Symptoms of heart disease
Mar 05, 2018
Heart disease - is a pathological structural change in the structure of the heart or large vessels, characterized by the damage or defect of one of the four heart valves: the left atrial-ventricular( mitral) valve, the aortic valve, the right atrioventricular( tricuspid) valve or pulmonary valve. The left and right atrioventricular valves control the flow of blood between the atria and ventricles( upper and lower chambers of the heart).The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve controls the flow of blood between the heart and the aorta and the blood vessels of the rest of the body. The mitral valve and the aortic valve are most often prone to defects.
The normal functioning of the valves ensures that blood flows with the right strength in the right direction and in a timely manner. With heart valve disease, the valves become too narrow and either do not open completely or do not close. The tapered valves cause the blood to stagnate in the adjacent chamber of the heart, while a leaky valve allows the blood to leak back into the chamber from which it was just pumped out. To compensate for the poor performance of the heart, the heart muscle increases and becomes thicker, losing its elasticity and becoming less effective. In addition, in some cases, when blood accumulating in the heart chambers tends to form clots, the risk of stroke or embolism of the pulmonary artery increases.
The degree of heart defect varies. In moderate cases, there may be no symptoms, while in severe development of the disease, heart disease can lead to congestive heart failure and other complications. Treatment depends on the severity of the disease.
• Symptoms of congestive heart failure: dyspnea and wheezing after limited physical exertion;swelling of the legs, hands, or abdomen.
• Palpitation;chest pain( may be mild).
• Dizziness or weakness( with aortic stenosis).
• Fever( with bacterial endocarditis).
• Rheumatism can cause heart disease. Bacterial endocarditis, infections of the heart muscle and heart valves are the cause of heart disease.
• High blood pressure and atherosclerosis can damage the aortic valve.
• A heart attack can damage the muscles that control the valves of the heart.
• Congenital heart valve anomaly may occur.
• Heart valve tissue may degenerate with age.
• Other diseases, such as cancers, rheumatoid arthritis, systemic lupus erythematosus or syphilis, can damage one or more heart valves( see sections on these diseases for more information).
• Metisergig, a medication that is commonly used for migraines, and some weight loss medications can contribute to heart disease.
• Radiation therapy( which is commonly used to treat cancer) can be associated with heart disease.
• Case history and physical examination. The doctor distinguishes between hearing a variety of sounds in the heart, known as the sound of the heart, which speak of heart disease.
• An electrocardiogram is necessary to measure the electrical activity of the heart, the regularity of the heartbeat, the thickening of the heart muscle and the damage to the heart muscle as a result of coronary heart disease.
• Examination after exercise( measurement of blood pressure, heart rate, changes in cardiogram and respiration rate when the patient is on the simulator).
• Chest X-ray.
• Echocardiogram( using ultrasonic waves to see the valve in motion during heartbeat).
• Insertion of a catheter into the heart chambers to measure pressure abnormalities in the valves( to detect their constriction) or to detect the reverse flow of the injected dye on the X-ray( to reveal an incompletely closing valve).
• Do not smoke;lead a healthy lifestyle. Avoid excessive consumption of alcohol, salt and diet pills, as all this can cause an increase in blood pressure.
• In the case of mild symptoms or lack of symptoms, the physician may take a wait-and-see attitude.
• People with heart disease before surgery or dental treatment are prescribed a course of antibiotics to prevent bacterial endocarditis.
• Prolonged antibiotic treatment is recommended to prevent the recurrence of streptococcal infection in those who have had rheumatism.
• Drugs against the formation of blood clots such as aspirin or ticlopidine can be prescribed to patients with heart disease who suffered an unexplained transitory disorder of cerebral circulation.
• More powerful anticoagulants such as warfarin can be prescribed to patients with atrial fibrillation( a common complication of heart disease) or to those who continue to experience transient impairment of cerebral circulation, despite treatment. Long-term use of anticoagulants may be necessary after the operation to replace the valve, because artificial valves are associated with a higher risk of blood clots.
• In order to expand the narrowed valve, an air canister can be used that is inserted into the bottle with a catheter and then inflated.
• An operation to repair or replace a damaged valve may be necessary. New valves can be artificial( artificial limbs) or made of animal tissue( bioprosthesis).The type of valve depends on the age of the patient, the condition and the type of damage to the valve.
Heart defects congenital is a violation of the development of the heart and large vessels, leading to a change in blood flow, overload and myocardial insufficiency of the heart chambers. Congenital heart defects are various heart and vessel defects that result from a fetal developmental fetal disorder. Typical for many congenital malformations, signs of general underdevelopment and sharp blueness of the skin. With pronounced cyanosis, the tetralogy of Fallot, the Eisenmenger complex, the transposition of large vessels proceed.
The causes of congenital heart disease in many ways remain unknown. It was noted that various viral diseases( rubella, measles) transferred by the mother in the first 3 months of pregnancy can be of adverse importance, and medications that can have a pathological effect, etc., can often be combined with other congenital defects of the organism, such as pathology of the gastro-intestinal tract, lungs, limb development defects. Factors of heredity can play a definite( but far from decisive) role. As a rule, the diagnosis of the defect is carried out in the child immediately after birth, but there are also possible options when the manifestations of the defect are revealed with the growth of the organism, i.e. when the heart is unable to provide adequate blood flow to the growing organism.
Congenital heart defects often occur as a result of improper removal of large vessels of the heart or the presence of defects in the heart partitions. In such cases, during the contraction of the ventricles, part of the blood from the left ventricle, which contains arterial, oxygen-rich blood, rushes to the right heart. There, it mixes with venous, oxygen-poor blood and returns from there to the lungs. Another option is possible;when part of the venous blood from the right heart, bypassing the lungs, enters the left ventricle, and then into the aorta and the tissues of the body. Poor oxygenated blood is not able to provide food to organs and tissues.
Among the most common congenital heart defects are the open arterial duct, the defect of the interventricular septum, the defect of the atrial septum, the coarctation( constriction) of the aorta, etc.
With the open arterial duct, there is a pathological communication between the aorta and the pulmonary artery. This leads to the fact that part of the blood flows from the aorta into the pulmonary artery, and thereby increases the load on both ventricles. Complaints of patients are usually associated with poor physical tolerance.
With severe defect, there may be low endurance to physical exertion, a delay in development, a tendency to pulmonary infections. In uncomplicated cases, surgical treatment is shown, the essence of which lies in the ligation of the duct. Untreated patients die either from progressive heart failure at a young age, or from septic endocarditis.
The essence of the defect of the interventricular septum is clear from its name. With this vicious discharge of blood is carried out from the left to the right heart;therefore, the right( less powerful) ventricle has to work with a constantly increased volume of blood. This leads to severe changes in the vascular bed of the lungs. Minor defect can be asymptomatic, i.e.not to give any clinical manifestations. With a pronounced defect, cyanosis develops( cyanosis of the tip of the nose, ears, lips), shortness of breath;there may be edema, enlargement of the liver, etc. With a small defect, the prognosis is favorable, and the vice does not require any special treatment. If a large defect is shown, compulsory surgical treatment, otherwise severe circulatory insufficiency and infective endocarditis may develop.
The essence of the defect of the interatrial septum is clear from its name. With this defect in the initial stages of its discharge of blood is carried out from the left atrium to the right, i.e.the arterial blood is mixed with the venous blood. However, as the disease progresses, the direction of discharge may change - and part of the blood from the right atrium will fall into the left ventricle. This is due to the fact that the pressure in the lungs rises sharply, which becomes higher than the pressure in the left ventricle. Patients may not have complaints in the initial period of the disease. After changing the direction of discharge, cyanosis of the skin appears, poor tolerance of physical exertion, propensity to respiratory infections. Treatment of such a heart defect is operative. The essence of the operation is the suturing of the defect. The most effective operation before a marked increase in pressure in the right atrium and lungs. It is advisable to perform the operation in childhood.
Coarctation of the aorta is usually observed at the point of departure from the left ventricle. In the event that the aortic contraction is sufficiently pronounced, the left ventricle is overloaded, the arterial pressure in the upper half of the body rises and sharply narrows in the lower half. Patients' complaints, their severity, depend on the degree of constriction of the aorta and, as a consequence, on the increase of arterial pressure in the upper half of the body. The patients feel a headache, malaise, dizziness, flashing of flies before their eyes. Treatment of patients with coarctation of the aorta is surgical. The cardiosurgeon, after conducting additional research, determines the possibility of performing the operation. Drugs designed to reduce the level of pressure, do not give a lasting effect.
Mitral stenosis is a narrowing, fusion of valve flaps located between the left ventricle and the left atrium. As a result of stenosis, the left atrium has to pump blood through the narrowed orifice. The left atrium is a weak muscle formation of the heart;consequently, its compensatory capabilities are small, it is rapidly depleted and decompensated. As a result, this atrium is not able to pump all the blood coming from the lungs, which leads to stagnation of blood in the lungs. Atrial stretching can be accompanied by the formation of parietal thrombi. These blood clots can come off and clog the vessels of the brain, kidneys and other organs. Mitral stenosis is characterized by the development of atrial fibrillation.
If the defect is small, the patient's state of health can remain satisfactory. In typical cases, an early complaint is shortness of breath, with the usual physical stress. There may be attacks of cardiac asthma, dyspnea at rest, hemoptysis, coughing, palpitations, as well as dizziness and fainting. Appearance of the patient, usually characterized by:
marked cyanosis of the lips, tips of the ears and nose, as well as bluish cheeks blush. The auscultatory picture of the heart is crucial for the diagnosis of mitral stenosis. As methods that can definitively establish the diagnosis of mitral stenosis, use phonocardiography( recording of sound waves of the heart) and an ultrasound method that allows visualizing the heart valve.
In addition to conservative methods of treatment, in each individual case it is necessary to weigh the feasibility of surgical intervention.
As an operative method of treatment, commissurotomy is used. The essence of this method is the separation of the fused mitral valve flaps. The operation is done in patients with isolated mitral stenosis, without a significant increase in the heart, whose activity is reduced due to dyspnea.
Mitral stenosis is contraindicated in work associated with physical and psychoemotional loads, as well as with hypothermia. With the development of complications or severe circulatory insufficiency, patients are usually disabled.
Prognosis: mitral stenosis, even small, is prone to progression due to repeated attacks of rheumatic fever;correct and complex conservative therapy, promptly conducted operative treatment, postoperative management of patients significantly improve the prognosis;However, there is a high risk of death from complications or progressive circulatory failure.
Mitral insufficiency is a mitral valve insufficiency. This defect is characterized by the fact that the valves of the mitral valve wrinkle and are unable to close the hole between the left atrium and the left ventricle. As a result, during the period when the left ventricle contracts, part of the blood returns to the left atrium. Thus, atrial and ventricular overflow occurs, as a result of which both these parts of the heart are stretched, increase in size, and then their decompensation begins.
For a number of years the vice may not be accompanied by any malaise. In the future, the patient begins to worry about heart palpitations, shortness of breath during physical exertion, night attacks of cardiac asthma. There is a cyanosis of the skin. In later stages, an increase in the liver, edema on the legs can occur. To confirm the diagnosis, a phonocardiographic and ultrasound examination is carried out, if necessary, heart probing.
Treatment is mainly due to complications of malformation. At present, surgical methods are increasingly being used, the essence of which is to replace the valve with an artificial one. The question of indications for surgery is solved with a cardiac surgeon.
In case of unexplained mitral insufficiency the patients are able to work, are active and can perform minor physical exertion. As progression of heart failure progresses, the work associated with physical and psychoemotional loads is contraindicated.
The prognosis for mitral insufficiency depends on the progression of the disease. Various complications can worsen the prognosis of the disease.
Aortic insufficiency - insufficiency of semilunar aortic valves. This defect is most often due to rheumatism. However, there are other possible causes: septic endocarditis, syphilis, rheumatoid arthritis, etc.
Incomplete closure of the aortic valve during contraction and then relaxation of the left ventricle results in a portion of the blood returning from the aorta to the left ventricle;this leads to overload of the ventricle, its stretching, increase in its muscle mass. Since the left ventricle is the most powerful department of the heart, which has great compensatory capabilities, it allows him to maintain a sufficient volume of blood circulation for many years. Aortic insufficiency lasts for a long time without causing any subjective sensations in the patient. One of the earliest symptoms of this defect is the feeling of increased contractions of the heart in the chest, as well as the peripheral pulse in the head, arms, along the spine, especially in the prone position. With severe aortic insufficiency, there are dizziness, a tendency to fainting, and an increase in the heart rate at rest. Perhaps the occurrence of pain in the heart, which resemble angina. Many patients are pale, their limbs are warm. When viewed, the marked pulsation of the carotid arteries can be noticeable. The diagnosis is based on the data of heartbeat, phonocardiogram and ultrasound examination.
Treatment of aortic insufficiency is performed during the development of complications of the disease. Treatment of heart failure is ineffective, since the left ventricle is unable to provide the right blood flow. Currently, the surgical method of treating the defect is widely used: the replacement of the affected valve with an artificial one is made. The operation is performed before the development of severe circulatory failure, otherwise it is ineffective.
Many patients with aortic insufficiency are able to perform heavy physical activities and even exercise. However, all this can accelerate the onset of decompensation.
The prognosis for aortic insufficiency depends on the ability of the left ventricle to work with increased blood volume. Usually decompensation develops late. However, having arisen, it develops rapidly, and it can be extremely difficult to suppress with drugs. Possible development of complications in the form of heart rhythm disturbances.
Aortic stenosis - stenosis, fusion of valves separating the left ventricle and aorta. Stenosis of the aorta is rheumatic or congenital. As a result of the development of stenosis, the left ventricle is forced to pump blood through the sharply narrowed aortic orifice. As a result, the left ventricle works with overload, and the organs and tissues do not receive enough blood. As with aortic insufficiency, the left ventricle, due to its internal reserves, for a long time copes with the excessive load, but eventually becomes depleted, which leads to heart failure.
Aortic stenosis is characterized by a long asymptomatic course. If the defect is isolated, it manifests itself under the condition that the area of the valve section decreases as a result of stenosis to 25% of the initial value. The main complaints made by a patient with aortic stenosis are primarily associated with insufficient blood flow to the internal organs and brain. Patients complain of dizziness, darkening of the eyes, loss of consciousness, dyspnea, pain in the heart. As well as with other vices, hearts, an important place in the diagnosis of aortic stenosis belongs to listening to the heart, phonocardiography and ultrasound examination of the heart.
In the absence of signs of circulatory failure, only the underlying disease that causes the defect is treated. In the stage of decompensation, the treatment of heart failure is prescribed, carefully applying cardiac glycosides, as strengthening the contractility of the left ventricle does not cause an improvement in blood supply to the internal organs. The question of surgical treatment is solved together with a cardiac surgeon. Possible commissurotomy( separation of the adhesions between the valves of the heart valves) or replacement of the valve with an artificial one. Operative treatment( komissurotomo-msho) should be performed at a young age, before the development of severe manifestations of circulatory insufficiency
Patients with aortic stenosis can work for a long time, performing physical exertion. With the development of heart failure, the work capacity of patients is limited or lost.
The flaws of the tricuspid valve and the valve of the pulmonary artery occur very rarely in isolated form. As a rule, they are combined with the defects of the mitral and aortic valves.
The tetralogy of Fallot is a combination of a narrowing of the pulmonary artery, a defect of the interventricular septum, aortic divergence from both ventricles, hypertrophy of the right ventricle. Vice is detected in early childhood. Expressed cyanosis, the growth of the child is slowed, with the slightest stress there is shortness of breath. When examined, fingers are identified in the form of tympanic sticks, systolic murmur, especially intense on the pulmonary artery. With the help of instrumental methods, an increase and hypertrophy of the right ventricle is detected. Diagnosis is clarified with cardiac catheterization by radiopaque examination. Usually there is a secondary erythrocytosis.
Surgical treatment, without which children live on average 15 years.
Eisenmenger complex is characterized by a large defect of the interventricular septum, transposition of the aorta with its passage from both ventricles and hypertension of the small circle with hypertrophy of the right ventricle. The disease is found most often in childhood. At the same time, a loud systolic murmur is heard in the third and fourth intercostal space near the edge of the sternum. Cyanosis and shortness of breath can be expressed moderately. Life expectancy without timely surgical intervention is 25-30 years.
The defect of the interventricular septum( Tolochinov-Roger disease) is manifested by coarse prolonged systolic murmur in the third to fourth intercostal space near the left edge of the sternum as a result of the flow of blood from the left ventricle to the right. When palpation of the same area is determined systolic jitter, the size of the heart for a long time remain normal. Relatively small defect of the septum for a long time does not cause large violations of hemodynamics and does not limit the duration of life. However, sometimes these patients develop severe pulmonary hypertension with the appearance of dyspnea with little stress and hypertrophy of the right ventricle. In such patients, surgical intervention is advisable. The disease can be complicated by prolonged septic endocarditis.
Deficiency of the interatrial septum leads to a discharge of blood from the left atrium to the right. The disease can be asymptomatic for a long time. Systolic murmur in the second - third intercostal space to the left of the sternum can be moderately pronounced. Clinical manifestations arise in connection with the development of hypertension in the pulmonary artery with hypertrophy of the right ventricle and the subsequent development of heart failure along a large range of blood circulation. Most often, difficulties arise in the differential diagnosis of this pathology with primary pulmonary hypertension. The latter also occurs with shortness of breath and cyanosis. For the diagnosis, the heart sounding data are crucial. With timely surgical treatment, hemodynamic disorders are eliminated, and the prognosis is significantly improved.
Non-infarction of the arterial( botallova) duct is a relatively frequent congenital defect. The arterial duct connects the pulmonary artery with the aortic arch. When it is not inflated, there is a constant flow of blood from the aorta into the pulmonary artery with overflow of the blood of the lungs and an increase in the work of both ventricles of the heart. Symptoms of the disease depend on the width of the duct and the amount of blood discharge. This vice can occur without complaints and is found sometimes in case of accidental medical examination. Characterized by a loud, blowing noise, heard primarily in the systole period, but persists also during diastole. Noise is recorded in the second to third intercostal space to the left of the sternum, there is an accent of the 2nd tone on the pulmonary artery. Pulse pressure can be increased. The ventricles of the heart are usually hypertrophied and enlarged. At the same time, the initial part of the pulmonary artery also expands. Cyanosis is often absent, but there may be dizziness, a tendency to fainting, a lag in growth. The diagnosis is confirmed by angiocardiography. The average life expectancy without surgery is 35 years.
Surgical treatment is a ligation of the arterial duct, which is relatively simple and gives a good result.
This defect is characterized by cyanosis, physical underdevelopment. There may be complaints of shortness of breath, pain in the heart, a tendency to fainting, dizziness;often the fingers look like drumsticks. In the study of the heart, there are signs of right ventricular hypertrophy, which has to overcome the resistance caused by the stenosis of the pulmonary artery. There is an intensified heart beat, the heart is enlarged to the right, a heart hump is possible. In the second intercostal space, systolic murmurs are heard on the left side of the sternum, the second tone on the pulmonary artery is weakened. Hypertrophy and overload of the right ventricle are also confirmed by instrumental methods. Possible right ventricular failure with circulatory disorders in a large circle. The average life expectancy is 20 years. Patients often die from joining pulmonary tuberculosis. Timely surgical treatment, shown with severe stenosis, significantly improves prognosis.
Subaortic stenosis is a narrowing of the output of the left ventricle due to the annular fibrous film. The aortic valve remains unchanged. The disease sometimes occurs only in a more mature age. There may be shortness of breath, fatigue, pain in the heart, sometimes fainting. On examination, an increase and hypertrophy of the left ventricle, an increase in the apical impulse, an extension of the heart to the left are found. In the second intercostal space to the right of the sternum systolic murmur and systolic tremor are determined. Noise is usually carried on the vessels of the neck. On the aorta II, the tone remains normal or weakened. It is often early diastolic noise, indicating aortic insufficiency. With X-ray examination, the ascending aorta is usually normal or slightly dilated. With moderate stenosis, the illness for a long time can proceed favorably, without complaints. With severe stenosis, surgery is necessary.
Coarctation of the aorta - a narrowing of the isthmus of the aorta immediately after the left of the subclavian artery. Therefore, the main manifestation of the disease is the increase in blood pressure in the arteries of the upper half of the body and its lowering in the arteries of the lower extremities. With a pronounced narrowing, there is a ripple in the head, headache, less often nausea, vomiting, impaired vision and increased pressure when measured on the hands. Simultaneously, due to a lack of blood supply to the legs, there is numbness, heaviness, weakness in walking, and a decrease in pressure when measured on the legs. In this regard, in cases of hypertension of unknown origin, it is necessary to measure pressure not only on the hands, but also on the legs. For this, the cuff is placed on the lower third of the thigh and the tones in the popliteal fossa are heard [normally, the systolic pressure exceeds the pressure on the shoulder by 2.67 kPa( 20 mm Hg), with coarctation of the aorta, the pressure on the hands may exceed the pressure on the femoralarteries up to 13.3 kPa( 100 mm Hg)].Usually at the same time, indistinct signs of hypertrophy and left ventricular dilatation are defined simultaneously, a relatively quiet systolic murmur in the second to fourth intercostal space at the edge of the sternum and behind the shoulder blades. Coarctation of the aorta may be indicated by the presence of collaterals in the form of pulsating inter-rib arteries enlarged in volume or in the form of uneven contour edges as a result of compression of the bone tissue with arteries. This heart defect can be complicated by a cerebral stroke on the soil of arterial hypertension, as well as the early development of atherosclerosis of the aorta and coronary arteries. The average life expectancy is 35 years. In this regard, surgical intervention is recommended at the age of 20-30 years. In rare cases, patients with this defect can live up to 70-80 years.
Heart defects acquired are most often due to rheumatism, less often prolonged septic endocarditis, atherosclerosis, syphilis. Heart defects may be associated with a narrowing of the opening between the chambers of the heart or the insufficiency of the valves, in the latter case the valves do not completely cover the holes. There are defects of individual valves and combined defects in which two or more valves of the heart are affected.
The acquired defects of are more often related to the mitral valve, more rarely - to the aortic, and even more rarely - tricuspid valve and pulmonary artery valve. The heart valves( there are only four) are located between the atria and ventricles( mitral between the left ventricle and the left atrium, the tricuspid between the right ventricle and the right atrium) and the vessels that drain from them( the aortic between the left ventricle and the aorta, the pulmonary between the right ventricle and the right atriumventricle and pulmonary artery).The mitral and tricuspid valves open during the atrial systole period, i.e.when blood comes from the atria into the ventricles. At the time when the ventricles pump blood( the left - into the aorta, the right - into the pulmonary artery), these valves close and prevent the flow of blood back to the atrium. At this moment, the aortic valve and the pulmonary artery valve open, which both pass the blood into the corresponding vessels. After the pressure in the vessels becomes high, these valves collapse and prevent the blood from returning to the ventricles. Thus, the valves of the heart provide both the correct flow of blood in the heart, as well as the phase function of the atria and ventricles.
The defeat of the heart valves in the formation of defects is noted mainly in two versions. In the event that, as a result of rheumatic or other damage, the valves of the valves are wrinkled or destroyed, the failure of a valve develops. The modified valves are unable to completely close the corresponding hole between the chambers of the heart. As a result, when the heart is working, the blood partially returns to the departments from which it came. This creates an additional load on the muscle of the heart( load an additional volume), which leads to an increase in the mass of the heart muscle( hypertrophy), and then to its depletion.
The second variant of the defeat of the heart valves is the fusion of valve flaps, which leads to a narrowing of the corresponding opening between the chambers of the heart. The modified joined valve flaps are not able to fully open. This leads to the fact that the heart( ventricles or atria) work with increased load: they have to pump blood through the narrowed orifices. Such a vice is called stenosis. As a result, just as in the first case, there is a thickening of the heart muscle and its fatigue. In actual clinical practice, isolated insufficiency or isolated stenosis is extremely rare;as a rule, they are combined with the predominance of one or another lesion. In severe cases, several valves of the heart can be affected.
Recently, rheumatism - a disease that most often causes heart defects - is hidden and does not manifest itself with joint pain, fever and other symptoms. Freestyle do not know that they have suffered rheumatism, and for the first time they turn to a doctor already with a developed heart defect. The fact that a patient with a heart disease for many years may not be aware of his disease is explained by the fact that the heart has great reserve capabilities that can compensate for the existing defect due to the increased work of the corresponding parts of the heart. At this stage, heart disease is called compensated.
As the disease progresses, there are signs of heart failure, i.e.a condition where the heart muscle can no longer work hard and provide normal blood flow, At this stage, the heart defect is called decompensated. The development of decompensation occurs over time with severe heart defects.
However, this may be accelerated by repeated attacks of rheumatism, which lead not only to an increase in the deformation of valve flaps, but also to the damage of the heart muscle itself. To aggravate the course of the process, there may be great physical exertion, infectious and other diseases, pregnancy and childbirth. In most cases, decompensation processes are relatively reversible. With timely started and comprehensive treatment, they can be suspended and maintained for years in a state of compensation.
Mitral valve insufficiency is a defect in which, during contraction of the left ventricle, part of the blood returns to the left atrium due to incomplete closure of the mitral orifice. The insufficiency of the mitral valve can be relative: the valves are not changed, but due to the expansion of the left ventricle and the pre-heart ventricular opening, the mitral valve flaps do not completely close. Organic insufficiency of the mitral valve is usually observed in combination with some narrowing of the mitral orifice and is more often caused by rheumatic endocarditis.
Symptoms. Patients may complain of shortness of breath with physical exertion, palpitations, weakness, which is associated with heart failure. Mark the increase in the heart up and to the left, which is best seen with fluoroscopy. In the first oblique position, the esophagus deviates along an arc with a large radius( 10 cm) due to an increase in the left atrium. An important symptom of mitral insufficiency is systolic murmur at the apex, with the most common being performed in the left axillary region. I tone is weakened, II tone on the pulmonary artery is strengthened. With the growth of stagnant phenomena in a small circle of circulation later, the right ventricle is enlarged, and then signs of its failure with stagnation in a large circle of circulation. On the ECG, signs of an increase in the left ventricle and a change in the P wave( enlargement, serration) are noted due to lesion of the left atrium, later signs of an increase in the right ventricle are added.
Systolic murmur at the apex of the part is due to functional changes in the heart and is found in 1/3 of healthy children and adolescents, somewhat less often in adults. Difficulties arise in differential diagnosis with mitral valve insufficiency. For the diagnosis of rheumatic heart disease, in addition to the presence of a rheumatic anamnesis, it is necessary to pay attention to the weakening of the I tone at the apex of the heart, the radiographic signs of an increase in the left ventricle and atrium, the intensity of systolic noise, and its duration. The diagnosis of the defect is especially convincing in the presence of signs of at least insignificant mitral stenosis.
Treatment. Therapy of active rheumatic heart disease with the appearance of heart failure is the appointment of cardiac glycosides and diuretics. With a pronounced defect, mitral valve prosthesis is possible.
Stenosis of the left venous aperture( mitral stenosis) - narrowing of the left atrioventricular orifice with difficulty and decrease of blood flow to the left ventricle from the left atrium. This heart disease, as a rule, is due to rheumatism. With it, the left atrium is enlarged with increased pressure in it and in the veins that flow into it. This leads reflexively to spasm of small arterioles, to an increase in pressure in the pulmonary artery. As a result, the load increases on the right ventricle of the heart.
Symptoms. Characteristics of complaints of dyspnea with a relatively low load, cough, hemoptysis. However, sometimes a sufficiently pronounced mitral stenosis proceeds without complaint for a long time. In patients, the cyanotic pink color of the cheeks is often detected( mitral blush).In the lungs there are signs of stagnation: wet wheezing in the lower parts. Characteristic is the propensity for attacks of cardiac asthma and even pulmonary edema. The increase and hypertrophy of the right ventricle with the appearance of pulsations in the epigastric region, displacement of the border of the heart to the right, as well as an increase in the left atrium with a shift of the upper border to the II rib are noted. In typical cases, presystolic noise is heard at the apex of the heart, and often proto-diastolic noise, a loud 1 tone and an additional tone immediately following the second tone( the tone of the opening of the mitral valve).The presence of an additional tone determines a peculiar three-term rhythm( "quail rhythm"). On the ECG, there are signs of right ventricular hypertrophy and an increase in the left atrium( enlarged and broadened P1-2 tooth).Mitral stenosis is one of the most important causes of atrial fibrillation. With severe pulmonary hypertension, patients develop stagnation over a large range of blood circulation.
Treatment of rheumatic heart disease and heart failure with this defect is carried out according to general rules. In severe mitral stenosis, commissurotomy is performed, and when combined with mitral insufficiency, mitral valve prosthetics are performed.
Aortic valve deficiency is a defect in which there is no complete closure of the aortic valves during diastole, as a result of which part of the blood discharged into the aorta returns to the left ventricle. The vice is caused by rheumatism, protracted septic endocarditis, syphilis, atherosclerosis, rheumatoid arthritis.
Symptoms. The disease can last for a long time without complaints. Often there are pains in the heart of a different nature, sometimes prolonged, especially with exercise. There are palpitations, pulsation in the neck, and later dyspnea. Characteristic pallor, pulsation of the arteries of the neck( "dance carotid").The left ventricle significantly hypertrophied and increased. This is manifested by the displacement of the apical impulse to the left and downward in the sixth to seventh intercostal space, its significant enhancement. In the X-ray study, the heart acquires an aortic configuration with an increase in the left ventricle and a pronounced waist. Most typical is the appearance of diastolic noise in the third to fourth intercostal space to the left of the sternum( Botkin's point), as well as in the second intercostal space to the right of the sternum( aortic point).Functional systolic noise may also be heard above the aorta. The pulse pressure is increased, the diastolic pressure can be zero, and the systolic pressure usually rises. In this connection, the pulse is fast, frequent, high. The ECG shows signs of left ventricular hypertrophy. In the late stage of the disease, the expansion of the left ventricle leads to the development of a relative deficiency of the mitral valve, stagnation of blood in the lungs with increasing dyspnea. With syphilitic disease, diastolic murmur is more clearly heard in the second and first intercostal spaces to the right of the sternum, often anginal pain in the heart, at the same time changes in the ascending aorta are observed during X-ray examination.
Treatment of heart failure, with this defect is carried out according to general rules. However, diuretics should be preferred, since the use of digitalis is usually ineffective due to the fact that it contributes to a decrease in rhythm and an increase in diastolic pauses, during which the blood returns to the left ventricle. Perhaps a radical elimination of a blemish is a prosthetic repair of the aortic valve.
Stenosis of the aortic orifice is a defect in which the narrowing of the aortic opening makes it difficult for the blood from the left ventricle to eject. The vice has a rheumatic origin. Developed primarily hypertrophy of the left ventricle. The course of the disease depends largely on the degree of stenosis.
Symptoms. After a certain period of a favorable course, patients develop pains in the region of the heart, fainting, shortness of breath and palpitations. On examination, an increase in the heart to the left is observed with a shift of the apical impulse outwards and downwards. Data from the instrumental study confirm an increase and hypertrophy of the left ventricle. Occasionally, radiologic examination reveals a calcification of aortic valves. The most characteristic is a coarse systolic murmur, which is heard in the second intercostal space on the right side of the sternum. Noise is carried on the vessels of the neck, sometimes along the entire thorax. On a phonocardiogram, it has a rhomboid shape. Often there is a systolic tremor over the aorta. Pulse is small and slow, pulse BP is reduced. This defect is often combined with aortic valve insufficiency. The course of the defect can be complicated by the addition of angina due to insufficient coronary blood supply with a decrease in the discharge of blood into the aorta. The prognosis sharply worsens in connection with the adherence of heart failure with circulatory disorders in the left ventricle type with shortness of breath, cardiac asthma.
Treatment of heart failure and rheumatic heart disease with this defect is carried out according to general rules. In severe aortic stenosis, surgery is indicated.
The insufficiency of the tricuspid valve is a vice in which during the right ventricular contraction part of the blood returns to the right atrium as a result of incomplete closure of the atrioventricular aperture with sclerosed valve flaps. This vice is usually found in combination with a mitral or aortic defect. In this case, there is often a relative insufficiency of the tricuspid valve due to stretching of the atrioventricular aperture as a result of expansion of the right ventricle.
Symptoms. On examination, the expansion of the cervical veins with their pulsation is revealed, synchronous with the pulsation of the arteries. The right border of the heart is shifted to the right by increasing its right divisions. A characteristic auscultative sign is a long systolic murmur at the base of the sternum. Patients develop early heart failure with congestion in the great circle of blood circulation: an increase in the liver, edema, ascites, an increase in venous pressure. There may be a pulsation of the liver.
Treatment. First of all, it is necessary to carry out therapy for heart failure.
Combined metral-aortic defect is characterized by the defeat of two valves, often with predominant stenosis or deficiency of one of them. Most often there is a combination of mitral malformation with a predominance of stenosis of the aperture with aortic valve insufficiency. At the same time, along with the signs of mitral stenosis, there is diastolic noise at the Botkin point, but it is less intense than with an isolated aortic valve failure. When combined with mitral stenosis with aortic stenosis, the symptoms of the latter are more moderately expressed due to a decreased filling of the left ventricle. With severe aortic valve insufficiency, the diagnosis of mitral stenosis may be difficult, since the presistolic noise at the apex is also observed with isolated aortic insufficiency( Flint noise).Diagnostic value is acquired by detecting the tone of the opening of the mitral valve and radiographic signs of mitral stenosis.
Mitral-tricuspidal and mitral-aortic-tricuspidal defects are detected on the basis of the characteristics described above, characteristic for each of them. Multiple valve damage should be considered with prolonged active flow of rheumatic heart disease.
The combination of mitral stenosis with bivalve valve insufficiency is the most frequent heart disease. One should always strive to clarify the prevalence of a particular defect. With the prevalence of stenosis, the clapping I tone is usually maintained, with the predominance of insufficiency it weakens. In this case, the defect may increase as the left ventricle due to the failure of the valve, and the right one, which is more characteristic of mitral stenosis. Both systolic and diastolic murmurs are heard. Precise diagnosis is assisted by a thorough X-ray examination, as well as echocardiography. Taking into account the development of cardiac surgery and the possibility of eliminating combined and associated heart defects, cardioangiography and heart probing are indicated to clarify the indications for surgery.
When performing a massage, the patient assumes sitting position, resting his head on the headrest.
At the very beginning of the procedure, stroking along the spinal column is applied on the segments from L1-D12 to D5-2 and from C7 to C3.
After stroking in the same area, techniques such as:
a) rubbing straight and circular, b) pressing, c) sawing, d) vibrating the end phalanges of the fingers are applied from the bottom up.
After that, kneading is performed on the area of the latissimus muscles of the back, the lateral surface of the back, the trapezius muscle.
Then it is necessary to work on the area of the intercostal space, using:
a) rubbing of the costal arches, with special effort on the left half, b) light percussion techniques, c) chest shaking.
And also massage the front surface of the chest in general, paying special attention to the sternum massage:
a) stroking, b) rubbing, c) kneading, d) light vibration.
When switching to massage, the heart projection area is used:
a) stroking, b) rubbing, c) kneading, d) labile vibration intermittent and non-continuous, d) breathing exercises.
At the end of the session, the patient assumes the supine position, and the masseur acts on the lower and upper limbs for 3-5 minutes, conducting:
a) stroking, b) kneading, c) passive and active movements in the joints.
The entire massage course for the treatment of heart disease consists of 12 procedures, conducted at intervals of one day for 15-20 minutes each.
• A healthy lifestyle helps reduce the risk of high blood pressure, atherosclerosis and heart attack.
• Consult a doctor if you feel shortness of breath, palpitations or dizziness.
• Attention! Call an "ambulance" if you experience severe chest pain.
All medical measures for heart diseases are performed by a doctor. These activities depend on the type of vice and the reasons that caused it. First of all, it is necessary to treat a disease that caused a defect or contributes to its progression. Most often for the acquired heart defects such a disease is rheumatism.
In the complex of curative therapy of heart defects special place occupy general hygienic measures. They are aimed at improving the efficiency of the heart and compensating for circulatory disorders. For this purpose, a sparing mode of work and a sufficient rest regime are established for the patient. Professional activity should be adequate to the capabilities of the patient and not lead to an overload of the heart. It is necessary to avoid such physical and psychoemotional loads that can cause shortness of breath, palpitations, the occurrence of irregularities in the heart. At the same time, we show exercises of physiotherapy exercises, on which exercises specially recommended by a doctor are performed.
With the appearance of severe signs of circulatory failure, the regime becomes more restrictive, and in some cases, bed rest is indicated. Patients with heart defects feel better with a raised head and with their legs flat.
It is necessary to follow medical recommendations regarding the diet, which should be full. The amount of food is limited to one reception, for overeating leads to difficulty in the work of the heart. Do not eat before going to bed. It is necessary to limit the amount of liquid consumed( up to 1.0-1.5 liters per day) and salt( up to 2-5 g).It should be remembered that salt leads to fluid retention in the body, and this can exacerbate signs of circulatory insufficiency.
The administration of drug therapy should be permanent. Self-abolition of drugs, changing their dosages are strictly prohibited, because this can cause severe, often irreversible changes.
During the period of state compensation, you can use sanatorium treatment.
Patients with heart defects should be under dynamic medical supervision, with a doctor's examination at least once every six months. Women, before deciding on the birth of a child, must necessarily consult a doctor, since pregnancy and childbirth - a heavy burden on the cardiovascular system.
The doctor determines the indications and contraindications to the surgical treatment of heart disease. In clinical practice, there are often situations when the patient in the compensation stage refuses to perform surgery, and at the stage of decompensation, when the therapy becomes ineffective, the risk of surgery increases so much that surgical treatment can not be performed or it is ineffective. Therefore, the decision on the timing of the operation is very responsible and is accepted by the doctors collegially.
With the right choice of profession, observance of the regime of work and rest, timely and systematic treatment of a patient with a heart defect can live a full life and for many years remain able to work.