Aortic valve stenosis
If the hole is close to the aortic valve begins to narrow, this leads to violations of blood flow within the left ventricle. Pathology called stenosis of the aorta, and diagnosed the disease can not only adults but also neonates. If you have fatigue, fainting, dizziness and shortness of breath - it is worth considering. Perhaps it is time to seek the assistance of a cardiologist.
Classification of aortic stenosis
Pathology of the aortic valve belongs to the group of malformations of the cardiovascular system. It's creeping illness, the consequences of which can be manifested through the years. If to speak about the origin of the disease, the doctors isolated congenital stenosis of estuary of aorta and acquired variety of the disease.
Depending on the localization of the disease is:
- 's a supravalvular;
The treatment will directly depend on the types of stenosis. Cardiologists found that symptoms of the disease depend on the degree of its severity. Hemodynamic disturbances in the organism divided on the extent (or stage), which is determined by the level of destruction of the aortic valve.
These stages are five:
- Full payment. At this stage, stenosis of the mouth of the aorta, auscultation reveals, as the narrowing very slightly. No dynamic observation of the cardiologist, the patient can not do, but surgery is not yet needed.
- Hidden heart failure. The patient complains of shortness of breath, fatigue, dizziness. Symptoms of disease of the aortic valve are supported by the data of x-ray and EKG. Recommended surgical correction.
- Relative coronary insufficiency. Shortness of breath increases, there the fainting and angina. Surgical intervention is necessary.
- Expressed heart failure. Arise night asthma attacks, calm condition the patient complains of shortness of breath. Operations that affect the region of the aortic valve, is contraindicated. Potentially helps cardiac treatment, but the effect is small.
- End-stage. Pathology inexorably progresses, otechny syndrome and shortness of breath pronounced. Applying the medication, doctors achieve short-term improvement. Surgical correction is absolutely contraindicated.
Aortic stenosis in youngchildren
If the pathology seen in newborns, it is based on the hereditary factor. If heart valves were exposed to diseases from family members baby, this increases the likelihood of disease. The kids who recover from bacterial endocarditis or rheumatic fever are also at risk to stenosis of estuary of aorta.
We list other possible causes of pathology in neonates:
- defects of the aortic valve (hereditary);
- improper closing;
- infection (which we have already mentioned).
Symptoms in newborn infants are similar in adult patients.
At first, the child is asymptomatic, but then you discover the following symptoms:
- increased physical fatigue;
- fainting (occur when a strong tension);
- irregular heartbeat;
- tightness in the chest;
- shortness of breath;
- arrhythmia (rare);
- asymptomatic sudden death.
To diagnose the disease in newborns is quite difficult, but with time the symptoms will appear brighter. Older patients the doctor recommends to refrain from excessive stress, and avoid sports. Treatment consists of antibiotics (during surgery or visits to the dentist).
The main causes of disease
Acquired stenosis of the aorta occurs as a result of rheumatic aortic valves. Deformed flapper valve gradually begin to coalesce and harden, then they become rigid. The valve ring narrows.
Here are some other probable causes:
- calcification of the aortic valve;
- atherosclerosis of the aorta;
- infective endocarditis;
- systemic lupus erythematosus;
- Paget's disease;
- terminal renal failure;
- rheumatoid arthritis.
Narrowing of the aortic mouth can be hereditary (from birth). The aortic valve can be bicuspid - another malformation in babies. It often happens that signs of the disease are diagnosed before the age of 30.
The formation of stenosis is accelerated in several cases:
Symptoms - what to look out for?
The symptoms of stenosis appear, depending on the stage of the disease - about it we wrote above. The discomfort gradually increases -this is due to the persistent narrowing of the aorta. Neonates and adult patients can identify a number of common symptomatic manifestations:
- shortness of breath (initially occurs during exercise, then observed continuously);
- muscle weakness;
- the feeling of "loud" heartbeat;
- fainting (with coronary insufficiency);
- pulmonary edema and cardiac asthma (severe cases).
Sometimes a stenosis of the mouth of the aorta is complemented by numerous complications.
Here they are:
- infective endocarditis;
- gastrointestinal bleeding;
- myocardial infarction.
Pathology of the aortic valve and right ventricular sometimes. This is a very dangerous kind of ailment, as in 10% of cases sudden death occurs. Right ventricular stenosis is diagnosed mainly in the elderly.
How to diagnose pathology
The complex of diagnostic procedures aimed at identifying a diseased aortic valve, always begins with palpation. Doctors check peripheral pulse and blood pressure, identify the systolic jitter.
Apply other methods of diagnostics:
- Auscultation. It is evident that the weakening of the second tone. Auscultated systolic murmur (broken and rough), which in elderly patients may radiate to the upper heart region.
- ECG. Left ventricle hypertrophied, but this sign is not seen in 15% of cases. Observed wave changes, and sometimes intraventricular blockade. Daily monitoring of the aortic valve allows to detect silent myocardial ischemia and cardiac arrhythmia.
- X-ray examination. Shows changes in heart size and poststenotic aortic extension. If a defect develops for a long time (not applicable for newborn), x-ray diffraction shows the presence of calcifications.
- Echocardiography. Two-dimensional diagnostics of the aortic valve allows to detect the thickening and hardening his wings.
- Coronary angiography. Usually combined with aortography - special invasive procedure in which there is vascular penetration (arteries injected solution with the reagent).
In addition to these research tools are made common blood and urine tests, collected and analyzed the medical history (including family), a test aimed at the study of physical activity (cross-countrytrack, walking, stationary bike).
Based on the above studies, the doctor prescribes the treatment, corresponding to the current stage of the defect.
Methods for the treatment of aortic stenosis
Treatment of damaged aortic valve includes conservative and surgical methods. Patients with asymptomatic disease are under constant medical supervision. Every six months or a year, these patients undergo sessions Echocardiography, and before visiting the dentist, take antibiotics. Pregnant women with stenosis require control of hemodynamic variables. Abortion may be required only in the most severe cases.
Conservative treatment pays special attention to neutralize the effects of arrhythmia and normal blood flow.
Here is the complete list of phenomena with which it is necessary to understand:
- normalization of blood pressure;
- the elimination of the arrhythmias;
- slowing the development of heart failure;
- prevention of coronary artery disease.
Pulmonary circulation is subject to congestion, therefore start treatment with this region. The patient is prescribed diuretics (Furosemide is the most common), with ongoing collection of subjective, instrumental and clinical data. The detection of atrial fibrillation starts receiving cardiac glycosides (e.g. Digoxin). Prescribed by doctors and potassium.
To the hypertrophied myocardium relaxed, recommended-blockers. The second option is antagonists blockers calcium. Group of nitrates, on the contrary, is contraindicated, because the minute volume of blood and cardiac output decrease. The development of defect conservative treatment begins be combined with surgical correction, but more on this below.
Drug treatment is relatively effective only in the early stages of the disease. Surgical intervention is the main tool in the fight against disease. This treatment depends on contraindications and the degree obtained patients disorders. The most common plastic balloon and the prosthetic valve. Here are the three main indications for surgical intervention:
- Satisfactory function of the myocardium.
- Left ventricular hypertrophy (development dynamics observed on the electrocardiogram).
- Exceeding the norm of the gradient of the systolic blood pressure.
In artificial prosthetic valve is damaged (the changes are minor), the amount of surgical correction is minimized. Fold valve under splicing, artificially separated.
src="https://www.youtube.com/embed/rc6bM6t_AGQ" frameborder="0" allowfullscreen="">
In some cases the tricuspid valve is replaced - then the patient is connected to an artificial blood supply. The aorta is dissected, the diseased valve is removed, after which the patient is embedded implant.
The valve prosthesis is checked on several indicators.
Here they are:
- the appropriate size holes;
- absence of air bubbles.
After operating the correction a patient undergoes a long rehabilitation. There is a risk of infective endocarditis, therefore, doctors use a broad range of antibiotics. Thromboembolism is also a risk. This complication need to fight through the antiplatelet agents and anticoagulants (Heparin, Aspirin).
Congenital stenosis is not possible to correct - simply do not exist to preventive measures. With regard to acquired forms of this terrible disease, prevention needs to begin with identifying diseases that were a backdrop to a stenosis of the mouth of the aorta.
- infectious endocarditis.
Some heart disease are the result of tonsillitis. Do not allow deposits of plaque on the walls of its vascular - so you extend their life and get rid of numerous problems in old age.
The material on the topic: mitral stenosis.