Aortit - the inflammatory process taking separate layers or all thickness of a wall of an aorta. Depending on an etiology and localization of defeat aortit it can be shown by development of an aortalgiya, a belly toad, vazorenalny hypertensia, ischemia of extremities; oznoba, fever, attacks of dizzinesses and faints. Aortit it is diagnosed on the basis of laboratory (biochemical, immunological) and tool researches (an aortografiya, UZDG, KT). Treatment of an aortit, first of all, assumes therapy of the main disease (infectious, allergic, autoimmune defeat).
Aortit – vaskulit, a special case of an aortoarteriit with exclusive or primary damage of an aorta. In view of variety of the reasons leading to development of an aortit, the disease is not only in sight of cardiology, but also rheumatology, venereology, allergology, pulmonology and phthisiology, traumatology.
Usually at an aortita the chest aorta is surprised, is more rare – belly. If the inflammation takes separate layers of an aorta, speak about an endaortita, a mezaortita, a periaortita; at defeat of all thickness of an arterial wall (intims, mussels and adventition) – about a panaortita. On distribution aortit can be ascending, descending and diffusion.
Reasons of an aortit
Depending on an etiology allocate 2 groups of aortit: infectious and allergic. Development of an infectious aortit is connected with penetration of the infectious activator into an aorta wall in the hematogenic or limfogenny way or distribution of inflammatory process on an aorta from fabrics, adjacent to it. Specific infectious aortit most often develops at syphilis, tuberculosis, is more rare – at a brucellosis. Nonspecific aortit usually has the bacterial nature and it is usually connected with the previous streptococcal infection and rheumatic fever. The aorta can be involved in an inflammation at lung abscess, a mediastinita, an infectious endocarditis.
Allergic aortit most often is caused by autoimmune diseases, collagenases, system vaskulita (Takayasu's disease). Cases of an aortit at Bekhterev's disease (an ankiloziruyushchy spondiloartrit), rheumatoid arthritis, the obliterating trombangiit are described. Aortit can be a component of a syndrome of Kogan who is also characterized by an inflammatory keratit, vestibular and acoustical dysfunction.
Classification and pathogenesis of an aortit
Taking into account prevalence of these or those pathological processes, distinguish purulent, necrotic, productive, granulematozny forms of an aortit. Purulent and necrotic aortita have a sharp or subsharp current, the others – chronic. Pathological changes in an arterial wall have the differences at aortita of various etiology.
At an aortita of the syphilitic nature the intimalny layer of an aorta is exposed to inflammatory and skleroziruyushchy processes therefore becomes wrinkled, cicatricial changed, with the rough folds reminding tree bark. Mouths of coronal arteries, and also semi-lunar gates of the valve of an aorta are involved in pathological process, promoting emergence of aortal insufficiency. In the late period of a syphilitic aortit meshkovidny or diffusion aneurisms of an aorta are formed. In an aorta wall syphilitic gumma sometimes are found.
Tubercular aortit develops at the corresponding damage of lymph nodes, lungs, bodies of a sredosteniye, zabryushinny space. In a vascular wall specific granulations and the centers of a kazeozny necrosis are formed. Existence of an ulceration an edoteliya, an aneurysm, a kaltsinoza of a wall of an aorta, perforation is characteristic of a tubercular aortit.
Rheumatic damage of an aorta proceeds as a panaortit. In this case in all layers of an aorta mukoidny hypostasis, fibrinoidny swelling with the subsequent granulematoz and a sclerosis develops. Purulent aortit is followed by a flegmonozny or abstsediruyushchy inflammation of a wall of an aorta, its stratification and perforation. Usually the inflammation passes to an aorta wall from the next bodies, surrounding cellulose or owing to septic thrombosis.
Ulcer and necrotic aortit usually is a consequence of a bacterial endocarditis, sepsis, is more rare – a complication of operations on the aortal valve or an open arterial channel. At the same time in an endoteliya of an aorta vegetations, the trombotichesky mass, sites of an ulceration, stratifying and perforation of an aortal wall come to light. Nonspecific aortoarteriit (Takayasu's disease) proceeds as a productive inflammation with hyperproduction of fibrous fabric.
Symptoms of an aortit
The clinical picture of an aortit is developed against the background of symptoms of the main disease (syphilis, rheumatism, tuberculosis, an infectious endocarditis, sepsis, etc.).
Actually aortit, mainly, it is shown by symptoms of ischemia of the bodies receiving blood supply through the main branches of an aorta. So, ischemia of a brain is followed by dizzinesses, headaches, sight violations, faints; ischemia of a cardiac muscle - stenocardia, a myocardial infarction (quite often bezbolevy); ischemia of kidneys – arterial hypertension; intestines ischemia – attacks of a belly toad.
Characteristic sign of an aortit are aortalgiya – the pains on the course of an affected area of an aorta connected with involvement of paraaortal nervous textures. Damage of a chest aorta is followed by the pressing or burning thorax pains which can be displaced in a neck, both hands, between shovels, epigastralny area. There can be tachycardia, short wind, koklyushepodobny cough which reasons are not clear. In case of damage of a belly aorta of pain are localized in a stomach or a waist. The pain syndrome at an aortita is expressed almost constantly, intensity of pains periodically changes.
Early patognomonichny sign of an aortit is asymmetry of pulse on beam, subclavial and carotids or its total absence on one party. At measurement of arterial pressure on one hand it can be considerably lowered or not be defined absolutely.
Bacterial embolisms, the stratified aorta aneurisms, a rupture of an aorta can be complications of an aortit a thrombembolia. Manifestations of a syphilitic aortit usually develop in 15-20 years after infection. Up to development of complications (aortal insufficiency, a cardiosclerosis, heart failure) syphilitic aortit proceeds almost asymptomatically.
Diagnostics of an aortit
For clarification of the reasons of damage of an aorta sick with suspicion on aortit have to be consulted by the venereologist, the rheumatologist, the phthisiatrician, the cardiologist. Justification of the diagnosis of an aortit requires studying of clinical, laboratory and tool data.
At suspicion on rheumatic aortit S-jet protein, blood immunoglobulins, anti-nuclear antibodies, the circulating immunocomplexes, etc. is investigated. Confirmation of a syphilitic aortit requires conducting serological blood tests (RPR test) or cerebrospinal fluid. At a tubercular aortit the phlegm research on VK by the PTsR method, a full radiological research (a X-ray analysis of lungs, a tomography) is shown. Diagnostics of a bacterial aortit demands carrying out crops of blood on sterility.
Treatment of an aortit
Treatment of an aortit is inseparably linked with active therapy of the main disease. At an infectious aortit as medicines of the first row serve antibiotics; at an allergic aortit – glucocorticoids, NPVS, immunosupressor; at a syphilitic aortit - medicines of bismuth, iodine, antibiotics of a penicillinic row. Efficiency of therapy is traced on dynamics of clinical laboratory indicators.
Existence of aneurism of an aorta, in particular signs of its stratification, is the basis for consultation of the vascular surgeon and angiokhirurgichesky treatment - aneurism resections with the subsequent prosthetics of an aorta. At development of an aortal stenosis carrying out balloon dilatation, stenting or shunting can be required.
Forecast and prevention of an aortit
Gravity of the forecast at an aortita is defined by its form and an etiology. The most serious forecast at a sharp and subsharp current of a bacterial aortit. The current of a syphilitic and tubercular aortit of subjects is more favorable, than specific treatment is begun earlier. Development of other forms of a chronic aortit more depends on the main disease. In the absence of treatment the disease is inclined to progressing and the complicated current.
For the prevention of an aortit timely therapy of primary diseases, prevention of STD, active detection of tuberculosis has paramount value.