Acquired heart disease - aortic stenosis

Aortic stenosis, also called stenosis of the aortic valve or stenosis of the aortic estuary, refers to acquired heart defects, which are an organic lesion of the heart valves, its septa, large vessels and myocardium. The cause of the development of aortic stenosis, as a rule, is rheumatic endocarditis, although it can also be caused by infective endocarditis and atherosclerosis.

As a result of rheumatic endocarditis, the aortic valve flaps, their thickening and constriction of the aperture located between the left ventricle of the heart and the aorta occur. An obstruction is formed during the passage of blood during the contraction of the heart, from the left ventricle to the aorta, that is, the stenosis of the aortic valve. In this defect, coronary vessels are often involved in the pathological process.

Violation of hemodynamics

Aortic stenosis leads to a violation of hemodynamics when the area of the aortic orifice is reduced to 0.75-1.75 sq.cm at a rate of 3-4 cm2. During systole, the blood that is ejected by the left ventricle encounters considerable resistance. Increased contraction of the left ventricle does not have time to throw blood into the aorta and some part of it remains in the cavity of the ventricle. During the next diastole, the usual amount of blood from the left atrium is added to the left volume of blood to the left ventricle. Gradually, the volume of blood in the ventricle increases significantly, which leads to its extension. This overload leads to hypertrophy and dilatation of the left ventricle. While the ventricle copes with the increased load, no violations are observed. Over time, it can not fully meet the needs of organs and tissues in the blood.

Clinical picture

In the stage of compensated malformation, the patient may not have any complaints. Over time, with physical exertion, pain in the heart, dizziness, fainting may appear. In the stage of decompensation of the defect, these complaints become permanent. In addition, dyspnea appears in the patients, which in the early stages of the defect arises reflexively, cardiac asthma with a possible transition to pulmonary edema. Patients often feel heaviness and pain in the right hypochondrium.

When examining the patient, the pallor of the skin is revealed through the spasm of the skin vessels in response to a low cardiac output of the blood. As a result of heart failure with the development of blood stagnation in the circulatory system appears acrocyanosis.

During palpation, a strengthened apical and cardiac impulse can be determined. With heart failure, the apical impulse is strengthened and shifts down and to the left. When performing palpation, systolic tremor of the thoracic wall in the second intercostal space is determined on the right, which is called the cat's purring symptom, at the Botkin point and in the jugular fossa.

Stenosis of the aortic orifice is auscultatory manifested by a weakening of the heart tones, splitting or bifurcation of the I tone and a rough intense systolic murmur in the second intercostal space to the right of the sternum. Noise is well carried into the jugular and supraclavicular fossa, to the carotid arteries.

Pulse and blood pressure during the compensation period of the blemish are not changed. As decompensation develops, systolic and pulse pressure decrease, the pulse becomes slow, bradycardia appears.

Diagnose aortic stenosis with the help of ECG, FCG, echocardioscopy data.

Treatment

Conservative treatment of aortic stenosis is the treatment of the main cause of the development of this disease - rheumatism, atherosclerosis, infective endocarditis, as well as manifestations of cardiac and coronary insufficiency.

If aortic stenosis is accompanied by an increase in the systolic pressure gradient on the aortic valve, the question arises about the need for surgical intervention. The most common method of surgery is balloon dilatation, but the main method of correcting this defect is aortic valve replacement.