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The acquired heart diseases


The acquired heart diseases – group of the diseases (a stenosis, insufficiency of the valve, combined and the combined defects) which are followed by violation of a structure and functions of the valvate device of heart, and leading to changes of intracardial blood circulation. The compensated heart diseases can proceed is reserved, dekompensirovanny are shown by short wind, heartbeat, fatigue, heartaches, tendency to faints. At inefficiency of conservative treatment operation is performed. Are dangerous by development of heart failure, disability and a lethal outcome.

The acquired heart diseases

The acquired heart diseases – group of the diseases (a stenosis, insufficiency of the valve, combined and the combined defects) which are followed by violation of a structure and functions of the valvate device of heart, and leading to changes of intracardial blood circulation. The compensated heart diseases can proceed is reserved, dekompensirovanny are shown by short wind, heartbeat, fatigue, heartaches, tendency to faints. At inefficiency of conservative treatment operation is performed. Are dangerous by development of heart failure, disability and a lethal outcome.

At heart diseases morphological changes of structures of heart and blood vessels cause violation of warm function and haemo dynamics. Distinguish the congenital and acquired heart diseases.

Congenital defects are caused by violations of development of heart and the main blood vessels in the prenatal period or preservation of pre-natal features of blood circulation after the birth. Various forms of congenital heart diseases occur at 1-1,2% of newborns and include both rather easy, states incompatible with life. Most often among vnutriutrobno the formed heart diseases the defects of interventricular and mezhpredserdny partitions, a stenosis and an abnormal arrangement of the main vessels developing as a result of the wrong formation of cavities of heart or division of primary general vascular trunk into an aorta and pulmonary artery meet.

After the birth at preservation of pre-natal features of blood circulation such heart diseases as an open arterial (botall) channel or a nezarashcheniye of an oval opening (an open oval window) develop. At congenital heart diseases it can be observed as the isolated damage of heart or vessels, and complex (for example, a triad or Fallo's tetrad). Pre-natal defects of development of the valvate device also occur among congenital heart diseases: semi-lunar valves of an aorta and pulmonary table, the left and right predserdno-ventricular.

Among the acquired heart diseases more than 50% are the share of defeat of the two-fold (mitralny) valve, about 20% - the semi-lunar valve of an aorta. The following types of defects of predserdno-ventricular openings and valves meet: stenosis, insufficiency, prolapse. Insufficiency of valves arises because of a sklerozirovaniye (deformation and shortening) shutters owing to what there is their incomplete smykaniye.

The stenosis (narrowing) of an atriventrikulyarny opening develops as a result of post-inflammatory cicatricial unions of the shutters of the valve reducing the area of an opening. Quite often insufficiency and a stenosis at the same time arise on one valvate device – such heart disease is called combined. If changes affect several valves, speak about the combined heart disease.

At a prolapse of the valve there is its protrusion, a vybukhaniye or a reversing of shutters in a heart cavity. The leading role in development of the acquired heart diseases belongs to rheumatism and a rheumatic endocarditis (75% of cases), a smaller part is caused by atherosclerosis, sepsis, injuries, system diseases of connecting fabric, etc. the reasons.

Classification of heart diseases

The acquired heart diseases are classified by the following signs:

  1. Etiology: rheumatic, owing to an infectious endocarditis, atherosclerotic, syphilitic, etc.
  2. Localization of the struck valves and their quantity: isolated or local (at defeat of 1 valve), combined (at defeat of the 2nd and more valves); defects of aortal, mitralny, trikuspidalny valves, valve of a trunk of a pulmonary artery.
  3. Morphological and functional defeat of the valvate device: stenosis of an atrioventricular opening, insufficiency of the valve and their combination.
  4. Degree of expressiveness of defect and extent of violation of haemo dynamics of heart: not having significant effect on intracardial blood circulation, moderately or sharply expressed.
  5. Condition of the general haemo dynamics: the compensated heart diseases (without insufficiency of blood circulation) subcompensated (with the passing decompensation caused by physical overworks, fever, pregnancy etc.) and dekompensirovanny (with the developed insufficiency of blood circulation).

Insufficiency of the left predserdno-ventricular valve

(mitralny insufficiency)

At mitralny insufficiency the two-fold valve during a systole of the left ventricle completely does not block the left predserdno-ventricular opening therefore there is a regurgitation (the return throwing) of blood in an auricle. Insufficiency of the mitralny valve can be relative, organic and functional.

As the reasons of relative insufficiency at this heart disease serve the myocardites, miokardiodistrofiya leading to weakening of the circular muscle fibers serving as a muscular ring around an atrioventricular opening or damage of papillary muscles which reduction helps with systolic closing of the valve. The Mitralny valve at relative insufficiency is not changed, however an opening which it covers, is increased and as a result is not blocked by shutters completely.

The leading role in development of organic insufficiency is played by the rheumatic endocarditis causing development of connecting fabric in shutters of the mitralny valve, and further - wrinkling and shortening of shutters, and also the tendinous threads connected to it. These changes lead to an incomplete smykaniye of shutters during a systole and to formation of the crack promoting the return current of a part of blood in the left auricle.

At functional insufficiency operation of the muscular device regulating closing of the mitralny valve is broken. Also functional insufficiency is characterized regurgitatsiy blood from the left ventricle in an auricle and quite often meets at a prolapse of the mitralny valve.

In compensation stage at insignificant or moderate insufficiency of the mitralny valve patients of complaints do not show and do not differ externally from healthy people; HELL and pulse are not changed. Compensated mitralny heart disease there can be long time, however when easing sokratitelny ability of a myocardium of the left departments of heart stagnation at first in a small, and then and big circle of blood circulation increases. In a dekompensirovanny stage there are cyanosis, short wind, heartbeat, further – hypostases on the lower extremities, the painful, increased liver, , swelling of veins of a neck.

Narrowing of the left predserdno-ventricular opening

(mitralny stenosis)

At a mitralny stenosis the reason of defeat of the left atrioventricular (predserdno-ventricular) opening it serves usually long the proceeding rheumatic endocarditis, the stenosis is more rare happens congenital or develops owing to an infectious endocarditis. Stenozirovany a mitralny opening it is caused by an union of shutters of the valve, their consolidation, a thickening, and also shortening of tendinous chords. As a result of changes the mitralny valve gets a funneled form with a slit-like opening in the center. Less often the stenosis is caused by cicatricial and inflammatory narrowing of a valvate ring. At a long mitralny stenosis of fabric of the valve can .

During compensation of the complaint are absent. At a decompensation and development of stagnation in a small circle of blood circulation cough, a blood spitting, short wind, heartbeat and interruptions, heartaches develop. At survey of the patient also the tsianotichesky flush on cheeks in the form of "butterfly" attracts attention , at children lag of physical development, "a warm hump", infantility is observed. At a mitralny stenosis pulse on the left and right hand can differ. As the considerable hypertrophy of the left auricle causes a sdavleniye of a subclavial artery, filling of the left ventricle decreases, and, therefore, and shock volume decreases - pulse becomes small filling at the left. Quite often at a mitralny stenosis vibrating arrhythmia, HELL usually normal develops, the insignificant tendency to decrease systolic and to increase in diastolic pressure is less often observed.

Insufficiency of the valve of an aorta

Insufficiency of the aortal valve (aortal insufficiency) develops at an incomplete smykaniye of the semi-lunar gates normal blocking an aorta opening therefore blood in a diastola comes from an aorta back to the left ventricle. At 80% of patients insufficiency of the aortal valve develops after a rheumatic endocarditis, is much more rare – as a result of an infectious endocarditis, atherosclerotic or syphilitic damage of an aorta, injuries.

Morphological changes in the valve are caused by the defect development reason. At rheumatic defeat inflammatory and sclerous processes in shutters of the valve cause their wrinkling and shortening. At atherosclerosis and syphilis the aorta can be surprised, extending and delaying shutters of not changed valve; sometimes valve shutters are exposed to cicatricial deformation. Septic process causes disintegration of parts of the valve, education in shutters of defects and the subsequent their scarring and shortening.

Subjective feelings at aortal insufficiency can long not be shown since this type of heart disease is compensated for the account of the strengthened work of the left ventricle. Over time the relative coronary insufficiency which is shown feelings of pushes and pains (as stenokardichesky) in heart develops. They are caused by a sharp hypertrophy of a myocardium and deterioration in a krovenapolneniye of coronal arteries with a low pressure in an aorta during a diastola.

As frequent manifestations of aortal insufficiency serve headaches, a pulsation in the head and a neck, dizziness, orthostatic faints as a result of violation of blood supply of a brain with a low diastolic pressure.

Further weakening of sokratitelny activity of the left ventricle leads to stagnation in a pulmonary circle of blood circulation and to emergence of short wind, weakness, heartbeat, etc. At external survey pallor of skin, , caused by an unsatisfactory krovenapolneniye of the arterial course in a diastola is noted.

Sharp fluctuations of arterial pressure in a diastola and a systole cause a pulsation on peripheral arteries: subclavial, sleepy, temporal, humeral, etc. also rhythmical swing of the head (Musset's symptom), change of coloring of nail phalanxes when pressing on a nail (Quincke's symptom or capillary pulse), narrowing of pupils in a systole and expansion in a diastola (a symptom of Landolfi).

Pulse at insufficiency of the aortal valve bystry and high owing to the increased shock volume of blood coming during a systole to an aorta and big pulse pressure. Arterial pressure at this type of heart disease is always changed: diastolic is lowered, systolic and pulse - are raised.

Stenosis of the mouth of an aorta

Narrowing or stenosis of the mouth of an aorta (aortal stenosis, narrowing of an aortal opening) at reductions of the left ventricle interferes with exile of blood in an aorta. This type of heart disease develops after the postponed rheumatic or septic endocarditis, at atherosclerosis, congenital anomaly. The stenosis of the mouth of an aorta is caused by an union of shutters of the semi-lunar valve of an aorta or cicatricial deformation of an aortal opening.

Signs of a decompensation develop at the expressed degree of a stenosis of an aortal opening and insufficient emission of blood in system of arteries. Violation of blood supply of a myocardium leads to emergence of heartaches of stenokadichesky type; reduction of blood supply of a brain - to headaches, dizziness, unconscious states. Clinical manifestations are more expressed at physical and emotional activity.

Due to the unsatisfactory krovenapolneniye of the arterial course integuments of patients pale, pulse small and rare, systolic arterial pressure is reduced, diastolic – is normal or is increased, pulse - is reduced.

Insufficiency of the right predserdno-ventricular valve

(trikuspidalny insufficiency)

At trikuspidalny heart disease organic and relative insufficiency of the right (three-leaved) predserdno-ventricular valve can develop. As the reasons of organic insufficiency serve the rheumatic or septic endocarditises, injuries which are followed by a rupture of a papillary muscle of the three-leaved valve. The isolated trikuspidalny insufficiency develops extremely seldom, usually it is combined with other valvate heart diseases.

Organic insufficiency is caused by expansion of the right ventricle and stretching of the right atrioventricular opening; it is often combined with mitralny heart diseases when in connection with high pressure load of the right ventricle increases in a small circle of blood circulation.

At insufficiency of the trikuspidalny valve the expressed developments of stagnation in venous system of a big circle of blood circulation cause emergence of hypostases and ascites, heavy feelings in the right podreberye, the pains connected with a gepatomegaliya. Integuments are cyanotic, sometimes with a yellowish shade. Cervical veins and veins of a liver (a syndrome of positive wine pulse) bulk up and pulse. The pulsation of veins is connected with throwing of blood from the right ventricle back in an auricle through the atrioventricular opening which is not blocked by the valve. In view of a blood regurgitation pressure in an auricle increases, and depletion of hepatic and cervical veins is at a loss.

Peripheral pulse usually does not change or becomes frequent and small, HELL is lowered, the central venous pressure increases to 200 — 300 mm of a water column.

As a result of long venous stagnation in a big circle of blood circulation trikuspidalny heart disease quite often is followed by heavy heart failure, violation of functions of kidneys, a liver, digestive tract. The expressed morphological changes are observed in a liver: development in it connecting fabric causes, the so-called, cardiac fibrosis of a liver leading to a heavy metabolic disorder.

The combined and combined heart diseases

Among the acquired heart diseases, especially rheumatic origin, the combination of defects (a stenosis and insufficiency) of the valvate device, and also the simultaneous, combined defeat of the 2nd or 3rd valves of heart often meets: aortal, mitralny and trikuspidalny.

Among the combined heart diseases insufficiency of the mitralny valve and a stenosis of a mitralny opening with prevalence of signs of one of them most often come to light. The combined mitralny heart disease early is shown by short wind and cyanosis. If mitralny insufficiency prevails over a stenosis, then HELL and pulse almost do not change, in the return case small pulse, the systolic and increased arterial pressure lowered are defined.

As the reason of the combined aortal heart disease (an aortal stenosis and aortal insufficiency) usually serves the rheumatic endocarditis. Aortas, characteristic of insufficiency of the valve (the increased pulse pressure, a vascular pulsation) and for an aortal stenosis (slow and small pulse, the reduced pulse pressure) signs at the combined defect of an aorta are not so sharply expressed.

The combined defeat of the 2nd and whether 3 valves it is shown by the symptoms typical for each defect separately. At the combined heart diseases it is necessary to reveal the prevailing defeat for definition of a possibility of surgical correction and further predictive estimates.

Diagnosis of the acquired heart diseases

At patients with suspicion of heart disease the health at rest, shipping of physical activities is investigated by them, the rheumatic and other anamnesis leading to formation of defects of the valvate device of heart is specified.

By means of fizikalny methods (survey, a palpation) existence of cyanosis, a pulsation of peripheral veins, short wind, hypostases reveal. Heart borders are defined by Perkutorno (for definition of a hypertrophy), warm noise and tones are listened (for clarification of a type of defect), the auskultation of lungs and palpatorny determination of the sizes of a liver is carried out (for diagnosis of heart failure).

Record ECG and daily monitoring of the ECG carry out for diagnostics of a rhythm of heart, a type of arrhythmia, blockade, symptoms of ischemia. Tests with loading are carried out at suspicion on aortal insufficiency in the presence of the cardiologist-resuscitator since they are unsafe for patients with heart disease. By means of results of the phonocardiography registering noise and tones of heart violations of warm activity, including defects of valves of heart are distinguished.

The roentgenogram of heart is carried out in four projections with contrasting of a gullet for diagnostics of pulmonary stagnation (Kerli's line), confirmation of a hypertrophy of a myocardium, specification of a type of heart disease. By means of an echocardiography defect, the area of an atrioventricular opening, expressiveness of a regurgitation, a state and the sizes of valves, chords is diagnosed, pressure in a pulmonary trunk, fraction of warm emission is defined. More exact data can be obtained at behavior of MCKT or MPT of heart.

From laboratory researches the greatest diagnostic value at heart diseases has conducting rheumatoid tests, definition of sugar, cholesterol, all-clinical blood tests and urine. Similar diagnostics is carried out as at primary inspection of patients with suspicion of heart disease, and in dispensary groups of patients with the established diagnosis.

Treatment of the acquired heart diseases

The conservative treatment which is carried out at heart diseases concerns prevention of complications and a recurrence of primary disease (rheumatism, infectious an endocarditis, etc.), corrections of violations of a rhythm and heart failure. Consultation of the heart surgeon is necessary for all patients for determination of terms of timely surgical treatment with the revealed heart diseases.

At a mitralny stenosis make a mitralny komissurotomiya with separation of accrete shutters of the valve and expansion of a predserdno-ventricular opening therefore the stenosis is partially or completely liquidated and heavy disorders of haemo dynamics are eliminated. At insufficiency carry out prosthetics of the mitralny valve.

At an aortal stenosis operation of an aortal komissurotomiya is performed, at insufficiency – prosthetics of the aortal valve. At the combined defects (a stenosis of an opening and insufficiency of the valve) usually make replacement of the destroyed valve on artificial, sometimes combine prosthetics with a komissurotomiya. At the combined defects perform operations on their one-stage prosthetics now.

The forecast at the acquired heart diseases

The minor changes from the valvate device of heart which are not followed by damage of a myocardium long time can remain in a phase of compensation and not break working ability of the patient. Development of a decompensation at heart diseases and their further forecast is defined by a number of factors: the repeated rheumatic attacks, intoxications, infections, a physical overwork, a nerve strain, at women – pregnancy and childbirth. The progressing defeat of the valvate device and a cardiac muscle leads to development of heart failure, sharply developed decompensation – to death of the patient.

Predictively the current of a mitralny stenosis since the myocardium of the left auricle is not able to support long compensated stage is adverse. At a mitralny stenosis early development of developments of stagnation of a small circle and insufficiency of blood circulation is observed.

Prospects of working capacity at heart diseases are individual and are defined by the size of physical activity, fitness of the patient and his state. In lack of signs of a decompensation working capacity can not be broken, at development of insufficiency of blood circulation easy work or the termination of work is shown. At heart diseases moderate physical activity, refusal of smoking and alcohol, performance of physiotherapy exercises, sanatorium treatment in cardiological resorts (Matsesta, Kislovodsk) are important.

Prevention of the acquired heart diseases

Prevention of rheumatism, septic states, syphilis belong to actions for the prevention of development of the acquired heart diseases. Sanitation of the infectious centers, a hardening, increase in fitness of an organism is for this purpose carried out.

At the created heart disease for the purpose of the warning of heart failure to patients it is recommended to observe the rational motive mode (foot walks, remedial gymnastics), good proteinaceous nutrition, restriction of reception of table salt, to refuse sharp changes of climate (especially mountainous) and active sports trainings.

For the purpose of control of activity of rheumatic process and compensation of warm activity at heart diseases dispensary observation at the cardiologist is necessary.

The acquired heart diseases - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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