Combined aortic heart disease: light, combined
Associated aortic heart disease refers to acquired defects.Most often they suffer from men.In the absence of adequate treatment, it can have very undesirable consequences.Combined heart defects are often confused with combined, but this is not correct.How to overcome a combined aortic valve defect, read in this article.
Features of a combined aortic heart disease
Combined aortic heart disease is a pathology that combines abnormalities in the structure and function of the main circulatory system.The first violation is associated with a decrease in the aortic duct when it leaves the heart, called stenosis of the aortic aorta.The second concerns the valve of the aorta, which carries the function of carrying out the blood barrier at its reverse current. Valve flaps are unable to completely collapse and blood can rush back to the heart. Such functional pathology is observed in the phase of ventricular diastole in the left part of the heart.
- Combined aortic heart disease develops in men after the onset o
f rheumatic diseases of organ systems with a predominance of inflammation in the heart.
- Women are more prone to other varieties of aortic malformations.
Typology of the disease
The disease progresses with the predominance of one or another type of pathology, which is the basis for the isolation of two forms of the disease:
- combined aortic disorder with predominant development of aortic stenosis in a narrow aortic lumen or normal;
- combined aortic malformation with predominant development of regurgitation( aortic valve insufficiency) with a pronounced aortic narrowing or without a change in the lumen of the trunk.
The pathology of the associated defect has 5 stages of progress:
- The first stage is characterized by complete compensation of the defect.The patient has no complaints, when studying the condition of the left ventricle, his moderate hypertrophy is revealed, there is no hyperplastic condition.
- In the second stage, the patient does not feel pain and discomfort in the heart area, but anatomical disorders occur: left ventricular hypertrophy is quite pronounced, the size of the left ventricle is larger than that of a healthy person.
- If the left ventricular hypertrophy is expressed in a sharp degree, and the size of the heart chamber has a clear increase, the patient is diagnosed with the third stage of a combined aortic malformation with moderate coronary insufficiency.
- Cardiologists set the fourth stage for left ventricular failure.The patient swells lungs at this stage of a combined aortic defect, there are frequent attacks of bronchial asthma.Mitral valve insufficiency is noted.
- The last, the fifth stage, states decompensation in the entire large circle of the patient's blood circulation.
You can find out how a double valve is shown in a combined aortic heart disease from the following video:
Reasons for the development of the pathology
The cases of detection of concomitant spleen of the heart do not have any recorded record of the inherent nature of the pathology, I.e.The acquired character of the pathology has an absolute value. The appearance of this type of blemish may be caused by the following reasons:
- disrupting the functioning of internal organs with predominant heart damage of rheumatic character;
- Inflammation of the inner membrane of the heart of an infectious nature - infectious endocarditis;
- deposition on the inner wall of the aorta of atherosclerotic plaques - atherosclerosis of the aorta;
- with syphilis( an infectious disease that has a source of infection - a pale treponem via the genital tract) in the initial stages of the disease, the skin and mucous membranes are affected.When untimely treatment of the disease, nodes with a pale treponema in the center and surrounding connective tissue membranes in the nervous system and internal organs are formed.One of these nodes can penetrate the aorta, forming a larger growth and causing, in time, a combined aortic defect.
Symptoms of the disease
Complaints of patients with a combined aortic defect are associated with signs of both narrowing of the artery( stenosis) and deformation of the valves of the aortic valve. The load in the reverse flow of blood and the problems of its movement from the heart to the aorta at the initial stages of the disease is left to the left ventricle, which is able to withstand such an increase in work, without letting the body know the pain and discomfort.Symptoms of a developing defect with predominance of aortic or valve damage are determined by the form of the disease.With pronounced signs of one of the violations in the cardiologist's task is the discovery of another disorder, symptomatically manifested less rapidly and intensely.
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The opinion of doctors. .. & gt; & gt;The general symptoms of a combined malformation may be as follows:
- sensation of increased heart beats and pulsations in the cervical region.
This symptom is associated with excess ventricular ejection( the amount of blood ejected is normal plus the returned blood from the aorta and the incompletely closed aortic valve); due to direct and reverse passage of blood through the aorta, the blood flow is disturbed not only in the aortic and left ventricle, but also in the coronary arteries of the heart that feed the organ itself.The lack of coronary blood supply causes pain in the squeezed area of pressing character; feeling of fatigue and malaise associated with an incorrect redistribution of arterial blood in the body; tachycardia develops as an adaptive mechanism of reducing the time for reverse flow of blood into the left ventricle; , when the blood flow through the aorta is reversed and its clearance is reduced, the brain cells do not receive sufficient oxygen supply, resulting in fainting, clouding of consciousness, and headaches.
If the patient is suspected of a combined aortic disorder, the following types of examination are prescribed to the patient:
- collecting an anamnesis from the patient's complaints about pain localization, limitation of their detection, etc.;
- anamnesis of the patient's life with a detailed explanation of the causes of the disease: the presence of infectious diseases in the past and what, whether a diagnosis of rheumatic fever, whether a tumor was found in him and his relatives, etc.;
- physical examination of the patient with pulse measurement in the ascending aorta, listening and percussion of the heart rhythm, measurements of systolic and diastolic pressure, examination of the skin in the nail and forehead, etc.;
- blood and urine test;
- magnetic resonance imaging and spiral computed tomography with obtaining radiographic images in different layers;
- X-ray chest examination with thoracic cavity examination;
- coronary cardiography;
- level of creatine, glucose, cholesterol, uric acid in a unit of blood volume;
- immunological blood test.
Patients with an identified disability are recommended to reduce physical activity.Strong physical load is fraught with an increase in blood flowing backward to the left ventricle, which threatens to rupture the aorta in the constricted part with a combined aortic defect.The increased need for blood supply can not be satisfied, as a result, the patient is likely to receive ischemic stroke and acute myocardial infarction.
The cause of the combined disorder should be eliminated during medical treatment.
If the disease is acute, the following types of medications are prescribed:
- vasodilators, removing the risk of increasing blood pressure, normalizing blood flow, slowing down the action of angiotensin converting enzyme;
- preparations for blockade of angiotensin receptors;
- means for excretion of calcium compounds from the cells reduce arrhythmia, increase the work of the heart;
- beta blockers are used only in cases of predominance of aortic stenosis.The pronounced insufficiency of the aortic valve should exclude the action of blockers;
- Verapamil and its analogues are calcium antagonists.
In the presence of complications or concomitant heart diseases, the treatment regimen is selected individually for the patient.
An operative treatment pathway for a patient with a combined aortic defect is indicated with low conservative treatment efficacy and disease stages that pose a risk to the patient's life. Operations are performed in two ways:
- transdermally( through the skin an endoscope is inserted into the aorta with devices for surgery), the patient's chest is not opened;
- with opening of the thorax and connection of the system of artificial circulation.
The following methods are distinguished according to the type of operations:
- Primary prevention, when a healthy lifestyle is being maintained, harmful habits are eradicated, infectious diseases are cured in a timely manner, casual sexual relations are eliminated, the organism is tempered from childhood.
- Secondary prophylaxis, when the defect is already detected, but it is necessary to reduce the effect of the causes that caused it and prevent the recurrence of rheumatic processes.
Complications that may occur with ASD:
- in the long absence of treatment of the disease, the ability of the left ventricle may decrease, and with it the mitral valve insufficiency may develop;
- may be impaired by blood flow to the arteries of the heart, and this threatens with acute infarction;
- cases of development of secondary infective endocarditis are not uncommon;
- often meets atrial fibrillation and similar disorders of the heart rhythm.
After operation, you may receive:
- thrombosis of the prosthesis or its destruction( for products from animal vessels) or calcification;
- infective endocarditis;
- Paravalvular fistulas.
In this case, you can make any predictions only taking into account the severity of the ailment that caused the development of the defect, as well as the condition of the myocardium.So, if such a disease became:
- atherosclerosis or rheumatism, then the prognosis is quite favorable;
- syphilis or infective endocarditis, then, alas, the prognosis is rarely positive.
Usually, from the moment of revealing an illness patients live more than 5 years.In this case:
- moderate severity of SAP does not reduce the patient's performance, he feels well;
- expressed degree and accompanying "troubles" often result in heart failure.