heart valve disease
Introduction
Introduction to valvular heart disease Heart valve disease is a very common heart disease in China, and valvular damage caused by rheumatic fever is one of the most common causes. With the aging of the population, valvular lesions caused by senile valvular disease and coronary heart disease after myocardial infarction are also becoming more common. These valvular lesions not only endanger life safety, affect the quality of life, but also bring heavy burdens and pressures to families and society. Therefore, the whole society needs to pay more attention to and raise awareness of this disease. To understand heart valve disease, start with the structure of the heart. The heart of the human body is divided into four chambers: the left atrium, the left ventricle, the right atrium, and the right ventricle. The two atriums are connected to the two ventricles, and the two ventricles are connected to the two aorta. The heart valve grows between the atria and the ventricles, between the ventricles and the aorta, acting as a one-way valve that helps the blood flow in one direction. The four valves of the human body are called the mitral valve, the tricuspid valve, the aortic valve and the pulmonary valve. If these valves have lesions, they will affect the movement of the bloodstream, causing abnormal heart function and eventually leading to heart failure. basic knowledge The proportion of illness: 0.012% Susceptible people: no special people Mode of infection: non-infectious Complications: acute pulmonary edema, acute heart failure, chronic heart failure, heart failure, infective endocarditis
Cause
Causes of valvular heart disease
Disease factor (35%)
1, rheumatic fever: is a common recurrent acute or chronic body connective tissue inflammation, mainly involving the heart, joints, central nervous system, skin and subcutaneous tissue. The clinical manifestations are mainly carditis and arthritis, which may be accompanied by fever, toxemia, rash, subcutaneous nodules, and chorea. Arthritis is usually more pronounced in acute attacks, but rheumatoid carditis can cause death in this stage. Acute heart attacks often leave different types of heart damage, especially valvular lesions, which form chronic rheumatic heart disease or rheumatic valvular disease.
2, mucus degeneration: mucus-like changes are common in mesenchymal tumors, atherosclerotic plaque, rheumatic lesions and malnutrition of bone marrow and adipose tissue. Such as rheumatic endocarditis, mitral or mitral and aortic valve involvement, mucinous and fibrinous necrosis, serous exudation and inflammatory infiltration.
3. Ischemic necrosis: The characteristic pathological change of ischemic necrosis is the death of bone cells caused by the blocked blood supply. The severity of ischemic necrosis depends on the degree of damage of the circulatory system.
Infection and trauma (25%)
Various infections and trauma can cause a single valvular lesion and can also cause multiple valvular lesions. The type of valvular lesion is usually narrow or incomplete. Once stenosis or insufficiency occurs, it can impede normal blood flow and increase the burden on the heart, causing damage to the heart and leading to heart failure.
Congenital factors (25%)
For example, tricuspid atresia is a cyanotic congenital heart disease, the incidence of which accounts for 1% to 5% of congenital heart disease, refers to the structural or chromosomal abnormalities of the fetus in the uterus.
Prevention
Heart valve disease prevention
Taking rheumatic heart disease as an example, the prevention of rheumatic heart disease should first focus on preventing the occurrence of rheumatic fever, so that heart valve disease has no basis at all. Once the valve damage has been formed, it is still necessary to actively control and prevent rheumatic activity, control symptoms, and improve heart function so as not to aggravate the lesion.
1. Prevention of streptococcal infection
Should pay attention to residential hygiene, acute streptococci infections such as scarlet fever, acute tonsillitis, pharyngitis, otitis media and lymphadenitis should be actively and thoroughly treated to avoid the onset of rheumatic fever. Repeated episodes of rheumatic fever can increase the damage of the heart valve.
2. Work and rest
Appropriate exercise and physical labor can increase the compensatory capacity of the heart. Patients without symptoms such as difficulty breathing can work and live as usual, but avoid vigorous exercise and heavy physical labor. Rest can reduce the burden on the heart. It is a necessary measure to prevent and treat this disease. The patient's condition should be based on symptoms and doctor's paralysis, restrict physical activity to varying degrees, or even stay in bed until the heart function is improved.
3. Stabilize the mind
Many people with rheumatic heart disease are nervous, and when they are emotionally excited, they will suddenly have tachycardia, increase the burden on the heart, and cause heart failure, so they should be calm and indifferent.
4. Reasonable diet
(1) Rheumatic heart disease is prone to edema, so it is necessary to limit the intake of salt, prevent edema from increasing, and prevent the burden on the heart. In general, the daily intake of salt in patients with rheumatic heart disease is between 1 and 5 grams. Suitable.
(2) Reduce the high-fat diet: the commercial fat diet is not easy to digest after ingestion, it will increase the burden on the heart, and some will also have arrhythmia, so use less or not a high-fat diet.
(3) The same as the restriction of salt, patients with rheumatic heart disease should eat less sodium-rich foods such as bananas, so as not to cause pulmonary edema.
(4) Slow-feeding beverages: When drinking a large amount of water, tea, soup, fruit juice, soft drinks or other beverages at a time, it will increase the blood volume rapidly, thereby increasing the burden on the heart. Therefore, do not eat too much, preferably no more than 500 ml at a time. When you need to drink more water, divide it into several drinks, each time less, and the interval is longer.
(5) stimulating food and excitement drugs: pepper, ginger, pepper, tobacco, wine and heavy drinking tea, taking caffeine, amphetamine and other stimulants will also burden the heart, heart function in patients with rheumatic heart disease When you are not good, pay special attention.
Complication
Complications of valvular heart disease Complications acute pulmonary edema acute heart failure chronic heart failure heart failure infective endocarditis
Common complications of valvular heart disease
Because combined valvular disease is caused by rheumatic heart disease (RHD), its complications are mostly related to rheumatic heart disease:
(1) Atrial fibrillation (Af): Af is the most common arrhythmia, with a prevalence of more than 50%. It is a relatively early complication, sometimes a first-episode disorder, or a cause of first-time dyspnea or limited physical activity. s begin. Start early room room speed atrial flutter paroxysmal atrial fibrillation (PAf) chronic persistent Af permanent Af. Atrial fibrillation: Late diastolic, atrial contraction assisted loss of blood function, left ventricular filling plus the length of diastole. 1 cardiac output is 20%, heart function is reduced to one level, and level II is reduced to level III. 2HR ventricular filling period (diastolic shortening) (increased transvalvular pressure difference) left atrial pressure increased dyspnea acute pulmonary edema. At this point, it is important to control the ventricular rate of Af or restore sinus rhythm as soon as possible.
(2) acute pulmonary edema: this is a serious complication, especially in the early stage, when the right heart function is good, often in severe physical activity, emotional agitation, infection, pregnancy and childbirth, concurrent AF or other tachyarrhythmia, and induced acute Pulmonary Edema. The performance is: difficulty breathing, purpura, can not sit down, sit and breathe, cough pink foamy sputum, double lungs covered with dry and wet rales, if not treated in time, may be fatal.
(3) thromboembolism: huge left atrium (>5.5cm), AF: CO is a risk factor for embolism. From left atrium 20% of systemic embolism, 80% of systemic embolism with AF, 1/4 of systemic embolism with repeated and multiple, 2 / 3 systemic embolism: cerebral embolism hemiplegia aphasia, extremity arterial embolism limb ischemia , necrosis, superior mesenteric artery embolization small intestinal necrosis, hemorrhagic enteritis, renal artery embolization hematuria, splenic embolism spleen pain. Right heart failure right atrial wall thrombus and / or pelvic vein, deep vein thrombosis of the lower extremity pulmonary embolism, left atrial massive thrombus or pedicle thrombosis block mitral valve mouth sudden death.
(4) Heart failure: the main cause of death is RHD, and the incidence of RHD in heart failure accounts for 50-70%. Strenuous activity, pregnancy, and active rheumatism are often the predisposing factors.
Right heart failure right heart discharge pulmonary circulation blood volume left atrial pressure decreased dyspnea, the risk of acute pulmonary edema and massive hemoptysis is reduced, this is a protective effect, but the price is heart The blood volume is reduced.
(5) Infective endocarditis: the incidence of 6-10% occurs in the early stage of valvular disease, late valvular calcification or atrial fibrillation is less common, more common in MI, AI, simple MS is rare.
The part of the neoplasm is located downstream of the blood flow from the high pressure chamber through the narrow mouth to the low pressure chamber to produce high-speed jets and turbulence such as: the atrial surface of the valve leaflet of the MI, the ventricular surface of the leaflet of the AI, the right ventricular surface of the VSD, and the blood. Flow at high speed impact on the heart or large intima. It is related to the decrease of lateral pressure and the decrease of intimal perfusion at this place, which is beneficial to microbial deposition and growth.
Infected bacteria are commonly found in Streptococcus viridans (oral cavity), Staphylococcus (skin), Enterococcus and Gram (the digestive tract urinary). Once infective endocarditis occurs, heart failure can be aggravated.
(6) Respiratory tract infection: It is easy to appear on the basis of pulmonary congestion. common. Combine bacterial infections and aggravate heart failure. However, pulmonary congestion is not conducive to the growth of TB, and it is not easy to incorporate TB in the lungs.
Symptom
Symptoms of valvular heart disease Common symptoms Labor dyspnea refers to the half moon armor is pink chest tightness heart murmur tired after chest pain tachycardia
Clinical manifestation
From the clinical manifestations, patients with valvular heart disease are most prone to fatigue and fatigue after activities, activity tolerance is significantly reduced, respiratory distress (ie, labor dyspnea) occurs when exercising slightly, and severe paroxysmal dyspnea occurs frequently at night. I can't even rest in the flat.
Some patients (especially those with mitral stenosis) will have respiratory tract hemorrhage in the chest tightness and asthma, and the blood in the light sputum will be accompanied by a large amount of blood in one time. In addition, prolonged pulmonary congestion can lead to frequent bronchitis in patients, especially in winter.
For some patients (especially aortic stenosis), dizziness or dizziness often occurs after the activity, and with the increase of age, the symptoms of precordial discomfort or angina are more and more frequent.
In addition, although some people do not have the above typical performance, if there is a recent history of palpitations, previous thromboembolism, gastrointestinal bleeding, skin blemishes or ecchymoses, and unexplained fever, it also provides important for the diagnosis of valvular heart disease. The clues should not be ignored.
Examine
Examination of valvular heart disease
Auxiliary inspection
First, X line
Chest radiography provides preliminary information about the size of the heart chamber, pulmonary blood flow, pulmonary circulation and systemic pressure, and the degree of calcification of the heart and aorta.
Second, the ECG
In most patients with coronary heart disease, the electrocardiogram at the time of no symptom onset is normal or basically normal. Therefore, normal ECG can not rule out coronary heart disease. So, what are the characteristics of electrocardiogram in angina pectoris? - When there is angina pectoris, temporary T wave inversion occurs, or ST segment is depressed (downward); when symptoms disappear (after rest or containing nitroglycerin tablets) The ECG returned to normal. Of course, in a few cases, more severe ischemia (such as more than fifteen minutes), ECG abnormalities can last for a long time (several days). On the contrary, the patient has no obvious symptoms, and the long-term abnormality of the ECG (mostly T wave inversion, or with ST segment depression), most of them are not coronary heart disease, may be cardiomyopathy, hypertensive heart disease, and are also common in normal people. Some people have an ECG T wave inverted for more than 30 years, and have not found any organic heart disease.
Some primary hospitals diagnosed a slight abnormality of the electrocardiogram (T-wave low or inversion) found in the physical examination as "myocardial ischemia." If these so-called abnormalities are not associated with chest pain or chest tightness symptoms, there is generally no clinical significance. Do not buckle the hat "myocardial ischemia" at will.
Third, color flow and Doppler spectrum echocardiography
As an important method for understanding valve morphology and function, cardiac chamber size, wall thickness, ventricular function, pulmonary vein and hepatic venous blood flow, and pulmonary artery pressure, color flow and Doppler spectral echocardiography are used to assess the condition ( Especially valvular heart disease is particularly important and is an indispensable means in the diagnosis and treatment process. "In most patients with coronary heart disease, the electrocardiogram at the time of no symptom onset is normal, or basically normal. Therefore, the normal ECG can not rule out coronary heart disease. So, what is the characteristic of ECG in angina pectoris? - When angina pectoris occurs Temporary T wave inversion, or ST segment depression (downward); when the symptoms disappear (after rest or containing nitroglycerin tablets), the electrocardiogram returns to normal. Of course, in a few cases, more severe ischemia occurs (such as time) More than fifteen minutes), the ECG abnormality can last for a long time (several days).
On the contrary, the patient has no obvious symptoms, and the long-term abnormality of the ECG (mostly T wave inversion, or with ST segment depression), most of them are not coronary heart disease, may be cardiomyopathy, hypertensive heart disease, and are also common in normal people. Some people have an ECG T wave inverted for more than 30 years, and have not found any organic heart disease.
Diagnosis
Diagnosis and diagnosis of valvular heart disease
Diagnostic identification
Cardiac auscultation is still considered to be the most straightforward and cost-effective method for clinical screening of valvular heart disease. The doctor will first refer to the patient's medical record and ask for symptoms, and then listen to the patient's heart for any noise. Patients may then be advised to undergo ultrasound, magnetic resonance, and cardiac catheterization.
Diagnosis of mitral regurgitation
1, the compensation period can be asymptomatic, when left heart failure can have heart palpitations, shortness of breath, fatigue and so on.
2, the heart to the left to expand, the apical area can be heard and loud, rough systolic hair-like noise, often conduction to the underarm or back, can smell the third heart sound, the second heart sound of the pulmonary valve area.
3. Auxiliary inspection:
(1) X-ray examination: the left atrium, the left ventricle are enlarged, and the pulmonary artery is prominent.
(2) Electrocardiogram examination: left atrial enlargement and left ventricular hypertrophy and strain.
(3) Echocardiography: When the left atrium of the left atrium is enlarged, the M-shaped map can be measured.
Diagnosis of aortic regurgitation
1, early asymptomatic, or have anterior discomfort or head artery pulsation, late left heart failure symptoms, acute severe patients have chest pain.
2, the face is pale, the apex capture shifts to the left, is lifted, the heart sounds the voice boundary to increase the boot shape, the aortic valve area and the left sternal border 3 to 4 intercostal can have diastolic, high pitch, diminishing Type-like gas murmur, conduction to the tip of the heart, apical area can be heard and low-pitched soft mid-diastolic murmur (Austin-Flint murmur), diastolic blood pressure decreased, pulse pressure increased, there may be peripheral vascular signs, such as water pulse, gunshot sound, Capillary capture and Durozicr sign.
3. Auxiliary inspection:
(1) X-ray examination: the left ventricle is enlarged with the ascending aorta flexing and prolonging, and the shape is like a boot. The fluoroscopy shows that the aortic pulsation is enhanced and the left ventricular capture is coordinated with a "rocking chair" pulsation.
(2) Electrocardiogram examination: left axis of the electric axis, left ventricular hypertrophy with strain.
(3) Echocardiography: It is helpful for the diagnosis of insufficiency and etiology.
Diagnosis of aortic stenosis
1, light can be asymptomatic, light and heavy have difficulty breathing, fatigue, and even angina, dizziness or black Mongolian performance.
2. The aortic valve area has a loud and rough systolic murmur that is transmitted to the neck and apex. In elderly patients, the noise is often high-profile and most loud in the apex, with systolic tremor, the second heart sound in the aortic valve area is weakened, the pulse is weak, the systolic blood pressure is reduced, and the pulse pressure is reduced.
3. Supplementary check:
(1) X-ray examination: the root of the ascending aorta often shows a stenosis and a dilatation. The severe stenosis almost has aortic valve calcification and left ventricular enlargement.
(2) Electrocardiogram examination: left ventricular hypertrophy with strain, sometimes left atrial enlargement.
(3) Echocardiographic examination: the aortic valve opening is reduced (<1.5cm), the opening speed is slowed, the left ventricular wall is thickened, the aortic wall may be thickened, and the ascending and descending speed is slowed down.
(4) Cardiac catheterization: great accuracy in the identification of moderate to severe stenosis.
