Acquired heart defects: causes, diagnosis and treatment
The defects that occur in a person with an initially healthy heart, as a result of the transferred diseases, are called acquired.The lesion concerns valvular anatomical structures of the heart.The valves and the tendon cords attached to them, which control the process of closing and opening, become functionally untenable.In this case, the state of insufficiency develops.If the valve flaps do not reach the phase of full opening, then we are talking about the narrowing of the hole( stenosis).Sometimes both are present simultaneously, and the other defect.Defects resulting from diseases can develop in children and adults.Table of contents: What causes heart defects, the causes of the disease What are the changes in the heart as a result of developing defect? Features of diagnosis of acquired heart defects. The main provisions for the treatment of acquired defects. The main types of acquired heart defects.
. What causes heart defects, causes of illness
The most common reason for the formation of pathological changes in the valves and openings of the heart is rheumatism, in particular - rheumatic heart diseaseIon-toxic process, localized in cardiac tissue).
Rarely, the causes of perverse destruction are:
- diseases of septic nature( blood poisoning);
- progressive atherosclerotic processes;
- trauma of the chest;
- is an organic lesion of the heart of syphilitic origin.
What changes in the heart occur as a result of developing defect
Narrowing( stenosis) can occur by forming connective tissue fibers in the valve flaps and scar processes in the tendon chords that regulate the synchronous operation of the valve apparatus.
Insufficiency of valvular structures is the result of destruction and processes of replacement of the valvular apparatus with scar tissue.Altered by the pathology, the valves disrupt the physiological flow of blood.The problem is that from the main volume of blood that has passed into the next chamber, the part comes back.This occurs as a result of the fact that the valves can not close completely, and there is a gap or other defect between the flaps.
To the normal volume of blood is added a portion thrown back.This process leads to an adaptive expansion of the heart chamber, then to a thickening of the muscular wall( hypertrophy).Over time, the heart muscle "tired" of constant overload and it comes to weakening, which leads to flaccidity( dilatation).As a result, chronic heart failure is formed with the inability of a normal "pumping" of blood.
Diagnostics of Acquired Heart Diseases
When establishing the presence of a defect, it is necessary to find out its cause, the available form of heart failure, and assess the degree of its development.The first who discovers a vice is a doctor who conducts auscultation( auscultation) of the heart.It is he who, due to acoustic changes in heart tones and the arising noise, puts the primary diagnosis.
The ultrasound of the heart is then performed, which allows to determine the exact location, the form of the defect, the degree of expression of the process by measuring the area of the valve openings.Dopplerometry of the heart is conducted to establish the fact of retrograde blood loss( regurgitation), due to insufficiency.
The X-ray study remains indispensable.An attentive dynamic examination of the patient with fluoroscopy allows to examine all the details of the developed pathology.
Laboratory analysis methods should be used to confirm possible changes in other organs that may have suffered as a result of circulatory problems.
More details on the diagnosis( ECG) of acquired heart defects are described in the video review:
. The main provisions for the treatment of acquired defects.
. Important: can completely get rid of such a disease as heart disease only surgically.
Drug treatment is indicated only in case of mild options and degrees of malaise, to maintain heart function, to prevent the development of possible complications and prevent the formation of heart failure.
In severe patients, conservative therapy is used to prepare the body for the transfer of surgical treatment and to relieve symptoms of heart failure.
After the surgical intervention, it is worth remembering the need for household and labor rehabilitation of the patient.Specific treatments for acquired defects will be described in particular cases of the disease species.
The main types of acquired heart defects
The variety of vices does not allow describing them in one article, therefore only the most common ones will be presented here.
Note : the human heart is formed by 4 chambers - two atria( left and right) and two ventricles.From the left ventricle scarlet arterial blood enters a large circle of circulation to supply oxygen to all tissues of the body, then it collects in the upper and lower hollow veins and already saturated with carbon dioxide falls into the right atrium.From it - into the right ventricle.Between these two chambers is a tricuspid( tricuspid) valve.From the right ventricle( a small circle of blood circulation) the blood through the pulmonary trunk( artery) is fed to the lung system, where gas exchange takes place - carbon dioxide release and oxygen saturation of blood.Further, the enriched blood flows through the pulmonary veins into the left atrium and through the bivalve( mitral) valve into the left ventricle, where it again falls into a large circle.The task of the valves is to restrain the reverse casting of the jerky blood moving.If the structure of the valves and the formations that regulate their function is impaired, vices and heart failure develop, that is, the inability of a normal blood passage.
Video "Circles of blood circulation":
Acquired mitral valve defect
The most common defects are of the mitral valve .This valve device is located between the left atrium and the left ventricle.Its defeat by a painful process in most cases forms simultaneous insufficiency and stenosis.The form of heart failure develops both over a large and a small circle of blood circulation.
At first the patient undergoes a pressure increase in the small circle of the circulation.
In patients with mitral valve defects, patients develop:
- dyspnea with exercise and then at rest.With stenosis, it is more pronounced;
- palpitation, as an attempt to compensate for problems in the circulation);
- cough( with phlegm), which appears due to sweat of the liquid part of the blood into the lung tissue.The fluid outlet occurs due to high pressure in the system of the small circle of blood circulation( an indicator of right ventricular failure);
- accumulation of fluid in the extremities, pain in the right upper quadrant - stagnation of blood in a large circle of circulation.Increasing the pressure in it also causes the fluid to escape from the vascular bed into the tissue, and the pain in the liver is caused by the dilatation of its capsule( rich in nerve endings).This organ is literally permeated with blood vessels, because of which a lot of blood in the tissues can accumulate and they seem to "swell";
- cyanotic( cyanotic staining of the skin and mucous membranes with insufficient oxygen saturation) in neglected cases;
- heart rhythm disturbances;
- compensatory thickening of the right ventricle gives a visible cardiac "push" in the epigastric region;
- Noise in the heart, determined by the doctor during auscultation.Noises have characteristic shades, according to which a good cardiologist very accurately determines the existing defect.Each noise was given a certain name, for example, "the rhythm of a gallop", the noise of "Graham Still", etc.
X-ray picture of the disease is formed by enlarged chambers of the heart, displacement of position and visible phenomena of stagnation in the lungs.Additional data for the diagnosis of mitral valve defect gives electrocardiography.
Isolated mitral stenosis or insufficiency is rare.As a rule, there is a combination of these with a predominance of constriction or insufficiency.
Mitral stenosis manifests itself:
- with specific( diastolic) noise, which is well audible at the apex of the heart.It occurs during the relaxation of the heart( diastole) due to the passage of blood through the narrowed hole, and it is also defined as "cat-purring" - the trembling of the joint valve flaps, I tone loud with flapping;
- pulse with low filling;
- with the common symptoms listed above;
- a specific sign is the blush on the child's cheeks - "butterfly".
Heart failure with stenosis develops early, but it is long and well amenable to medical correction.The vice is often complicated by thromboembolism( separation of blood clots from the walls of the right atrium), rhythm disturbances and the development of a pulmonary infarct with hemoptysis.
Video "Mitral stenosis":
Operative treatment - commissurotomy is performed by a patient with a mitral valve defect with an increasing heart failure.Valves valves are separated and blood flow is restored.
Mitral insufficiency is determined by:
- systolic murmur, which is caused by the passage of blood back to the left atrium through a valve defect;
- general complaints, characteristic of all vices.
The disease remains in the compensated phase for a long time, since the left ventricle has the greatest ability to adapt to pathological changes.Operative treatment of a defect is offered in case of increase of clinic of chronic insufficiency of blood circulation.Surgical intervention involves the installation of an artificial valve( prosthesis).
Video "Treatment of mitral insufficiency":
Acquired defects of tricuspid valve
Insufficiency of tricuspid valve - is a rare isolated defect.Usually it is combined with a combined pathology.With tricuspid insufficiency, stagnant phenomena of venous bed rapidly develop.The organs with a specific parenchymal tissue( liver, spleen) are enlarged.Fluid penetrates the abdominal cavity, ascites develops.Tricuspidal defect often occurs with a bicuspid valve defect.In this case, the pressure in the small circle of blood circulation decreases, due to the dropping of blood through the tricuspid valve into the right ventricle.
The tricuspid( tricuspid) stenosis is very rare in its own embodiment.Accompanying the combined vices, combined with mitral defects.The right atrium in this pathology is enlarged, due to the difficulty of the passage of blood into the right ventricle.In patients early developed shortness of breath with physical exertion, a feeling of heaviness in the pit of the stomach, swelling.There is cyanosis of the skin with icteric tinge.The liver grows in size and pulsates.The palpitation is rapid.
Acquired aortic valve defects
Stenosis of the aortic aperture occurs frequently in combination with aortic valve failure.Usually remains in an unrecognized form.With this defect, blood from the cavity of the left ventricle enters the aorta through the narrowed orifice.The obstacle does not allow it to completely exit, and the rest is mixed with the usual portion.As a result, excess blood leads to an increase in the cavity and hyperextension of the walls of the left ventricle, which corresponds to an increase in the mass of the myocardium, and then to its relaxation( dilatation).
Patients rarely complain about health problems.Sometimes there are heart pains, fainting.The pulse is slowed down, the skin is pale, since the blood goes to the tissues less than the prescribed one.There are specific noises in the heart.Disease with slow progress.If there is a phase of heart failure, then it manifests itself with cardiac asthma.
The aortic valve failure of is also often combined with other defects.Blood from the aorta through the defect of the valves again comes back to the left ventricle.Hypertrophy of the ventricle compensates the problem for a long time, therefore this type of defect rarely causes complaints.In patients with time, there is headache and heart pain, pulsation in the neck, with the development of deficiency - shortness of breath.These symptoms are a consequence of the weakened contractility of the ventricle.
Important: treats aortic malformations using the same principles as the valves between the atria and ventricles - the separation of valve adhesions, prosthetics, enlargement of the hole is used.
The combined defects of proceed with the predominance of changes and complaints of the main type of defect, which complements the secondary signs of the disease.
Heart defects and pregnancy
In pregnant women with heart defects, births occur with complications.More often there are late toxicosis.In comparison with healthy women, the percentage of untimely discharge of water increases in patients with heart defects, the weakness of labor activity develops.In childbirth, there is often a lack of blood circulation( about half).Therefore, these patients need constant monitoring from the gynecologist and cardiologist.In severe cases, abortion is recommended.
Important : if a woman insists on childbirth, then it must be placed in a stationary environment with constant monitoring of the condition and holding maintenance courses of therapy.
Stepanenko Vladimir, surgeon