Congenital cardiovascular disease in the elderly
Introduction
Introduction to congenital cardiovascular disease in the elderly Congenital cardiovascular disease (CCD) referred to as congenital heart disease, refers to the fetal heart in the mother's development of defects or partial pauses, there are cardiovascular disease after birth, elderly congenital cardiovascular disease (ECCD) Atrial septal defect (ASD) is the most common, as well as congenital aortic stenosis (two-lobed), aortic coarctation, patent ductus arteriosus. basic knowledge The proportion of illness: 0.0001%-0.0003% Susceptible people: the elderly Mode of infection: non-infectious Complications: pulmonary hypertension
Cause
The cause of congenital cardiovascular disease in the elderly
(1) Causes of the disease
At present, the disease is considered to be a multifactorial disease, mainly due to the interaction between genetic factors and intrauterine environmental factors. The incidence of congenital heart disease in mothers with congenital heart disease is 316, and the father is a child with congenital heart disease. The incidence of congenital heart disease is 13, which is much higher than the prevalence of normal people. This indicates that genetic factors play an important role in the pathogenesis of congenital heart disease. Some intrauterine environmental factors also cause the risk of congenital heart disease, mainly Intrauterine viral infections (such as rubella virus), drug effects (such as phenytoin, warfarin), as well as the environment, premature delivery, advanced maternal, radiation effects.
(two) pathogenesis
Due to the different anatomical lesions, there are different types of atrial septal defect, mainly the patent foramen ovale, the first hole is not closed, and the second hole is not closed. It is more common in the ASD of the elderly congenital heart disease. ASD is a congenital heart malformation of atrial left-to-right shunt. In the ventricular systole, the second and tricuspid valves are closed, and the left and right atrial pressure steps are not large. In the ventricular diastolic phase, the blood is filled with resistance from the left atrium to the left ventricle. (Left ventricular wall thickness), filling pressure is also high; and blood through the atrial septal defect filling right ventricle encountered less resistance (right ventricular wall thin), filling pressure is also low, right ventricle easy to expand (good compliance), so ASD general For the left-to-right shunt in the diastolic phase, the size of the sub-flow depends mainly on the compliance of the left and right ventricles and the size of the defect. ASD patients can survive to the elderly, generally have a small defect, and the flow rate is not much, often in adolescence. It has been found that with age, especially in elderly patients with hypertension or coronary heart disease, left ventricular compliance can be reduced due to elevated blood pressure or myocardial ischemia caused by coronary heart disease, and left and right ventricular filling Increased pressure difference At this time, although the size of the defect is unchanged, the blood volume of the left-to-right shunt will increase sharply. The increase of long-term pulmonary blood flow may lead to intimal hyperplasia of the pulmonary arteriole, thickening of the middle layer, narrowing of the lumen, and significant increase of pulmonary artery pressure may occur. Pulmonary hypertension, when the pulmonary artery pressure is significantly increased, there may be a right-to-left shunt that causes cyanosis, called Eisenmenger's syndrome.
Prevention
Congenital cardiovascular disease prevention in the elderly
Avoid cold to prevent colds, and actively carry out surgery to cure the primary disease.
Complication
Congenital cardiovascular disease complications in the elderly Complications pulmonary hypertension
Complicated with pulmonary hypertension, atrial fibrillation, right heart failure and so on.
Symptom
Symptoms of congenital cardiovascular disease in the elderly Common symptoms Sudden fatigue after palpitations, asthma, edema, contraction, early sputum, hepatoma, hemoptysis, systolic murmur
Clinical symptoms
The symptoms of this disease vary depending on the size of the defect. The mild symptoms can be asymptomatic. The main symptoms are palpitations, wheezing, fatigue, cough and hemoptysis after exertion. In the later stage, cyanosis and right heart failure may occur, showing venous filling and hepatic enlargement. Edema, etc., the elderly may have paroxysmal supraventricular tachycardia, atrial flutter and other arrhythmias.
2. Signs
(1) The heart's voiced sounds are enlarged, and the left anterior sternal border of the anterior cerebral region may have a lifting pulsation.
(2) The second intercostal space on the left sternal border can be heard and squeaky in the 2 to 3 systolic period, and more often without tremor.
(3) The second heart sound of the pulmonary valve area is enhanced, and some patients with obvious division (fixed wide division) have early contraction of the contraction; when hypertension is present, the second heart sound of the aortic valve area is hyperthyroidism.
(4) When the pulmonary artery pressure is significantly increased, the diastolic air-like murmur caused by the relative pulmonary regurgitation may be heard, and the tricuspid valve area may smell the rumbling-like diastolic murmur or relativity caused by the relative tricuspid stenosis. Close the incompletely generated systolic murmur.
Examine
Examination of congenital cardiovascular disease in the elderly
Respiratory infections, elevated white blood cells.
1. X-ray examination: typical X-ray changes include: lung field congestion, pulmonary artery segmentation, pulmonary vascular shadow thick and pulsation enhanced; right atrium and right ventricle increased, pear-shaped heart; aortic arch is small.
2. Echocardiography: The central echo of the atrial septal defect can be interrupted, the right ventricle, the right atrium is enlarged, the pulmonary artery is widened; the color Doppler flow shows the red shunt column of the interatrial septum, and the elderly patients with hypertension with hypertension The wall of the chamber can be thickened; if coronary heart disease is combined, the segmental wall motion abnormality can be displayed, and the acoustic imaging can be performed for elderly patients with cyanotic ASD.
3. Electrocardiogram: There may be incomplete right bundle branch block, complete right bundle branch block and right ventricular hypertrophy, the former is the most common; P wave may increase, the right axis is biased, PR The period may be extended.
4. Magnetic resonance: The defect of the atrial septum can be displayed at different levels.
5. Cardiac catheterization: It can be proved that there is a left-to-right shunt in the atrial level. The cardiac catheter can enter the left atrium from the right atrium through the defect, to understand the size of the flow and the defect, the pressure and resistance of the pulmonary artery.
Diagnosis
Diagnosis and diagnosis of congenital cardiovascular disease in the elderly
diagnosis
According to typical symptoms and signs and laboratory findings, it is not difficult to diagnose the disease.
Differential diagnosis
1. High ventricular septal defect: The second and third intercostal spleen and systolic murmurs are often accompanied by systolic tremor. Unlike ASD, cardiac B-ultrasound is helpful for differential diagnosis.
2. Congenital pulmonary stenosis: its signs, electrocardiogram and X-ray findings have many similarities with the disease, but the former is mixed with acoustics, often accompanied by tremors, while P2 is reduced or inaudible; X-ray films show clear lung fields, Echocardiography has pulmonary valve abnormalities, and right heart catheterization has evidence of systolic pressure gradient between the right ventricle and the pulmonary artery without diversion, which can be confirmed.
3. Primary pulmonary hypertension: The patient has signs of pulmonary hypertension, but the lung field is not congested or clear, and there is no evidence of left-to-right shunt in the right heart catheter or echocardiography.
4. If the patient has a cyanosis, it must be differentiated from pulmonary heart disease.
