• Acquired heart defects - Causes, symptoms and treatment. MF.

    Causes of

    Symptoms of heart defects
    Treatment of
    Prophylaxis of acquired heart defects

    Normally, the human heart consists of two atria and two ventricles separated by valves that pass blood from the atria to the ventricles. The valve, located between the right atrium and the ventricle, is called tricuspid and consists of three valves, and between the left atrium and the ventricle is called mitral and consists of two valves. These valves are supported by the ventricles with tendon chords - the threads that provide movement of the valves and complete closure of the valve at the time of the expulsion of blood from the atria. This is important for the blood to move only in one direction and not be thrown back, as this can disrupt the work of the heart and cause the wear of the heart muscle( myocardium).There is also an aortic valve that separates the left ventricle and the aorta( a large blood vessel that supplies the whole body with blood) and the pulmonary artery valve that separates the right ventricle and the pulmonary trunk( a large blood vessel carrying venous blood into the lungs for subsequent oxygen saturation).These two valves also prevent backflow, but already in the ventricles.

    If severe deformations of the internal structures of the heart are observed, this leads to a disruption of its functions, which affects the work of the whole organism. Such conditions are called heart defects, which are congenital and acquired. This article is devoted to the main aspects of acquired heart defects.

    Acquired defects are a group of heart diseases that are caused by a change in the anatomy of the valve apparatus due to organic damage, which causes a significant violation of hemodynamics( blood movement inside the heart and circulation of blood throughout the body as a whole).

    The prevalence of these diseases is according to different authors, from 20 to 25% of the number of all heart diseases.

    Causes of heart disease

    In 90% of cases in adults and children acquired defects are a consequence of acute rheumatic fever( rheumatic fever).This is a serious chronic disease that develops in response to the introduction of group A hemolytic streptococcus into the body( as a result of sore throat, scarlet fever, chronic tonsillitis), and manifests itself in the defeat of the heart, joints, skin and nervous system. Also, bacterial endocarditis( damage to the inner shell of the heart due to ingress of pathogenic microorganisms into the blood-sepsis, and their settling on the valves) can be the cause of the defects.

    In other cases, autoimmune diseases( rheumatoid arthritis, systemic scleroderma, etc.), atherosclerosis, ischemic heart disease, myocardial infarction, especially with the formation of a large post-infarctal scar, are rare causes in adults.

    Symptoms of acquired heart defects

    The clinical picture of heart defects depends on the stage of compensation for hemodynamic disorders.

    1st stage: compensation .It implies the absence of clinical symptoms due to the fact that the heart produces compensatory( adaptive) mechanisms for the correction of functional disorders in its work, and the body can still adapt to these disorders.
    2nd stage: subcompensation .Characterized by the appearance of symptoms during exercise, when protective mechanisms are no longer enough to level the changes in hemodynamics. At this stage, the patient is disturbed by shortness of breath, tachycardia( rapid heartbeat), chest pain on the left, cyanosis( blue or violet staining of the skin of the fingers, nose, lips, ears, whole face), dizziness, fainting or unconsciousness, swelling of the lower limbs. These symptoms appear, as a rule, in cases of unusual for the patient loads, for example, when walking fast for long distances.
    Stage 3: Decompensation. Indicates depletion of compensatory mechanisms of the heart and the whole organism, which leads to the appearance of the above-described symptoms in normal household activity or at rest. With severe decompensation due to the inability of the heart to pump blood, blood stasis occurs in all organs, it is clinically manifested by pronounced dyspnea at rest, especially in the supine position( therefore the patient can only be in the semi-sitting position), cough, tachycardia, increased or more often low blood pressure,swelling of the lower extremities, abdomen, sometimes the whole body( anasarka).At the same stage, blood supply to all organs and tissues with dystrophic changes in them is disturbed, the body is not able to cope with such severe pathological changes, and the terminal stage( death) of occurs.

    Also acquired defects vary widely depending on their type and location. By the nature of the defect, insufficiency( incomplete closure of valve flaps) and stenosis( constriction) of the valve ring aperture are isolated. Localization distinguish the lesions of the mitral, tricuspid, aortic valves and the valve of the pulmonary trunk. There are both their combinations( lesions of two or more valves), and combinations( stenosis and insufficiency of one valve).Such defects are called combined or combined, respectively. The most common defects of the mitral and aortic valves.

    Mitral stenosis( narrowing of the atrioventricular aperture on the left). Characteristic for him are the patient's complaints of pain in the chest and between the scapula on the left, a feeling of palpitations and shortness of breath, first under load, and then at rest. Dyspnoea may be a symptom of pulmonary edema( due to stagnation of blood in the lungs), which is a threat to the life of the patient.

    Mitral valve insufficiency. Clinically, it can not manifest itself for dozens of years from the onset of the formation of a defect, in the absence of active rheumatic carditis( rheumatic "inflammation" of the heart) and damage to other valves. The main complaints in the development of subcompensation are complaints of dyspnea( also, like stenosis, which can be a manifestation of pulmonary edema), heart failure, pain in the right upper quadrant( due to overfilling with the blood of the liver), swelling of the lower extremities.

    Stenosis of the aortic valve. If a patient has a slight narrowing of the valve ring, for decades he may feel satisfactory even at high physical exertion. With severe stenosis, complaints of general weakness, fainting, pale skin, chilliness of the limbs( due to a decrease in the discharge of blood into the aorta) appear. Next, pain in the heart, shortness of breath, episodes of pulmonary edema.

    Insufficient aortic valve. Clinically for a long time, it can manifest itself only by sensation of irregular heartbeats in severe physical exertion. Later, addiction to fainting, pressing pains in the chest resembling angina, and shortness of breath, which can be a formidable symptom with the rapid development of pulmonary edema, are added.

    The isolated stenosis of the right atrioventricular orifice and the lack of the tricuspid valve are very rare defects, and are more common against the background of mitral and / or aortic defects. The earliest signs are irregularities in the heart and heart palpitations during exercise, then, with the increase in right ventricular failure, edema of the lower limbs, heaviness and pain in the right upper quadrant( due to stagnation of blood in the liver), abdominal enlargement( ascites - accumulation of fluid in the abdominal cavity), pronounced dyspnea at rest.

    Isolated stenosis and insufficiency of the pulmonary valve of the are also a rare disease, most often the flaws of this valve are combined with the defects of the tricuspid valve. Clinically manifested by frequent protracted bronchitis, irregular heartbeat during exercise, edema of the lower extremities, enlargement of the liver.

    Diagnosis of acquired heart defects

    Diagnosis of heart disease can be assumed in the process of clinical examination of the patient with mandatory auscultation of the chest, when listening to which reveal pathological tones and noise caused by malfunction of the heart valves;also the doctor can hear wheezing in the lungs due to stagnation of blood in the vessels of the lungs. Attention is drawn to the pallor of the skin, the presence of edema, palpable( when probing the abdomen) enlarged liver.

    General laboratory tests of blood and urine are assigned from laboratory and instrumental methods of blood tests to detect abnormalities in kidney and liver function, ECG reveals rhythm disturbances, hypertrophy( growth) of the atria or ventricles, chest radiography reveals signs of blood congestion in the lungs,expansion of the transverse dimensions of the heart, angiography - the introduction of a contrast medium through the vessels in the heart cavity followed by radiography, echocardiography( ultrasound of the heart).

    So, for example, looks like a heart with atrial and ventricular hypertrophy in heart defects on the roentgenogram.

    Echocardiography helps to reliably confirm or disprove the diagnosis from the listed methods of investigation, as it allows visualizing the heart and its internal structures.

    In mitral stenosis, ultrasound of the heart determines the severity of stenosis in the area of ​​the atrioventricular orifice, the compaction of valve flaps, the left atrial hypertrophy( increase in mass), turbulent( not unidirectional) blood flow through the atrioventricular orifice, and increased left atrial pressure. Insufficiency of the mitral valve by ultrasonography is characterized by a break in the echoes from the valves at the time of closure of the valve, the degree of severity of regurgitation( the reverse transfer of blood into the left atrium) and the degree of hypertrophy of the left atrium are also determined.

    When stenosis of the aortic aperture is determined by ultrasound, the severity of stenosis, myocardial hypertrophy of the left ventricle, reduction of the ejection fraction and shock volume of the blood( indicators characterizing the flow of blood into the aorta for one cardiac contraction).Aortic insufficiency is manifested by deformation of aortic valve flaps, their incomplete closure, regurgitation of blood into the cavity of the left ventricle, hypertrophy of the left ventricle.

    With tricuspid valve and valve pulmonary trunk, the same indicators are detected and evaluated, only for the right heart.

    Treatment of acquired heart defects

    Treatment of acquired defects continues to be a complex and topical topic in modern cardiology and cardiac surgery, as it is very important for each individual patient to determine the fine line when the operation is already necessary but not yet contraindicated. In other words, cardiologists should carefully monitor such patients in time to identify situations when drug therapy no longer allows to keep the defect in a compensated form, but the pronounced decompensation did not have time to develop and the body is still able to transfer the operation on the open heart.

    There are medical and surgical methods for treating heart defects. Medical therapy is used in the active stage of rheumatism, in the stage of subcompensation( if it is possible to achieve correction of hemodynamic disorders with the help of drugs or if the operation is contraindicated due to concomitant diseases - acute infectious diseases, acute myocardial infarction, repeated rheumatic attack, etc.)in the stage of pronounced decompensation. The following groups are appointed from medication:

    - antibiotics and anti-inflammatory drugs for arresting the active rheumatic process in the heart; a group of penicillins( bicillin in injections, ampicillin, amoxicillin, amoxiclav, etc.), non-steroidal anti-inflammatory drugs( NSAIDs) - diclofenac, nimesulide, ibuprofen, aspirin, indomethacin;
    - cardiac glycosides( digoxin, digitoxin) are prescribed in certain cases to improve the contractile activity of the myocardium( cardiac muscle);
    - drugs that improve the trophicity( nutrition) of the myocardium - panangin, magnerot, magne B 6, etc.;
    - diuretic drugs( furosemide, indapamide, etc.) are indicated to reduce the volume overload of the heart and vessels;
    - ACE inhibitors( captopril, lisinopril, ramipril, etc.) have cardioprotective properties, promote normalization of arterial pressure;
    - B-adrenergic blockers( bisoprolol, carvedilol, etc.) are used to reduce pressure and decrease the rhythm if the patient develops heart rhythm disturbances with an increase in the heart rate;
    - antiplatelet agents( aspirin and its modifications - cardiomagnesium, Aspidin Cardio, trombo Ass and others) and anticoagulants( heparin, fractiparin) are prescribed to prevent increased clotting of the blood with the formation of blood clots in the vessels or heart;
    - nitrates( nitroglycerin and its analogues - nitromite, nitrospray, nitrosorbide, monochinke) are prescribed if angina develops in a patient with heart disease( due to insufficient blood supply to the hypertrophied cardiac muscle).

    Cardiac surgical treatments for are a radical way to correct a defect. Of these, commissurotomy is used for stenosis( resection of cicatricial adhesions on the valve flaps), hemming of unlabeled valves, enlargement of a small area of ​​stenosis with a probe brought to the heart through the vessels, valve replacement( excision of the valve and its replacement by artificial).

    In addition to the listed methods of treatment, the patient needs to lead a certain lifestyle, for example:

    - it is rational to eat, keep to a diet with restriction of table salt, the volume of liquids drunk, foods with high cholesterol content( fatty meat, fish, poultry and cheese, margarine, eggs), with the exception of fried, spicy, salty dishes, smoked products.
    - walk in the fresh air more often;
    - exclude sports;
    - to limit physical and psycho-emotional loads( less stress and nervousness);
    - to organize a day regime with a rational distribution of labor and rest, and with a sufficient length of sleep;
    - a pregnant woman with an acquired heart disease regularly visit a woman's consultation, a cardiologist or cardiac surgeon to make a decision about the possibility of maintaining pregnancy with the choice of the optimal delivery method( usually by caesarean section).

    Prophylaxis of acquired heart defects

    Since the main reason for the development of these diseases is rheumatism, prevention is aimed at the timely cure of diseases caused by streptococcus( tonsillitis, chronic tonsillitis, scarlet fever) with the help of antibiotics, sanation of chronic foci of infection in the body( chronic pharyngitis, carious teeth andetc).This is a primary prevention. Secondary prophylaxis is used in patients with an existing rheumatic process and is carried out through annual injections of antibiotic bicillin and the use of anti-inflammatory drugs.


    Despite the fact that the stage of compensation( without clinical manifestations) of certain heart defects is calculated in decades, the overall life expectancy can be reduced, as the heart inevitably "wears out", heart failure develops with blood supply and nutrition of all organs and tissues, whichleads to a lethal outcome. That is, the prognosis for life is unfavorable.

    The prognosis is also determined by the possibility of developing life-threatening conditions( pulmonary edema, acute heart failure) and complications( thromboembolic complications, cardiac arrhythmias, protracted bronchitis and pneumonia).With surgical correction of the blemish, a prognosis for life is favorable, provided that medications are taken as prescribed by the doctor and the development of complications is prevented.

    Doctor therapist Sazykina O.Yu.