imbalance high and low density, and others;
- instrumental methods: held electrocardiogram (single or daily monitoring if indicated), phonocardiography (PCG - research method to convert the sound signals of a heart murmur in power, record them on photographic paper and conduct a full analysis of acoustic phenomena with heart defects), chest X-ray, echocardiography (ultrasound of the heart).Ultrasound of the heart - the only non-invasive (no introduction in the tissues of the body) techniques, allowing accurate diagnosis.In carrying out this method, estimated quantity, structure, thickness and mobility of the leaflets, the degree of narrowing of the valve opening with his measuring the area, the degree of hemodynamic - left ventricular hypertrophy with an increase in its volume, an increase in pressure in the left ventricle and a decrease in the aorta, decreased stroke volume and fractionoutput (amount of blood ejected into the aorta in one heartbeat).
Depending on the degree of narrowing of the valve ring at the mouth of the aorta to distinguish between three levels of aortic stenosis:
1 degree - slight stenosis - the opening area of the valve ring is more than 1.6 square meters.See
2 degree -. moderate stenosis - an area of 0.75 - 1.6 square meters.See
3 degree -. severe stenosis - narrowing of an area less than 0.75 square meters.cm.
In diagnostically ambiguous cases as well as in front of the valve operation can be displayed cardiac catheterization cameras with differential pressure measurement in the left ventricle and the aorta.This pressure gradient is also the basis for classification, with a slight stenosis corresponds to a gradient of less than 35 mmHg, moderate stenosis - 36 - 65 mm Hg, severe stenosis - above 65 mm Hg, that is, the greater the stenosis and obstruction to blood flow, thehigher pressure in the left ventricle and the aorta less, which adversely affects the ventricular walls and the blood supply of the whole organism.
Treatment of aortic stenosis
Choosing the best method of treatment is determined individually by the attending physician for each patient.Apply medicated preparations for aortic valve surgery and combinations thereof.diuretics (veroshpiron, indapamide, furosemide), cardiac glycosides (digitoxin, strofantin), drugs that reduce blood pressure (perindopril, lisinopril) and slows the heart rate (Concor, Coronal):
following may be appointed from the pharmacological groups of drugs.These drugs are appointed strictly on the evidence of a possible significant reduction in blood pressure and the occurrence of any deterioration in state of health is necessary to inform the treating physician.
drugs that extend peripheral vessels and is used to treat pulmonary edema and angina (nitrates - nitroglycerin nitrosorbid) used is not always and with extreme caution, since their use in angina due to aortic stenosis (relative coronary insufficiency) firstly,ineffective, and secondly, it is fraught with a sharp decrease in pressure up to the collapse of restricted blood supply to organs and tissues.
radical method of treatment of aortic valve stenosis is a cardiac surgery.Surgery is indicated in moderate to severe degree of stenosis and presence of hemodynamic disturbances and / or clinical manifestations.With moderate stenosis can be used valvuloplasty (dissection of adhesions and adhesions in the leaflet), and in patients with severe stenosis, especially if it is combined with a failure might valve prosthesis (artificial replacement by a mechanical or biological prosthesis).
aortic valve replacement with a mechanical prosthesis
Lifestyle in aortic stenosis
Compliance with recommendations on lifestyle at this vice is not much different from other cardiovascular diseases.The patient must eliminate physical exertion, limit your intake of fluids and salt, to give up alcohol, smoking, fatty, fried, high cholesterol food.You also need to constantly and regularly taking prescribed medications and attending physician with necessary diagnostic measures.
In the case of pregnancy with aortic stenosis tactics of the doctor to preserve pregnancy depends on the clinical stage of the process.The stages of compensation and subcompensation pregnancy can be prolonged, but decompensation blemish is an indication for termination of pregnancy.This is due to the fact that during gestation the load on the circulatory system of a pregnant increases, and this may lead to a deterioration of hemodynamic parameters, the development of complications in the mother and fetus (the threat of premature birth, fetoplacental insufficiency and others).
Complications of aortic stenosis
Without treatment, the disease is strictly goes through all five stages of its development, that is, sooner or later there comes a degenerative, irreversible changes in the heart muscle, lung, brain, liver, kidneys and other organs, which leads to death.According to some authors, more than half of patients do not receive treatment, die in the first two - three years after the onset of clinical symptoms.It is also quite likely to develop complications that threaten human life - fatal cardiac arrhythmias (eg, ventricular fibrillation, complete atrioventricular block, ventricular tachycardia), sudden cardiac death, acute heart failure, systemic thromboembolism (release of blood clots in the lung blood vessels, heart, brain,intestines, femoral artery).
Complications can develop not only as a result of long-existing aortic stenosis, but also during the operation on the aortic valve, in particular, the development of bacterial inflammation of the valve flaps as a result of contact with pathogens in the blood - bacterial endocarditis, blood clots on the wings or in the cavities of the heartwith a possible release them into the blood vessels, cardiac arrhythmia, the occurrence of restenosis (restenosis) in the late postoperative period as a result of repeated attacks of rheumatic fever.Prevention of such a life is oslozheny receiving anticoagulants and antiplatelet agents - drugs, "thinning" the blood and preventing increased blood clots, such as chimes, warfarin, clopidogrel, aspirin, and many others.In addition, prevents the development of infectious complications antibiotics in the early operational period and during medical diagnostic procedures and minor operations in the subsequent life of the patient, for example, the removal of a tooth, studies with his bladder catheterization, abortion and so on.
Weather Forecast untreated unfavorable.After surgical correction of the defect start to improve clinical and hemodynamic parameters and survival of these patients reaches about seventy of the hundred for ten years after the operation, that is good enough criterion for successful treatment of cardiac surgery of aortic stenosis.
therapists Sazykina OJ