Aortic insufficiency: treatment, classification, causes
Aortic insufficiency refers to the acquired heart defects. The essence of the disease is reduced to the disruption of normal hemodynamics and associated pathological changes in the structure of a heart valve. The disease is quite treatable, surgery is prescribed only in extreme cases.
According to medical statistics this disease is the prevalence of second place after a mitral insufficiency. And as usual in such cases, the biggest problem is not itself a violation, and the changes that it causes.
The clinical picture of the disease
Normal functioning of the heart ensures uninterrupted functioning of the atrium and ventricle. An indispensable condition is passage of blood in one direction.
Oxygen-rich blood from the left atrium is pushed into the left ventricle. Valvular fold between these parts of the heart in this tightly closed. Upon compression of the ventricular folds open the semilunar valve and the blood ejected into the aorta and from there moves along the divergent arteries.
- Aortic valve insufficiency is expressed in the disruption of the folds of the valve: after compression of the stomach, when the blood moves into the aorta, folds do not close completely and part of the blood flows back. The next compression of the ventricle tries to push blood got back together with a new portion. However, some of the blood returns.
- In the end, the left ventricle is continuously working with additional load and constantly under pressure of the remaining blood. To compensate for the additional load, this site hipertrofiada, his muscles compacted, the ventricle increases in volume.
But this is only one side of the breach. As part of the blood is returned back into the systemic circulation from the very outset formed the lack of blood. Accordingly, the body receives less oxygen and nutrients if it is normal, sufficient work of breathing organs.
While reduced diastolic pressure, which serves to signal the heart of the transition to the intensive mode.
Since the main burden of compensation of low pressure lies to the left ventricle, for a long time the blood circulation is insignificant. The symptoms are practically non-existent.
Often people do not know about the disease, especially when aortic insufficiency occurs in a chronic form.
- However, when reverse flow of blood reaches a significant amount (more than 50%, hypertrophy, and exposed to all heart muscles. Heart expanding, the orifice between the left ventricle and atrium is stretched and formed mitral valve.
- At this stage, decompensation occurs. Violation of left ventricular type cause the development of asthma, can be triggered by pulmonary edema. Right ventricular decompensation in type occurs later and usually develops much faster.
If the compensation stage symptoms may not be manifested at all - in patients was not observed even shortness of breath when doing sport, then upon the occurrence of decompensation aortic insufficiency becomes very ominous signs.
On severe stages of the disease life expectancy depends on prompt intervention.
Chronic and acute forms
Aortic valve insufficiency can be chronic, but may take the acute form. Usually the disease is determined by the cause. Traumatic impact with a blunt instrument, of course, will cause an acute form, while lupus erythematosus, childhood, "will leave the chronic.
Symptoms may not be observed absolutely, especially with a good physical preparation of the patient. The heart compensates for some lack of blood, so the symptoms of the disease do not cause enough concern.
Aortic insufficiency in the chronic form has the following symptoms:
- frequent headaches, concentrated mainly in the frontal lobe, accompanied by noise and a feeling of pulsation;
- fatigue, fainting and loss of consciousness due to a sudden change of position;
- heart pain at rest;
- the pulsation of the arteries - "dance of the arteries", as a feeling of pulsation - the most typical symptoms of malformation. Ripple is noticeable by visual inspection and caused by the large pressure with which the left ventricle ejects blood into the aorta. But if aortic insufficiency is accompanied by other heart disease, this characteristic pattern can not be observed.
Shortness of breath unlike mitral regurgitation, for example, is manifested only at the stage of decompensation, when a violation of the exchange of blood in the lungs and symptoms of asthma.
Acute aortic valve insufficiency is characterized by pulmonary edema and hypotension. Operative treatment method in most cases carried out only by the pronounced symptoms and severe stages of the disease.
Classification of the disease
Consider two ways of classification: according to the length of the jet of regurgitation of blood, that is, the return ofaorta into the left ventricle, and the number of returned blood. The second classification used in the survey and conversations with patients, as more understandable.
- The first disease severity is characterized by the volume of blood regurgitating not more than 15%. If the disease is in the stage of compensation, the treatment is not assigned. The patient required continuous monitoring by a cardiologist and a regular ultrasound.
- Aortic insufficiency with the volume of returned blood from 15% to 30% is called 2 degrees of severity and, as a rule, symptoms not accompanied by. At the stage of payment treatment is not carried out.
- At 3 degrees the volume of blood that the aorta loses that reaches 50%. It is characterized by all of the above symptoms, eliminating physical activity and have significantly influenced the way of life. Treatment therapeutic. Regular monitoring is essential as this increase in volume regurgitation blood disrupts the hemodynamics.
- When 4 severity of aortic valve exceeds 50%, i.e., half of the blood returns to the ventricle. The disease is characterized by severe shortness of breath, tachycardia, pulmonary edema. Taken medication and surgical treatment.
For a long time the disease can be quite favorable. However, the formation of heart failure life expectancy is worse than in patients with lesions of the mitral valve - an average of 4 years.
Aortic insufficiency may be congenital: if instead of 3-leaf valve is formed by 1-, 2 - or 4-leaf.
However, more common causes of the disease are the following:
- rheumatism or rheumatoid arthritis, is the cause of the defect in the 60-80 cases. Since the beginning of the disease is transferred in adolescents, rheumatic fever, diagnose aortic insufficiency can be difficult;
- infectious myocarditis - an inflammatory lesion of the heart muscle;
- syphilitic aortic valve damage - there is a probability of transition of the process from the aortic valve, treatment is difficult;
- atherosclerosis can also go from the aorta, although less frequently;
- chest trauma;
- systemic connective tissue diseases, e.g. lupus erythematosus.
The treatment of the disease 3, 4 severity requires first to determine the real cause of the disease and, if not, surgical intervention, to proceed to its treatment, as the defect is in the nature of the secondary.
The main methods of diagnosis are the data of physical examination:
- describedsymptoms - tendency to fainting, feeling of pulsation, heart pain etc;
- characteristic pulsation of the arteries - the carotid, subclavian, and so on;
- very high systolic and very low diastolic pressure;
- high pulse, education pseudocyphellaria pulse;
- the weakening of the first tone - the apex of the heart, and pouring diastolic murmur after the second tone.
Diagnosis, aortic valve insufficiency, confirmed by instrumental methods:
- EKG - it reveals hypertrophy of the left ventricle;
- Echocardiography helps establish the absence or presence of flutter, mitral valve. This phenomenon is caused by impact of the jet with the regurgitation of the blood;
- x-ray examination allows to evaluate the shape of a heart and to detect the expansion of the ventricle;
- phonocardiography - provides an opportunity to assess diastolic murmur.
The treatment of the disease
When the disease 1 and 2 degrees of severity treatment is usually not carried out. Assigned only the monitoring and planned evaluation.
Treatment with 3 and 4 degrees of severity is determined by the form of the disease, symptoms and the primary cause. Drugs are appointed taking into account the primary treatment.
- Vasodilators - hydralazine, ACE inhibitor. Drugs to slow down the dysfunction of the left ventricle. This group of drugs is necessarily assigned with contraindications to surgery.
- Cardiac glycosides - isolani, strophanthin.
- Nitrates and beta blockers - prescribed for the extension of the aortic root.
- Antiplatelet agents included in the treatment if there are thromboembolic complications.
Surgery is indicated for very severe disease and usually consists of the implantation of the aortic valve.
The aortic valve is quite hard to prevent, because the primary impetus to its development are inflammatory processes. However, hardening and timely treatment of infectious diseases, especially associated with impaired hemodynamics, allows to get rid of most threats.