Among the adult population, heart defects such as aortic stenosis or stenosis of the orifice of the aorta / aortic valve are common. There are many pathological conditions that can lead to this disease. In the absence of timely treatment, serious complications may develop, in particular, bacterial inflammation of the valve leaflets.
Aortic stenosis (CA) is a narrowing of the opening located on the sort of aorta due to the fusion of the valve leaflets. Such a violation is an obstacle to blood flow, as a result of which, against the background of a prolonged course of SA, pathological changes in the left ventricle develop, in severe cases, left ventricular failure.
The first description of aortic stenosis was presented in 1663 by the French physician Lazar Riviera.
Aortic stenosis occurs for several reasons, including congenital malformations, calcification of the valves, and acute rheumatic fever. For the diagnosis of narrowing of the aortic opening, instrumental research methods are important. Two-dimensional (2D) Doppler echocardiography is most commonly used today. For treatment, both medicinal and surgical effects are used.
Video: Aortic Stenosis - "Simple about the Difficult"
Description
The aortic valve (in Latin valva aortae) is located between the left ventricle (LV) and the mouth of the largest vessel, the aorta, which allows blood to flow in only one direction. The valve is based on three leaflets, but with congenital defects there may be two or even one leaflet. Normally, they open towards the aorta.
In CA, the valves are interconnected due to inflammatory or destructive processes. This leads to a narrowing of the lumen through which blood begins to pass from the left ventricle to the aorta under great pressure.
Severity of aortic stenosis:
- Light - tapering at least 20 mm.
- Moderate - constriction is in the range of 10-20 mm
- Pronounced - the opening in the aorta is less than 10 mm.
Severe aortic stenosis rarely occurs in infancy, with a 0.33% prevalence of the defect in live neonates, who have a predominantly unicuspid or bicuspid valve.
Pathogenesis of CA
When the aortic valve is affected and stenosis develops, there is resistance to systolic ejection. This obstruction of blood flow leads to an increase in systolic pressure in the left ventricle (LV). As a compensatory mechanism for the normalization of the condition, the thickness of the LV walls increases due to the parallel replication of sarcomeres, causing concentric hypertrophy. At this stage, the chamber does not expand and the ventricular function is preserved.
With prolonged development of SA, the LV end-diastolic pressure increases, which causes a corresponding increase in pressure in the small arteries of the lungs and a decrease in cardiac output due to diastolic dysfunction. The contractility of the heart muscle (a measure of systolic function) can also decrease, which further contributes to a decrease in cardiac output. Eventually, heart failure develops.
In many patients with aortic stenosis, LV systolic function is preserved, and cardiac output is not impaired for many years of life, although LV systolic pressure can be increased. Although cardiac output is normal at rest, it often increases inadequately during exercise, which can lead to symptoms during exercise.
Some statistics on aortic stenosis:
- Aortic sclerosis (calcification of the aortic valve without obstructing blood flow, considered a precursor of calcified degenerative aortic stenosis) increases the incidence of SA with age and is determined in 29% of people over 65 years of age and in 37% of people over 75 years of age.
- In the elderly population, the prevalence of aortic stenosis ranges from 2% to 9%.
- Degenerative calcified AS usually occurs in individuals over 75 years of age and is most common in men.
Causes
Aortic stenosis is congenital and acquired. In each case, the specific causes of the development of the disease are considered.
Congenital aortic valve stenosis
Congenital unilocular, bicuspid, tricuspid, or even quadricuspid valves often contribute to the development of SA. In newborns and children under 1 year of age, a one-leaf valve can cause severe narrowing. It is the most common anomaly in neonates with fatal aortic valvular stenosis. In patients under 15 years of age, single leaf valves are most common in symptomatic SA.
In adults with symptoms of congenital AS, the problem is usually the bicuspid valve. Such violations do not cause significant narrowing of the aortic opening in childhood. The altered design of the bicuspid aortic valve provokes turbulent flow with continuous trauma to the leaflets. Ultimately, this leads to their fibrosis, increased stiffness and calcification, and this is a direct path to narrowing of the aortic opening in adulthood.
The Tzemos study, which included 642 adults with bicuspid aortic valves, showed that a survival rate of no lower than that of the general population was determined over an average follow-up of 9 years. However, young people with bicuspid aortic valve were at high risk for surgery due to aortic valve reconstruction.
Congenital malformations of a tricuspid aortic valve with irregular leaflets (“functionally bicuspid” valves) can also cause turbulent flow leading to fibrosis and ultimately calcification and stenosis.
Clinical manifestations of congenital aortic stenosis in adults usually appear after the fourth decade of life.
Acquired aortic stenosis
The main causes of acquired aortic stenosis are:
- Degenerative calcification
- Less commonly, rheumatic heart disease.
Degenerative calcification of aortic stenosis (also called senile calcified aortic stenosis) is a progressive calcification of the valve leaflets resulting in limited opening during systole.
Risk factors for degenerative calcified aortic stenosis include:
- advanced age;
- hypertension;
- hypercholesterolemia;
- diabetes;
- smoking.
In rheumatic aortic stenosis, the main process is progressive fibrosis of the valve leaflets with varying degrees of fusion, often with retraction of the leaflet edges and, in some cases, calcification. As a result, the rheumatic valve stops flowing normally to the orifice of the aorta.
Other rare causes of aortic stenosis:
- obstructive vegetation;
- homozygous type II hypercholesterolemia;
- Paget's disease;
- Fabry disease;
- ochronosis;
- irradiation.
It is worth noting that although a differentiation is often made between tricuspid and bicuspid aortic stenosis, it is often difficult to quantify the number of aortic valve cusps. In addition, surgical and postmortem examinations have confirmed frequent inconsistencies with earlier assumptions.
Clinic
Symptoms of aortic stenosis usually develop gradually after an asymptomatic latency period, often lasting 10–20 years.
The classic triad of symptoms in patients with aortic stenosis is as follows:
- Chest pain: These are like angina pain and are usually worse with exertion and better with rest.
- Heart failure: Symptoms of HF include paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and in severe cases, at rest.
- Fainting: Often on exertion, when systemic vasodilation in the presence of a fixed direct stroke volume results in a decrease in systolic blood pressure
Systolic hypertension can be combined with aortic stenosis. However, the systolic blood pressure is above 200 mm Hg. Art. rare in patients with critical SA.
During a physiological examination, the following signs of aortic stenosis are determined:
- Pulsus alternans: May occur when left ventricular systolic dysfunction is present
- Hyperdynamic left ventricle: suggests concurrent aortic regurgitation or mitral regurgitation
- Systolic murmur: in the classic course of aortic stenosis, begins shortly after the first heart sound; the intensity increases towards the medium size, and ends just before the second heart sound
Diagnostics
To assess the general condition of the patient, the following are determined:
- Serum electrolytes
- Cardiac biomarkers
- General blood analysis
- B-type natriuretic peptide
From instrumental diagnostic methods are used:
- Electrocardiography: A standard ECG may show progression of aortic stenosis
- Chest X-ray: the images show changes in the size of the heart
- Echocardiography: 2D and Doppler
- Cardiac catheterization: may be used if clinical findings do not match echocardiogram findings
- Angiography: an invasive technique by which the vessels are contrasted
- Radionuclide ventriculography: may provide information about LV function
- Stress testing: contraindicated in symptomatic patients with severe aortic stenosis
Treatment
The only definitive treatment for aortic stenosis in adults is aortic valve replacement (either surgically or percutaneously). Infants, children, and adolescents with bicuspid valves may have balloon or surgical valvotomy.
Ambulance
A patient suffering from decompensated heart failure should be taken to the hospital as soon as possible, where he can be monitored for pulmonary and cardiac activity. Also, the medical staff will make an intravenous access, through which loop diuretics, nitrates, morphine will be injected, if necessary and tolerated.
Patients with severe heart failure due to aortic stenosis who are resistant to medical treatment are usually referred for emergency surgery.
Pharmacological therapy
Drugs used in the treatment of patients with aortic stenosis include the following:
- Digitalits, diuretics, and angiotensin-converting enzyme inhibitors(ACE) - used with caution in patients with pulmonary obstruction.
- Vasodilators- can be used for heart failure and hypertension, but they can be used with extreme caution and only as directed by a doctor
Digoxin, diuretics, ACE inhibitors, or angiotensin receptor blockers - recommended by the European Society of Cardiology (ESC) / European Association for Cardiothoracic Surgery (EACTS) for patients with symptomatic heart failure who cannot undergo surgery or transcatheter aortic implantation
Aortic valve replacement
- Severe symptoms due to severe aortic stenosis are identified
- There is asymptomatic, severe aortic stenosis due to coronary artery bypass graft surgery
- There is an asymptomatic, severe form of aortic stenosis, while the patient has previously undergone surgery on the aorta or other heart valves
- Against the background of asymptomatic, severe aortic stenosis, LV systolic dysfunction (ejection fraction<0,50)
Percutaneous balloon valvuloplasty
This minimally invasive method is used as a palliative measure for critically ill adults who cannot undergo standard surgery. In other cases, it is used to temporarily improve the condition of a patient preparing for aortic valve replacement.
Forecast
Asymptomatic patients, even those with critical aortic stenosis, have an excellent prognosis with a mortality rate of less than 1% per year, with only 4% of sudden cardiac deaths in severe aortic stenosis associated with asymptomatic disease.
Among symptomatic patients with moderate to severe aortic stenosis, mortality from symptom onset is approximately 25% during the first year and 50% after two years. More than 50% of deaths are sudden.
Patients with untreated aortic valve stenosis have a poor prognosis when symptoms appear.
Although SA tends to develop more rapidly with degenerative aortic valve calcification than with congenital or rheumatic disease, it is impossible to accurately predict the rate of progression in individual patients.
Catheterization and echocardiographic studies show that, on average, the area of the valves decreases by 0.1-0.3 sq. cm per year; while the systolic pressure gradient across the valve can increase by 10-15 mm Hg. Art. in year.
A more rapid progression of CA is observed in elderly patients with coronary artery disease and chronic renal failure.
Video: Life is great! Aortic stenosis
Narrowing of the aortic opening near the valve entails disruption of normal blood flow in the region of the left ventricle of the heart. This disease is called aortic valve stenosis, or simply aortic stenosis, and is referred to as diseases of the cardiovascular system. Such a heart defect is congenital and acquired - up to 30 years old, it is considered congenital, and after - acquired, or rheumatic. Aortic stenosis is considered one of the most common cardiac pathologies, and occurs in almost 80% of patients (mainly in men).
Aortic valve stenosis is a condition in which the lumen of the valve and stenosis of the aortic orifice narrows, resulting in impaired blood flow from the left ventricle to the systemic circulation.
This heart disease belongs to the sluggish, its consequences can be felt many years after the onset.
Symptoms
Cardiac stenosis of the aorta is supravalvular, subvalvular and valvular, depending on its location.
Symptoms of aortic stenosis differ at different stages of the disease, of which there are only five:
- Full compensation. This stage is characterized by very slight deformation of the vessel, and, as a rule, does not require any surgical correction. However, already at this stage of the disease, you should definitely contact a cardiologist for observation.
- Latent heart failure... It is highly desirable to correct this degree of the disease with the help of surgical intervention. Symptoms of the second stage of stenosis can already be seen on the electrocardiogram and during radiography. The patient begins to suffer from shortness of breath, dizziness and fatigue.
- Relative coronary insufficiency. In the third stage of aortic stenosis, the intervention of a surgeon becomes necessary. The patient faints, angina pectoris begins, and shortness of breath greatly increases.
- Severe heart failure... Shortness of breath occurs even when the patient is at rest. Asthmatic attacks begin at night. Arterial valve surgery is no longer effective and is simply contraindicated. In some cases, cardiac surgery can help.
- Terminal stage. The final stage of the development of the disease. Pathology progresses, treatment with medications does not give any significant results. Shortness of breath is pronounced, edematous syndrome is added to it. Surgical intervention is impossible.
It is easy to conclude that, having noticed dizziness, shortness of breath (up to attacks of suffocation), excessive fatigue and a tendency to fainting, you need to immediately visit a doctor - identifying the disease at an early stage will allow for timely medical or surgical correction.
Unfortunately, aortic stenosis can manifest itself at absolutely any age, and often its symptoms can be seen in young children or even newborns. In the latter case, we are most often talking about heredity.
Although other reasons are possible that give an impetus to the development of a heart defect:
- Bacterial endocarditis or rheumatic fever - children who have had these diseases often develop aortic stenosis.
- Incorrect closure of the heart valve, its congenital abnormalities.
- Some infectious diseases.
- At first, you may not notice any manifestations of stenosis in a child, but as the disease progresses, the following symptoms are found:
- The heartbeat becomes irregular, in some cases arrhythmia begins.
- The child gets tired very quickly, with strong emotional or physical stress, he faints.
- A feeling of tightness begins in the chest, pains appear.
Increased fatigue in a child is one of the causes of aortic stenosis In order to fully answer the question of whether it is scary when aortic stenosis develops in children, it should be noted that in certain cases aortic stenosis in a child ends in sudden asymptomatic death.
In newborn babies, it is quite difficult to diagnose the disease, however, the symptoms of aortic valve stenosis appear more pronounced as they grow older. Doctors recommend that children suffering from this ailment avoid emotional stress and physical overwork. Aortic stenosis is usually treated with antibiotics.
Causes
The main reason for the development of the disease is rheumatism of the aortic valves. As a result of rheumatism, the valve flaps are deformed, become denser and gradually spliced, which entails a reduction in the valve ring.
Also, aortic stenosis can develop for reasons such as renal dysfunction, lupus and aortic valve calcification. The development of the disease is significantly accelerated by factors such as smoking, frequent high blood pressure and hypercholesterolemia.
Early treatment of aortic stenosis includes constant medical supervision and regular check-ups. To begin with, stenosis of the aortic valve is diagnosed by carrying out all the necessary tests and laboratory tests, then appropriate therapy is prescribed.
Medications for aortic stenosis are diuretics (most often Furosemide), cardiac glycosides, and potassium-containing drugs. In more advanced cases, surgical correction is used: balloon plastic and prosthetics.
Prophylaxis
Of course, in cases where aortic stenosis is a congenital pathology, it is inappropriate to talk about prevention. But the development of the acquired form is quite possible to prevent, preventing and timely curing the diseases that cause it. It is worth knowing that even a common sore throat, not properly cured, can give serious complications to the heart.
You need to carefully monitor the state of your blood vessels, preventing cholesterol deposits on their walls - in this way you can significantly extend your life and avoid many health problems, both in adulthood and in extreme old age.
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Aortic stenosis is a pathological condition in which a narrowing of the opening occurs in the valve of the same name. For this reason, there is a violation of the outflow of blood from the left ventricle. It belongs to the category of heart defects.
Features of pathogenesis
From the left ventricle, blood through the aorta penetrates to the main organ systems. This is a large circle of blood circulation. Its weak link is the aortic valve at the mouth of the vessel. It has 3 valves and opens, allowing a portion of biological fluid into the vascular system. With each contraction, the ventricle pushes it out. By closing, the valve is an obstacle to the reverse flow of blood. In this place, pathological changes occur.
In the case of stenosis, the soft tissues of the leaflets and the aorta undergo various changes. These can be scars or adhesions, calcium salt deposits, atherosclerotic plaques or adhesions. As a result, the following violations are observed:
- the lumen of the vessel begins to gradually narrow;
- valve walls lose elasticity;
- the opening and closing of the flaps is not fully carried out;
- the blood pressure in the ventricle increases.
Against the background of the ongoing changes, there is a lack of blood supply to the main organ systems.
Causes
Aortic stenosis has a congenital or acquired etiology. In the first case, the occurrence of an anomaly is due to a genetic predisposition or pathological abnormalities in the process of fetal development. Normally, the valve has 3 leaves. In congenital stenosis, this element consists of 2 or 1 valve.
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However, most often the narrowing of the aorta refers to acquired defects. The reasons may include the following health problems:
- rheumatoid arthritis;
- Paget's disease;
- diabetes;
- calcification / atherosclerosis of the aorta;
- lupus erythematosus;
- advanced renal failure;
- endocarditis of an infectious nature.
Doctors identify a number of factors, in the presence of which the risk of pathology increases. These include smoking and hypertension.
Classification
Depending on the location of the aortic stenosis is:
- subvalve;
- overvalve;
- valve.
To assess the severity of aortic stenosis, classification implies pressure gradient results. This is the difference in blood pressure before and after the aortic valve. In a healthy person, this indicator is minimal. The tighter the constriction, the higher the pressure. For example, in grade I stenosis, the gradient is from 10 to 35 mm Hg. Art. Grade IV is considered critical. In this case, the pressure gradient is more than 80 mm Hg. Art.
In addition, there are several stages in the development of the pathological process. Each of them has a characteristic clinical picture that helps to establish an accurate diagnosis:
- Compensation stage. This period is not accompanied by severe symptoms. The heart fully copes with the assigned load. The defect is detected only with auscultation of the muscle.
- Subcompensation stage. Initial symptoms of malaise appear (fatigue, shortness of breath), which intensify after physical exertion. Determined by means of an ECG.
- Decompensation stage. It is characterized by overt heart failure. The symptoms of angina pectoris remain even in a calm state.
- Terminal stage. Death occurs due to irreversible pathological disorders.
Symptoms
In aortic stenosis, symptoms do not make themselves felt for several decades. In the initial stages, when the lumen of the vessel closes by 50% or more, it manifests itself as weakness after exertion.
As the disease progresses, shortness of breath persists after moderate exertion. It is almost always accompanied by general fatigue and dizziness. When the vessel lumen closes 75% or more, the patient develops the main signs of heart failure.
Also, pathology is manifested by the following symptoms:
- pallor of the skin;
- loss of consciousness;
- pressing pain in the sternum;
- swelling of the ankles;
- violation of the heart rhythm.
Stenosis can cause sudden death with no visible external manifestations.
The course of the disease in children
In newborns and preschool children, the disease is often asymptomatic. As they grow, the clinical picture becomes more pronounced due to the increase in the size of the heart. However, the narrow lumen in the aortic valve remains unchanged.
It is possible to diagnose pathology in the fetus already at the 6th month of pregnancy by means of echocardiography. In rare cases, stenosis appears immediately after the baby is born. In 30% of cases, the condition suddenly worsens by 5-6 months. Among the main symptoms of a disorder in newborns, doctors distinguish the following:
- frequent regurgitation;
- weight loss;
- rapid breathing;
- the skin has a bluish tint;
- lack of appetite.
If the aortic opening near the valve begins to narrow, it leads to impaired blood flow within the left ventricle. The pathology is called aortic stenosis, and the disease can be diagnosed not only in adults, but also in newborns. If you experience increased fatigue, fainting, dizziness and attacks of suffocation, it is worth considering. It may be time to seek help from a cardiologist.
Classification of aortic stenosis
Pathology of the aortic valve belongs to the group of defects of the cardiovascular system. This is a sluggish ailment, the consequences of the development of which can manifest themselves in years. If we talk about the origin of the disease, then doctors distinguish congenital stenosis of the aortic orifice and an acquired variety of this pathology.
Depending on the localization, the disease is:
- supravalvular;
- subvalve;
- valve.
Treatment will directly depend on. Cardiologists have found that the symptoms of the disease depend on the severity of the disease. Hemodynamic disorders in the body are conventionally divided into degrees (or stages), according to which the level of damage to the aortic valve is determined.
There are five of these stages:
- Full compensation... At this stage, aortic stenosis is detected by auscultation, since the narrowing of the vessel is extremely insignificant. The patient cannot do without dynamic observation by a cardiologist, but surgery is not yet required.
- Latent heart failure... The patient complains of shortness of breath, fatigue, dizziness. Symptoms of aortic valve disease are confirmed by X-ray and ECG findings. Surgical correction is recommended.
- Relative coronary insufficiency... Shortness of breath increases, fainting and angina pectoris occur. Surgical intervention is required.
- Severe heart failure... There are nocturnal asthmatic attacks, with a calm state, the patient complains of shortness of breath. Operations affecting the area of the aortic valve are contraindicated. Cardiac surgery potentially helps, but the effect is small.
- Terminal stage... Pathology is inexorably progressing, edema syndrome and shortness of breath are pronounced. By applying medication, doctors achieve short-term improvement in the situation. Surgical correction is categorically contraindicated.
Aortic stenosis in young children
If the pathology manifests itself in newborns, it is based on a hereditary factor. If the heart valves have been susceptible to diseases in family members of the baby, this significantly increases the likelihood of illness. Babies who have had bacterial endocarditis or rheumatic fever are also at risk of aortic stenosis.
We list other possible causes of the manifestation of pathology in newborns:
- aortic valve defects (hereditary);
- improper closing;
- infections (we have already mentioned them).
Symptoms in newborn babies are similar to those in adult patients.
At first, the child is asymptomatic, but then you will find the following manifestations:
- increased physical fatigue;
- fainting (occurs with strong exertion);
- irregular heartbeat;
- tightness in the chest;
- pressure;
- compression;
- pain;
- dizziness;
- arrhythmia (rare);
- asymptomatic sudden death.
It is quite difficult to diagnose an ailment in newborns, but over time, the signs of the disease appear brighter. For older patients, the doctor recommends refraining from excessive exertion and avoiding sports. Treatment consists of taking antibiotics (during surgery or visits to the dentist).
The main causes of the disease
Acquired aortic stenosis results from rheumatic lesions of the aortic cusps. Deformed valve flaps begin to grow together and thicken gradually, then they become rigid. The valve ring is narrowed.
Here are a number of other likely causes:
- calcification of the aortic valve;
- infective endocarditis;
- systemic lupus erythematosus;
- Paget's disease;
- renal terminal failure;
- rheumatoid arthritis.
Narrowing of the aortic orifice can be hereditary (in newborns). The aortic valve can be bicuspid - another developmental anomaly in babies. Often, signs of the disease are diagnosed before the age of 30.
The formation of stenosis is accelerated in several cases:
- hypercholesterolemia;
- smoking;
- arterial hypertension.
Symptoms - what to watch out for?
The symptoms of stenosis appear depending on the stage of the disease - we wrote about this above. The discomfort gradually increases - this is due to the constant narrowing of the aorta. In newborns and adult patients, a number of common symptomatic manifestations can be distinguished:
- shortness of breath (at first occurs during physical exertion, then it is observed constantly);
- muscle weakness;
- fast fatiguability;
- feeling of a "loud" heartbeat;
- fainting (with coronary insufficiency);
- attacks of angina pectoris;
- dizziness;
- pulmonary edema and (severe cases).
Sometimes aortic stenosis is complemented by numerous complications.
Here they are:
- ischemia;
- infective endocarditis;
- AV blockade;
- arrhythmias;
- gastrointestinal bleeding;
- myocardial infarction.
Pathology of the aortic valve is also right ventricular. This is a very dangerous type of ailment, since sudden death occurs in 10% of cases. Right ventricular stenosis is diagnosed mainly in the elderly.
How pathology is diagnosed
The complex of diagnostic measures aimed at identifying the affected aortic valve always begins with palpation. Doctors check peripheral pulse and pressure, and detect systolic tremors.
Other diagnostic methods are also used:
- ... A weakening of the second tone is clearly seen here. A systolic murmur (scratching and rough) is heard, which in elderly patients can radiate to the upper cardiac regions.
- ECG. The left ventricle is hypertrophied, but this sign is not traced in 15% of cases. Changes in the tooth are observed, and sometimes intraventricular blockade. 24-hour monitoring of the aortic valve reveals painless myocardial ischemia and cardiac arrhythmias.
- X-ray examination. Changes in the size of the heart and post-stenotic aortic enlargement are visible. If the defect develops for a long time (this does not apply to newborns), the X-ray shows the presence of calcifications.
- Echocardiography. A two-dimensional diagnostic mode of the aortic valve reveals compaction and thickening of its cusps.
- Coronary angiography. It is usually combined with aortography, a special invasive procedure in which vascular penetration occurs (a solution with a reagent is injected into the artery).
In addition to the instrumental studies listed, general blood and urine tests are done, anamnesis (including family history) is collected and analyzed, and a test aimed at studying physical activity (treadmill, walking, exercise bike) is carried out.
On the basis of the above studies, the doctor prescribes treatment that corresponds to the current stage of the defect.
Treatment options for aortic stenosis
Treatment of a damaged aortic valve includes conservative and surgical methods. At the same time, patients with an asymptomatic course of the disease are under vigilant medical supervision. Every six months or a year, these patients undergo EchoCG sessions, and take antibiotics before visiting the dentist. Pregnant women with stenosis need to be monitored for hemodynamic parameters. Termination of pregnancy may be required only in the most advanced cases.
Conservative treatment pays special attention to neutralizing the effects of arrhythmia and normal blood flow.
Here is a complete list of the phenomena that need to be dealt with:
- normalization of blood pressure;
- elimination of arrhythmias;
- slowing down the development of heart failure;
- prevention of ischemic heart disease.
The pulmonary circulation is prone to stagnation, so treatment is started from this area. The patient is prescribed diuretics (the most common is Furosemide), while the collection of subjective, instrumental and clinical data continues. If detected, the intake of cardiac glycosides (for example, Digoxin) begins. Prescribed by doctors and potassium preparations.
In order for the hypertrophied myocardium to relax a little, B-blockers are recommended. The second option is calcium blocker antagonists. The nitrate groups, on the contrary, are contraindicated, since the minute blood volume and cardiac output are reduced. As the defect develops, conservative treatment begins to be combined with surgical correction, but more on that below.
Surgical intervention
Drug treatment is relatively effective only in the early stages of pathology. Surgical intervention is the main means of combating the disease. Such treatment directly depends on contraindications and the degree of disorders received by the patient. The most common are balloon plastic and valve prosthetics. There are three main indications for surgery:
- Satisfactory myocardial function.
- Left ventricular hypertrophy (developmental dynamics can be seen on the cardiogram).
- Exceeding the normal gradient of systolic pressure.
With artificial prosthetics of a damaged valve (changes are insignificant), the amount of surgical correction is minimized. The valve flaps, which are in the splice stage, are artificially separated.
In some cases, the tricuspid valve is replaced - then the patient is connected to an artificial blood supply. The aorta is dissected, the affected valve is removed, after which the implant is inserted into the patient's body.
The prosthetic valve is tested for several parameters.
Here they are:
- functionality;
- integrity;
- compliance with the size of the hole;
- no air bubbles.
After the surgical correction, the patient undergoes a long course of rehabilitation. There is a danger of infective endocarditis, so doctors use a wide range of antibiotics. Thromboembolism is also dangerous. This complication must be fought with antiplatelet agents and anticoagulants (Heparin, Aspirin).
Prophylaxis
Congenital stenosis cannot be corrected - there simply are no preventive measures. As for the acquired form of this terrible pathology, prevention should begin with the identification of diseases that served as a background for stenosis of the aortic opening.
It is necessary to warn:
- atherosclerosis;
- rheumatism;
- infective endocarditis.
Some heart diseases are the result of a sore throat. Prevent the deposition of cholesterol plaques on the walls of your blood vessels - this way you will prolong your life and get rid of numerous problems in old age.
For a long time they may be absent altogether. Among the main symptoms of the disease are:
- shortness of breath. In the initial stages of the disease, it appears only after physical exertion and completely disappears at rest. With the progression of the disease, shortness of breath can appear at rest and intensify with excitement, sometimes occurring at night;
- pain in the region of the heart (sometimes they are without a clear localization (location)). Pain in the heart, like shortness of breath, often appears against the background of physical exertion, with excitement, stress. The pain can be stabbing, pressing in nature and last more than 5 minutes. Often the pain is of a stenocarditis nature (acute, compressive pain spreading to the left arm, shoulder, under the scapula) and appears even when the defect is compensated (the absence of pronounced clinical manifestations of the disease);
- fainting. They are often observed during physical exertion, rarely at rest;
- feeling of rapid heartbeat;
- dizziness, weakness, fatigue, decreased performance;
- attacks of suffocation, aggravated by lying down.
Forms
There are several forms of aortic stenosis.
- By localization (location) of the constriction
:
- valvular stenosis(narrowing in the valve area);
- supravalve(narrowing is observed above the valve);
- undervalve(narrowing is observed below the valve).
- By origin
:
- Congenital heart defect(occurs when there is a violation of the development of the valve apparatus of the heart in the fetus);
- acquired heart disease(stenosis of the aortic orifice is formed after suffering diseases of the heart and blood vessels).
- By the degree of compensation of blood circulation
(that is, by how the heart handles the load):
- compensated defect(stenosis of the aortic orifice does not lead to severe disruption of the heart);
- decompensated defect(there is a violation of the heart and a pronounced clinical picture of the disease: constant shortness of breath, fainting, pain in the heart, etc.).
- By the degree of narrowing of the aortic opening:
- moderate stenosis- a slight narrowing of the mouth of the aorta;
- severe stenosis- significant narrowing of the mouth of the aorta;
- critical stenosis - very strong narrowing of the aortic opening.
Causes
Congenital heart disease occurs when the development of the valve apparatus of the heart in the fetus is impaired.
The reasons for the acquired defect:
- chronic rheumatic heart disease (heart disease that occurs after suffering acute rheumatic fever (a disease that occurs more often after suffering a sore throat or other infection caused by group A hemolytic streptococcus));
- atherosclerosis of the aorta and aortic valve (arterial disease associated with impaired lipid (fat) metabolism and the deposition of cholesterol (a substance that can be deposited in the walls of blood vessels and lead to atherosclerosis) in the walls of blood vessels and valve leaflets);
- calcification (calcification) of the aorta and aortic valve (against the background of atherosclerosis or chronic rheumatic heart disease).
Diagnostics
- Analysis of the anamnesis of the disease and complaints (when shortness of breath, heart pain, dizziness appeared (from birth or after a previous illness), with which the patient associates the onset of symptoms, etc.).
- Analysis of life history (whether there were heart diseases, what chronic diseases the patient has).
- Family history (does any of the close relatives have cardiovascular diseases, have there been any cases of sudden death in the family).
- Examination: pallor of the skin is noted, sometimes with the development of acrocyanosis (bluish coloration of the limbs, associated with impaired circulation in small vessels (capillaries)). In addition, the boundaries of the heart, heart murmurs, and the presence of wheezing in the lungs must be determined.
- A general blood test is performed to determine the content of hemoglobin (a protein involved in the transfer of oxygen), erythrocytes (red blood cells), platelets (blood cells that are involved in blood coagulation), leukocytes (white blood cells), etc.
- General urine analysis.
- Electrocardiography (ECG) is a method of determining the electrical activity of the heart, which allows you to assess the work of the heart.
- Echocardiographic study (EchoCG) is a method of ultrasound examination of the heart, which makes it possible to assess the degree of narrowing of the aortic orifice, the performance of the heart.
- Radiography of the heart - allows you to assess the size and configuration (structure) of the heart, to identify changes in the lungs that appear with a complication of the disease.
- Coronary angiography with aortography (an invasive procedure involving penetration through the vessels of the arms or legs, which allows examining the vessels of the heart and the aorta).
- Exercise test (exercise tests) - the reaction of the cardiovascular system to physical activity is assessed:
- 6-minute walk test;
- bicycle ergomeria (exercise bike);
- tradmill test (on a treadmill).
- Consultation is also possible.
Treatment of aortic stenosis
- With moderately severe stenosis and no complaints, treatment is not carried out, the observation tactics are chosen.
- Close medical supervision every 3-6 months, performing an echocardiographic study (EchoCG) every 6-12 months.
- Prevention of endocarditis (inflammation of the inner lining of the heart (endocardium)) before dental treatment or other invasive procedures (prophylactic antibiotics).
- aortic valve replacement (replacement of the affected aortic valve);
- aortic valve repair (reconstruction of the affected aortic valve).
Complications and consequences
- Sudden death.
- Heart failure (a complex of disorders associated with impaired contractile (contraction of the heart) heart function).
- Infective endocarditis (infectious inflammation of the heart valves).
- Frequent fainting.
- Violation of the rhythm of the heart.
- Lung edema.
Prevention of aortic stenosis
- There is no prophylaxis for congenital aortic stenosis.
- Prevention of acquired stenosis consists in the timely treatment of diseases on the background of which aortic stenosis has developed (acute rheumatic fever and chronic rheumatic heart disease (diseases that occur after a previous tonsillitis), aortic atherosclerosis (vascular disease associated with the deposition of lipids (fats) in their wall), as a result of which the vessels lose their elasticity)).
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