Acquired Heart Defects

Lesions of the heart valve(s), the valves of which are unable to fully open (stenosis) or close (valve insufficiency) or both (combined defect). Etiology and pathogenesis. The etiology of stenosis and combined defect is rheumatic, valve insufficiency is usually rheumatic, rarely septic, atherosclerotic, traumatic, syphilitic.

Stenosis is formed as a result of cicatricial fusion or cicatricial rigidity of the valve leaflets and subvalvular structures; valve insufficiency - due to their destruction, damage or scar deformation. Affected valves form an obstacle to the passage of blood - anatomical in case of stenosis, dynamic in case of insufficiency. The latter is that although some of the blood passes through the hole, it returns back in the next phase of the cardiac cycle.

A “parasitic” volume is added to the effective volume, performing a pendulum-like movement on both sides of the affected valve. Significant valvular insufficiency is complicated by relative stenosis (due to an increase in blood volume). Obstruction to the passage of blood leads to overload, hypertrophy and expansion of the overlying chambers of the heart. The expansion is more significant with valve insufficiency, when the overlying chamber is stretched by additional blood. With stenosis of the atrioventricular orifice, the filling of the underlying chamber is reduced (left ventricle with mitral stenosis, right ventricle with tricuspid stenosis); There is no hypertrophy or expansion of the ventricle.

With valve insufficiency, the filling of the corresponding ventricle is increased, the ventricle is dilated and hypertrophied. Difficulty in the functioning of the heart due to improper functioning of the valve and degeneration of the hypertrophied myocardium leads to the development of heart failure.

The diagnosis must contain an indication of the etiology (proven or probable) of the defect, its form, the presence of heart failure (if present, then its degree). It should be taken into account that anamnestic indications of the etiology of the defect - rheumatism, sepsis, syphilis, trauma - are not always clear enough, and indications of frequent sore throats are not very specific.

The defect itself is manifested almost exclusively by acoustic signs. Echocardiographic examination allows you to detect stenosis and assess its degree; in sectoral scanning mode, the degree of mitral stenosis (the area of ​​the left atrioventricular orifice) is determined with great accuracy. Valve insufficiency is judged by indirect signs - dilatation and volume overload of the chambers.

A Dopplercardiographic study reveals reverse blood flow (valve insufficiency).

Treatment of the defect itself can only be surgical. To clarify the indications for such treatment, timely consultation with a cardiac surgeon is necessary.

Conservative therapy is reduced to the prevention and treatment of relapse of the main process and complications, to the treatment and prevention of heart failure, as well as heart rhythm disturbances. Timely and adequate professional guidance and employment of the patient are of great importance.

Mitral valve disease is a lesion of the mitral valve, accompanied by difficulty in the passage of blood from the small circle to the large circle at the level of the left atrioventricular opening.

Heart failure manifests itself primarily in the form of congestive left ventricular failure, then right ventricular failure.

Symptoms, course. With increasing pressure in the pulmonary circle, complaints of shortness of breath (more pronounced with stenosis), palpitations, cough appear, and with increasing right ventricular failure - fluid retention and pain in the right hypochondrium.

Upon examination and palpation, signs of congestive right ventricular failure may be detected; in severe cases, a characteristic cyanotic blush of the cheeks and lips is noticeable. Extrasystole often occurs. Atrial fibrillation with insufficiency occurs no less frequently than with