What is heart disease and why is it dangerous? Heart defects: classification, diagnosis, treatment and prevention

The heart is one of the main organs of our body. This is a unit that has been working without rest for decades. It has fantastic reliability and perfection. However, its design is quite simple. However, in the heart, as in any mechanism, there can also be defects. In medicine, such defects are called heart defects.

What is a heart defect?

This pathology of the heart leads to violations of cardiac hemodynamics, expressed in an overload of some parts of the heart, which, in turn, leads to heart failure, changes in systemic hemodynamics and lack of oxygen in the tissues.

To understand what heart disease is, it is necessary to make a brief overview of its structure. The heart consists of four chambers - two atria and two ventricles. In the right and left sides of the heart is the atrium and ventricle. Venous blood enters the right side of the heart, which then goes to the lungs, where it is saturated with oxygen. From the lungs, it returns to the left side of the myocardium, from where it enters the artery adjacent to the heart - the aorta. Between the atria and ventricles, as well as between the arteries and ventricles, there are valves, the purpose of which is to prevent the reverse flow of blood during myocardial contractions. The valve between the left chambers of the heart is called the mitral (bicuspid) valve, and between the right - the tricuspid (tricuspid). The valve between the right ventricle and the pulmonary artery is called the pulmonary valve, and the valve between the aorta and the left ventricle is called the aortic (semilunar). Also, the right and left parts of the heart are separated from each other by muscular partitions.

Such a system guarantees the efficiency of blood circulation, as well as the absence of mixing of venous blood with arterial. However, the barriers inside the heart are not always reliable. Most heart defects are just related to the malfunctioning of the valves, as well as defects in the septum that separates the right and left parts of the organ. The most common defects are the mitral valve located between the left ventricle and the left atrium.

Heart defects are divided into two large groups - congenital and acquired. As you might guess from the name, congenital malformations are present in a person from birth. Congenital heart defects occur in 1 out of 100 newborns. Of all congenital anomalies, heart defects take the second place after defects of the nervous system.

Acquired heart defects appear during a person's life, due to diseases, less often due to heart injuries.

In general, defects in the heart muscle account for about a quarter of all pathologies associated with the heart.

If we take all types of defects, then the most common anomalies associated with the valves. In this case, the valve flaps may not fully close or not fully open. In both cases, hemodynamics is disturbed.

Congenital pathologies

The development of the heart in the fetus occurs in the middle of pregnancy and this process can be negatively affected by many circumstances. The cause of heart defects in newborns can be both genetic anomalies and disturbances in the normal development of the fetus as a result of external factors:

• toxic substances;
• deviations during pregnancy;
• smoking or drinking by the mother;
• uncontrolled intake of drugs by the mother;
• radiation;
• lack of vitamins or, conversely, vitamin poisoning;
• mother-borne viral infections, such as rubella.

Substances that are mutagenic and affect the likelihood of developing heart defects in a child include:

• NSAIDs
• phenols,
• nitrates,
• benzopyrene.

Often the cause of the disease is both genetic and external factors.

Factors contributing to the development of heart defects in the fetus: chronic diseases of the mother (diabetes mellitus, phenylketonuria, autoimmune diseases), a large number of abortions in history. Also, with an increase in the age of the parents, the likelihood of abnormalities in the development of the heart in the fetus increases.

The frequency of occurrence of individual birth defects depends on gender. Some CHD are more common in boys, others are more common in girls, and still others occur in both sexes with approximately equal frequency.

Predominantly female congenital pathologies include:

• triad of Fallot,
• atrial septal defect,
• open ductus arteriosus,

Predominantly male UPU:

• common arterial trunk,
• coarctation or stenosis of the aorta,
• Fallot tetrad,
• transposition of the great vessels.

The most common type of birth defect is the ventricular septal defect. However, an atrial septal defect may also occur.

Often there is such a congenital pathology as non-closure of the Botallian duct. This defect leads to the fact that arterial blood is discharged into the pulmonary circulation.

Classification

Pathologies are divided into simple and combined. With combined defects, several parts of the myocardium and the main vessels adjacent to it are affected at once. Examples of combined congenital malformations are Fallot's tetrad or Cantrell's pentad.

Cardiac anomalies can be compensated - in the event that the body adapts to the limited functionality of the heart and decompensated, when the disease manifests itself in insufficient blood supply to the tissues.

Also, heart defects are divided into those in which mixing of arterial and venous blood occurs, and those in which this phenomenon is absent. The defects of the first group are called white, the second - blue.

White anomalies, in turn, are divided into:

• enriching the small circle of blood circulation,
• impoverishing the pulmonary circulation,
• impoverishing the systemic circulation,
• not significantly altering systemic hemodynamics.

Blue defects are divided into impoverishing and enriching the pulmonary circulation.

White vices include:

• atrial and ventricular septal defects,
• open ductus arteriosus,
• aortic coarctation,
• disposition of the heart (location of the heart on the right, in the abdominal cavity, in the neck, etc.),
• aortic stenosis.

White anomalies are given this name because the patients who suffer from them usually have a characteristic pallor of the skin.

Blue defects include Fallot's tetrad, transposition of the great vessels, Ebstein's anomaly, and some others. With these defects, the heart throws out into the systemic circulation blood that is not saturated with sufficient oxygen. Blue defects are so named because they lead to cyanosis, in which the patient's skin becomes bluish in color.

The following types of defects are also distinguished:

• hypoplasia - underdevelopment of individual parts of the heart,
• obstructive defects (valvular and aortic stenoses),
• partition defects.

Diagnostics

It is difficult to overestimate the role of timely diagnosis in the treatment of the disease. Initially, the doctor studies the history of the disease - the patient's lifestyle, the presence of relatives with heart defects, and the patient's infectious diseases.

For diagnostics are used:

• echocardiography,
• daily ECG monitoring,
• dopplerography,
• phonocardiography,
• plain radiography of the heart,
• angiography,
• CT scan,

There are a number of signs that help a doctor determine the presence of a heart defect by listening to heart murmurs. For this, methods of palpation, percussion, auscultation (listening to heart sounds with a stethoscope or phonendoscope) are used. Even a simple examination reveals such characteristic signs of defects as swelling of the limbs, blue fingers or face.

Blood tests (general and biochemical), urinalysis are also done. They help to identify signs of inflammation and determine how much the blood is clogged with "bad" cholesterol - low-density lipoprotein and triglycerides.

The most important diagnostic method is ECG. The cardiogram allows you to identify changes in the rhythm of the heart, its electrical conductivity, determine the type of arrhythmia, detect manifestations of insufficient supply of oxygen to the myocardium.

With phonocardiography, murmurs and heart sounds are recorded, including those that the doctor cannot determine by ear.

Echocardiography is an ultrasound of the heart. This method allows you to determine the type of heart disease, assess the thickness of the walls of the myocardium, the size of the chambers, the condition of the valves and their size, and blood flow parameters.

For example, the main manifestations of mitral stenosis on Echo-KG:

• thickening of the walls of the myocardium,
• left atrial hypertrophy,
• multidirectional flow,
• an increase in pressure within the atrium.

With aortic stenosis, left ventricular hypertrophy is observed, a decrease in the amount of blood entering the aorta.

Angiocardiography is an X-ray method in which a contrast agent is injected into the vessels of the heart and lungs. Using this method, it is possible to determine the size of the myocardium and its chambers, to diagnose pathological changes.

If we are talking about congenital pathologies, then some of them are detected even at the stage of intrauterine development. After birth, the child also undergoes medical examinations - in the first month of life, and at the age of one year. Unfortunately, many pathologies remain undiagnosed until adolescence. Often they make themselves felt after severe respiratory diseases.

How is heart disease manifested?

The set of symptoms for each type of heart disease can be different. However, there are some common manifestations that are characteristic of most defects:

• dyspnea,
• the presence of symptoms of circulatory insufficiency,
• pain in the heart or a feeling of heaviness in the chest,
• fainting (especially often when changing body position),
• dizziness,
• headache,
• weakness,
• fast fatiguability,
• arrhythmias,
• respiratory disorders,
• cyanosis and acrocyanosis (cyanosis of the fingertips),
• bright red cheeks,
• swelling of the lower extremities,
• ascites,
• variability in body temperature
• nausea.

At first, the presence of symptoms such as shortness of breath, weakness, chest pain, is observed only during physical exertion. However, as the disease progresses, they can also occur at rest.

During auscultation, with all types of valvular defects, characteristic noises are heard.

Children with congenital defects have:

• low immunity, expressed in frequent respiratory infections;
• insufficient development of limbs and muscles;
• small stature;
• poor appetite.

Symptoms of mitral insufficiency

Such an acquired pathology as mitral valve insufficiency may not show any symptoms in the initial stage. However, as the disease progresses, there are:

• pain in the right hypochondrium due to an enlarged liver,
• pain in the heart of the ischemic type,
• acrocyanosis,
• dry cough,
• swelling of the neck veins
• heartbeat,
• dyspnea,
• swelling.

Symptoms of mitral stenosis

Symptoms of mitral valve stenosis:

• dyspnea,
• cough,
• heartbeat,
• heartache,
• weakness,
• fatigue,
• hemoptysis,
• cyanosis of the lips and tip of the nose,
• decrease in blood pressure,
• the difference between the pulse on the right and left hands (the pulse on the left is weaker).

Perhaps the development of atrial fibrillation.

Symptoms of aortic stenosis

Aortic stenosis in the early stages may be asymptomatic. The main symptoms of aortic stenosis are chest pain during exercise, dizziness, fainting, headaches.

Shortness of breath, fatigue, swelling of the lower extremities, pain in the right hypochondrium, pallor of the skin, acrocyanosis, swelling of the jugular veins, and a decrease in systolic blood pressure may also appear.

Symptoms of aortic insufficiency

Aortic insufficiency can be asymptomatic for a long time, compensated by increased contractions of the left ventricle.

It can be expressed in the following phenomena:

• heartbeat,
• ischemic heart pain
• dizziness,
• fainting
• dyspnea,
• swelling,
• pain in the right hypochondrium,
• pallor of the skin,
• increase in systolic blood pressure and decrease in diastolic blood pressure.

Symptoms of tricuspid insufficiency

Symptoms of tricuspid valve insufficiency:

• swelling,
• ascites,
• hepatomegaly,
• cyanosis of the skin,
• pulsation of the neck veins,
• lowering blood pressure.

Damage to the kidneys and gastrointestinal tract is also possible. Atrial fibrillation may develop.

Acquired heart defects

The main cause of acquired heart defects is rheumatism. It is responsible for more than half of all acquired vices.

Rheumatism is an autoimmune disease that develops due to a streptococcal infection. This infection causes an immune response, and lymphocytes begin to attack the cells of the connective tissue of the human body itself. Myocardial tissues also fall into this category. As a result, myocarditis or endocarditis may develop. These diseases lead to most cases of acquired heart defects.

Other causes of acquired heart defects:

• syphilis and other bacterial infections leading to endocarditis;
• atherosclerosis;
• myocardial injury;
• connective tissue diseases.

Usually acquired defects affect the valves. Depending on the valve affected by the disease, mitral, aortic and tricuspid defects are distinguished. There are also anomalies affecting two or three valves.

Mitral valve disease is the most common (more than half of all acquired heart defects), in 20% of cases there is aortic valve disease. Pathologies associated with the right valves are rare.

Simple types of valve defects include stenosis, insufficiency, and prolapse (prolapse).

Normally, the valve leaflets should close completely during systole and then fully open during diastole without interfering with blood flow. If the valve does not open enough, then a certain amount of blood accumulates in front of it. Blood stasis develops. If the valves do not close completely, then there is a reverse flow of blood. And the heart has to make double efforts to push the blood in the right direction.

With stenosis, narrowing of the valve leaflets is observed. This condition is caused by fusion, flattening and thickening of the valves. There may be a narrowing of the valve ring as a result of inflammation. With prolonged development of the defect, the valves may become covered with limescale.

With insufficiency, on the contrary, the valve leaflets do not fully close during systole. The condition is usually caused by the development of connective tissue in the leaflets, their wrinkling and shortening. Also, insufficiency often leads to a violation of the muscles that control the closure of the valves. Aortic valve insufficiency is often the result of damage to the walls of the aorta and their expansion.

With prolapse (prolapse), protrusion of the valve leaflets is observed.

On one valve, stenosis and insufficiency can be observed simultaneously. Such a defect is called combined. The most common is a combined lesion of the mitral valve. In this case, usually some kind of pathology (valve insufficiency or stenosis) prevails. Also, defects can be detected on several valves at once.

Stages of valve defects

Is it deadly?

This question can only be answered on a case-by-case basis.

Of course, in some cases of congenital or acquired defects, medicine is unable to help the patient. However, often a person lives with the disease for decades and does not even suspect it. Sometimes only surgery can help, and sometimes conservative treatment will be sufficient.

By severity, myocardial defects are divided into those that do not have a serious effect on hemodynamics, defects of moderate severity, and pronounced ones.

The presence of most defects is the basis for obtaining a disability.

The consequences of vices can be:

• heart failure,
• bacterial endocarditis,
• chronic,
• lung failure,
• myocardial infarction,
• dyspnea,
• cyanosis,
• rhythm disturbances,
• thromboembolism.

Many of these complications can lead to death.

In addition, almost any myocardial defect, even compensated, leads to the fact that the heart wears out prematurely, and hence to a reduction in life expectancy. If a surgical operation is performed in a timely manner, and the patient has successfully completed a course of rehabilitation, then the likelihood of serious complications decreases.

Treatment

In most cases, heart disease can only be radically cured by surgery. If a pathology is detected in a newborn, then, if possible, an operation is performed to eliminate the defect. If it is detected in an adult, then the indications for surgery largely depend on the patient's condition. Circumstances such as the presence or absence of decompensation are taken into account, life risks associated with the operation are assessed, etc.

In case of valve dysfunctions in cases where it is impossible to restore their work, the treatment consists in prosthetics operations. Operations are also possible to expand the valve (in case of stenosis), or to narrow it (in case of insufficiency). The first operation is called a valvotomy, the second is a valvuloplasty. Heart surgeries are performed using artificial circulation systems. After surgical treatment, the patient undergoes a course of rehabilitation and is under medical supervision.

Treatment also includes the use of antiarrhythmic and heart-supporting drugs. Medicines help stabilize the patient's condition, prevent the development of CHF and other complications. Also, drugs can be taken to combat inflammatory processes in the myocardium.

The main classes of drugs used in the treatment of acquired heart defects are:

• anticoagulants;
• beta-blockers;
• ACE inhibitors;
• diuretics;
• antiarrhythmic drugs;
• glycosides;
• preparations of potassium and magnesium, vitamin complexes;
• antibiotics (to treat bacterial infections that cause endocarditis).

An important role in the treatment of the disease is played by the regulation of the mode of physical activity. Patients are contraindicated in high physical activity, stress. A doctor may prescribe a diet and exercise therapy. Patients are recommended regular walks, control of cholesterol levels in the blood.

Prevention

The main causes of defects are rheumatism, infections, diseases of the myocardium and the cardiovascular system. Therefore, prevention is mainly in the fight against infections and careful attitude to one's health. Also important are the rejection of bad habits, proper nutrition and adherence to a rational regime of work and rest.

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Classmates

Heart disease is a disease characterized by a violation of the anatomical structure of individual parts of the heart, valvular apparatus, septum, large vessels. As a result, the main function of the heart suffers - the supply of oxygen to organs and tissues, "oxygen hunger" or hypoxia appears, and heart failure increases.

Congenital - are formed in the fetus as a result of improper development of organs and systems at the stage of laying groups of cells. It is customary to single out two reasons for these violations:

Doctors have a popular distribution by type of:

• simple, "clean" - this is an isolated change in one valve, narrowing of one hole;
• complex - are a combination of two or more structural disorders (narrowing of the hole + valve insufficiency);
• combined heart defects - even more complex combinations of anatomical disorders, when lesions of several openings and valves of the heart are detected.

Depending on the localization of the defect, the classification distinguishes:

• valve defects (mitral, aortic, tricuspid, pulmonary valve);
• defects of the interventricular and interatrial septa (upper, middle and lower).

For a complete characterization of the consequences can be grouped:

• "white" defects - there is no mixing of venous and arterial blood, tissues receive enough oxygen for life;
• “blue” - venous blood is mixed and thrown into the arterial bed, as a result, the heart pushes blood out without sufficient oxygen concentration, symptoms of heart failure appear early in the form of cyanosis of the lips, ears, fingers and toes.

In the formulation of the diagnosis, the degree of circulatory disorders (from the first to the fourth) is always added after the description of the defect.

Diagnostics

Diagnosis of heart defects begins with an examination of a pregnant woman. Listening to heartbeats allows you to suspect heart disease in the fetus. The woman is examined by specialists for the viability of the unborn child. Immediately after birth, neonatologists examine the baby, listen to the baby's heart murmurs, monitor the first hours and days of life. If necessary, they are transferred to specialized children's centers.

Clinical examination of children of preschool and school age necessarily includes an examination by a pediatrician and auscultation of the heart. If unclear noises are detected, children are sent to a cardiologist, they are given an electrocardiographic and ultrasound examination of the heart (ultrasound) and large vessels. A more objective method for studying heart murmur is phonocardiography. There is a recording and subsequent decoding of sounds. It is possible to distinguish functional noise from organic noise.

Ultrasound and Doppler echocardiography of the heart allow you to visually assess the work of different parts of the heart, valves, determine the thickness of the muscle, the presence of backflow of blood.

X-ray examination helps to diagnose the expansion of individual parts of the heart and aorta. Sometimes this option is used to contrast the esophagus. In this case, the patient takes a sip of the contrast agent, and the radiologist observes its progress. In certain heart defects, the enlarged chambers cause the esophagus to deviate. On this basis, it is possible to ascertain the presence of anatomical defects.

We will analyze functional and structural disorders in more detail, we will analyze the main symptoms of heart defects separately for different forms of the disease.

Acquired heart defects

This disease is the most common cause of disability and death at a young age.

According to primary diseases, defects are distributed:

• about 90% - rheumatism;
• 5.7% - atherosclerosis;

Heart disease in adults is associated with any of these diseases. The most common are valvular defects. Under the age of 30 - insufficiency of the mitral and tricuspid valves. Syphilitic aortic insufficiency manifests itself by the age of 50-60. Atherosclerotic defects occur at the age of 60 and older.

The mechanism of functional disorders

As a result of valve insufficiency, blood ejected during systole (contraction) from one section to another or into large vessels partially returns back, meets with the next portion, overflows the entire section of the heart, causes stagnation.

When narrowing the heart hole, the same difficulties are created. Through a narrow opening, blood hardly passes into the vessels or the next chamber of the heart. There is overflow and stretching.

Acquired heart defects are formed gradually. The heart muscle adapts, thickens, and the cavity in which excess blood accumulates expands (dilates). To a certain extent, these changes are compensatory in nature. Then the adaptive mechanism "gets tired", circulatory failure begins to form.

The most common defects in this group are:

• mitral valve insufficiency;
• mitral stenosis;
• insufficiency of aortic valves;
• narrowing of the mouth of the aorta;
• insufficiency of the tricuspid (tricuspid) valve;
• narrowing of the right atrioventricular orifice;
• insufficiency of valves of a pulmonary artery.

Characteristic functional disorders and symptoms of acquired defects

Mitral valve insufficiency refers to rheumatic heart disease. The mitral valve (bicuspid) is located between the left atrium and the ventricle. This is the most common valvular disease (3/4 of all). Only in 3.6% of cases is observed in a "pure" form. Usually this is a combination of valvular disease and stenosis of the left atrioventricular orifice (the passage between the left atrium and ventricle). This combined defect is also called "mitral heart disease".

The rheumatic process leads to wrinkling of the valves, shortening of the tendons that ensure their work. As a result, there remains a gap through which the blood, when the left ventricle contracts, returns back to the atrium. During the next contraction, more blood enters the ventricle. As a result, its cavity expands, the muscles thicken. The adaptive mechanism does not cause a violation of the well-being of patients, allows you to perform the usual work. Decompensation develops due to the addition of stenosis due to the ongoing activity of the rheumatic process.

The first symptoms in children appear after suffering a sore throat. The child complains of fatigue in physical education classes, shortness of breath, palpitations. Toddlers stop taking part in games. In adults, the first signs of decompensation are shortness of breath when walking, especially when going uphill, a tendency to bronchitis.

The appearance of the patient is characteristic: lips with a bluish tint, blush on the cheeks. In babies, due to the increased cardiac impulse, a protrusion of the chest can form, it is called the “heart hump”. When examining and listening to the heart, the doctor diagnoses characteristic murmurs. The prognosis of the course of the disease is favorable if it is possible to stop the attacks of rheumatism at the stage of valve insufficiency and prevent the development of stenosis.

Mitral stenosis - narrowing of the left atrioventricular orifice. The most common rheumatic defect. About 60% of cases are observed in a "pure" form. The inability to push blood into the ventricle leads to the expansion of the left atrium to an enormous size. As a compensatory mechanism, the right ventricle expands and thickens. It is he who supplies blood through the lungs to the left atrium. Failure of the device leads to stagnation of blood in the lungs.

Shortness of breath is the main symptom of this defect. Children grow up pale, physically underdeveloped. Over time, there is a cough with frothy sputum containing blood, palpitations, pain in the heart. This symptom is especially characteristic after exercise, overwork. Small congestive veins surrounding the lung tissue are torn.

The patient is pale, cheeks, tip of the nose, lips and fingers are cyanotic. In the epigastrium, a pulsation of the heart is visible. Changed breathing is heard in the lungs. Diagnosis is not difficult. A complication is dangerous - blood clots form in the stretched left and right atria. They are able to pass through the bloodstream and cause heart attacks of the kidneys, spleen, brain, and lung. The same reason contributes to the development of atrial fibrillation. With the rapid course of rheumatism, disability of patients occurs due to severe complications.

Aortic valve insufficiency occurs with a long course of rheumatism, syphilis, chronic sepsis, is the result of severe atherosclerosis. The valves become tight, inactive. They do not completely close the outlet, through which blood flows from the left ventricle to the aorta. Part of the blood returns to the ventricle, it expands sharply, the muscles thicken. Circulatory failure first occurs according to the left ventricular type (cardiac asthma, pulmonary edema), then right ventricular manifestations join (as with mitral stenosis).

Patients are pale, a strong pulsation of the vessels of the neck is visible, a symptom of shaking the head along with pulsation is characteristic. Complaints of dizziness, headache, pain in the heart are associated with insufficient oxygen supply. A change in blood pressure is characteristic: the upper numbers are increased, the lower ones are significantly reduced. The prognosis is related to the course of the underlying disease.

Insufficiency of the tricuspid valve, located between the right sections of the heart, does not occur in a "pure" form. This defect is formed as a consequence of compensation in mitral stenosis. The manifestations of the defect are observed against the background of other symptoms. You can attach particular importance to swelling and puffiness of the face, cyanosis of the skin of the upper half of the body.

According to medical statistics, other acquired forms of defects account for about 1%.

congenital heart defects

Congenital malformations are complex disorders of the development of the heart in the fetus during the embryonic stage. Exact indications of the causes of the occurrence do not yet exist. A certain role of infection of the maternal organism in the initial stage of pregnancy (influenza, rubella, viral hepatitis, syphilis), lack of protein and vitamins in the diet of the expectant mother, and the influence of background radiation have been established.

The most common defects are non-fusion:

Rare defects: narrowing of the pulmonary artery, isthmus of the aorta.

Isolated defect occurs in isolated cases. In most children, abnormal development results in a complex combined anatomical alteration of the heart.

An open ductus duct is necessary in the uterine period of development. It connects the pulmonary artery and the aorta. By the time of birth, this path should be closed. The defect is more common in women. It is characterized by the transfusion of blood from the right ventricle to the left ventricle and vice versa, the expansion of both ventricles. Clinical signs are most pronounced with a large hole. When small, they can go unnoticed for a long time. Treatment is only surgical, the duct is stitched and its complete closure.

A ventricular septal defect is an open hole up to 2 cm in diameter. Due to the high pressure in the left ventricle, the blood is distilled to the right. This causes expansion of the right ventricle and congestion in the lungs. The left ventricle also increases compensatory. Even in the absence of complaints in patients, characteristic murmurs are determined when listening to the heart. If you put your hand in the region of the fourth intercostal space on the left, you can feel the symptom of "systolic trembling". Treatment for decompensation of the defect is only operative: the hole is closed with synthetic material.

Atrial septal defect accounts for up to 20% of all congenital malformations. It is often part of the combined vices. Between the atria there is an oval hole, which closes in early childhood. But in some children (more often girls) it never closes. From the side of the left atrium, the hole is covered with a valve leaf and presses it tightly, since there is more pressure here. But with mitral stenosis, when the pressure in the right side of the heart increases, blood flows from right to left. If the hole is not completely closed even by a valve, then there is a mixture of blood, an overflow of the right parts of the heart. Treatment of the defect is only operational: a small defect is sutured, a large one is closed with a graft or prosthetic materials.

Complications of congenital clefts are unusual thromboembolism.

For diagnosis in these cases, an X-ray study with a contrast agent is used. Entered into one chamber of the heart, it passes through the open ducts into another.

Of particular difficulty in the treatment are combined malformations of four or more anatomical defects (tetralogy of Fallot).

Surgical treatment of congenital malformations is currently carried out in the early stages to prevent decompensation. Dispensary observation of patients requires constant protection against infection, control of nutrition, physical activity.

Heart disease is a kind of a series of structural anomalies and deformations of valves, partitions, openings between the heart chambers and blood vessels that disrupt blood circulation through the internal heart vessels and predispose to the formation of an acute and chronic form of insufficient circulatory work.

As a result, a condition develops, which in medicine is called "hypoxia" or "oxygen starvation". Gradually, heart failure will increase. If you do not provide qualified medical care in a timely manner, this will lead to disability or even death.

What is a heart defect?

Clinical picture

What doctors say about hypertension

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If the usual (normal) structure of the heart and its large vessels is broken - either before birth, or after birth as a complication of the disease, then we can talk about a defect. That is, a heart disease is a deviation from the norm that interferes with the movement of blood, or changes its filling with oxygen and carbon dioxide.

The degree of heart disease varies. In mild cases, there may be no symptoms, while in severe cases, heart disease can lead to congestive heart failure and other complications. Treatment depends on the severity of the disease.

Changes in the structural structure of the valves, atria, ventricles or heart vessels, causing a violation of the movement of blood in a large and small circle, as well as inside the heart, are defined as a defect. It is diagnosed in both adults and newborns. This is a dangerous pathological process leading to the development of other myocardial disorders from which the patient can die. Therefore, timely detection of defects ensures a positive outcome of the disease.

In 90% of cases in adults and children, acquired malformations are the result of acute rheumatic fever (rheumatism). This is a severe chronic disease that develops in response to the introduction of group A hemolytic streptococcus into the body (as a result of tonsillitis, scarlet fever, chronic tonsillitis), and manifests itself as a lesion of the heart, joints, skin and nervous system.

The etiology of the disease depends on what kind of pathology is: congenital, or arising in the process of life.

Causes of acquired defects:

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• Infectious or rheumatic endocarditis (75%);
• Rheumatism;
• Myocarditis (inflammation of the myocardium);
• Atherosclerosis (5–7%);
• Systemic connective tissue diseases (collagenoses);
• Injuries;
• Sepsis (general damage to the body, purulent infection);
• Infectious diseases (syphilis) and malignant neoplasms.

Causes of congenital heart disease:

• external - poor environmental conditions, mother's illness during pregnancy (viral and other infections), the use of drugs that have a toxic effect on the fetus;
• internal - associated with hereditary predisposition through the father and mother, hormonal changes.

Classification

The classification divides heart defects into two large groups according to the mechanism of occurrence: acquired and congenital.

• Acquired - occur at any age. The most common cause is rheumatism, syphilis, hypertension and ischemic disease, severe vascular atherosclerosis, cardiosclerosis, trauma to the heart muscle.
• Congenital - are formed in the fetus as a result of improper development of organs and systems at the stage of laying groups of cells.

According to the localization of defects, the following types of defects are distinguished:

• Mitral - the most commonly diagnosed.
• Aortic.
• Tricuspid.

• Isolated and combined - changes are either single or multiple.
• With cyanosis (so-called "blue") - the skin changes its normal color to a bluish tint, or without cyanosis. There are generalized cyanosis (general) and acrocyanosis (fingers and toes, lips and tip of the nose, ears).

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Defeated hypertension at home. It's been a month since I forgot about pressure surges. Oh, how many things I tried - nothing helped. How many times I went to the clinic, but I was prescribed useless medicines again and again, and when I returned, the doctors just shrugged. Finally I got over the pressure, and it's all thanks to this article. For anyone with blood pressure issues, this is a must read!

congenital heart defects

Congenital malformations are the abnormal development of the heart, a violation in the formation of the main blood vessels during the prenatal period.

If he talks about congenital malformations, then most often among them there are problems of the interventricular septum, in this case the blood from the left ventricle enters the right one, and thus the load on the small circle increases. When conducting an x-ray, such a pathology looks like a ball, which is associated with an increase in the muscle wall.

If such a hole is small, then the operation is not required. If the hole is large, then such a defect is sutured, after which patients live normally until old age, disability in such cases is usually not given.

Acquired heart disease

Heart defects are acquired, while there are violations of the structure of the heart and blood vessels, their influence is manifested by a violation of the functional ability of the heart and blood circulation. Among the acquired heart defects, the most common is the defeat of the mitral valve and the semilunar valve of the aorta.

Acquired heart defects are rarely subject to timely diagnosis, which distinguishes them from CHD. Very often, people carry many infectious diseases "on their feet", and this can cause rheumatism or myocarditis. Acquired heart defects can also be caused by inappropriate treatment.

This disease is the most common cause of disability and death at a young age. According to primary diseases, defects are distributed:

• about 90% - rheumatism;
• 5.7% - atherosclerosis;
• about 5% - syphilitic lesions.

Other possible diseases leading to a violation of the structure of the heart are prolonged sepsis, trauma, and tumors.

Heart disease symptoms

The resulting defect in most cases may not cause any disturbances in the cardiovascular system for a long period of time. Patients can engage in physical activity for quite a long time without feeling any complaints. All this will depend on which part of the heart has suffered as a result of a congenital or acquired defect.

The main first clinical sign of the developed defect is the presence of pathological murmurs in the heart sounds.

The patient makes the following complaints in the initial stages:

• shortness of breath
• constant weakness;
• children are characterized by developmental delay;
• fast fatiguability;
• decreased resistance to physical stress;
• heartbeat;
• chest discomfort.

As the defect progresses (days, weeks, months, years), other symptoms join:

• swelling of the legs, arms, face;
• cough, sometimes streaked with blood;
• heart rhythm disturbances;
• dizziness.

Signs of congenital heart disease

Congenital pathology is characterized by the following symptoms, which can occur in both older children and adults:

• Constant shortness of breath.
• Heart murmurs are heard.
• The person often loses consciousness.
• Atypically frequent SARS are observed.
• There is no appetite.
• Slow growth and weight gain (a sign is typical for children).
• The occurrence of such a sign as blueness of certain areas (ears, nose, mouth).
• A state of constant lethargy and exhaustion.

Symptoms of the acquired form

• fatigue, fainting, headaches;
• difficulty breathing, feeling short of breath, coughing, even pulmonary edema;
• palpitations, violation of its rhythm and change in the place of pulsation;
• pain in the heart - sharp or pressing;
• blue skin due to blood stasis;
• an increase in the carotid and subclavian arteries, swelling of the veins in the neck;
• development of hypertension;
• swelling, enlargement of the liver and a feeling of heaviness in the abdomen.

The manifestations of the defect will directly depend on the severity, as well as the type of illness. Thus, the definition of symptoms will depend on the location of the lesion and the number of affected valves. In addition, the symptom complex depends on the functional form of the pathology (more on this in the table).

• Patients often have a cyanotic-pink coloration of the cheeks (mitral flush).
• There are signs of stagnation in the lungs: moist rales in the lower sections.
• Characterized by a tendency to attacks of cardiac asthma and even pulmonary edema

• heart pain;
• weakness and lethargy;
• dry cough;
• heart murmurs

One of the earliest symptoms of this defect is:

• feeling of increased contractions of the heart in the chest,
• as well as the peripheral pulse in the head, arms, along the spine, especially when lying down.

With severe aortic insufficiency, the following are noted:

• dizziness,
• prone to fainting
• increased heart rate at rest.

There may be pain in the heart, which resemble angina pectoris.

• severe dizziness up to fainting (for example, if you abruptly get up from a prone position);
• in the supine position on the left side there is a feeling of pain, tremors in the heart;
• rapid pulsation in the vessels;
• annoying tinnitus, blurred vision;
• fast fatiguability;
• sleep is often accompanied by nightmares.

• severe swelling;
• stagnation of fluid in the liver;
• a feeling of heaviness in the abdomen due to overflow of blood vessels in the abdominal cavity;
• increased heart rate and decreased blood pressure.

Of the signs common to all heart defects, blue skin, shortness of breath and severe weakness can be noted.

Diagnostics

If, after reading the list of symptoms, you find matches with your own situation, it is better to play it safe and go to the clinic, where an accurate diagnosis will reveal the heart disease.

The initial diagnosis can be determined using the pulse (measured while at rest). The patient is examined by palpation, the heartbeat is listened to detect noises and changes in tone. The lungs are also checked, the size of the liver is determined.

There are several effective methods that allow you to identify heart defects and, based on the data obtained, prescribe the appropriate treatment:

• physical methods;
• ECG is performed to diagnose blockade, arrhythmia, aortic insufficiency;
• Phonocardiography;
• X-ray of the heart;
• echocardiography;
• MRI of the heart;
• laboratory methods: rheumatoid tests, KLA and OAM, determination of blood sugar levels, as well as cholesterol.

With heart defects, conservative treatment is to prevent complications. Also, all efforts of therapeutic therapy are aimed at preventing relapses of the primary disease, for example, rheumatism, infective endocarditis. Correction of rhythm disturbances and heart failure is mandatory under the supervision of a cardiac surgeon. Based on the form of heart disease, treatment is prescribed.

Conservative methods are not effective in congenital pathologies. The goal of treatment is to help the patient and prevent heart failure attacks. Only the doctor determines which pills to drink for heart disease.

The following drugs are usually indicated:

• cardiac glycosides;
• diuretics;
• vitamins D, C, E are used to support immunity and antioxidant effect;
• preparations of potassium and magnesium;
• anabolic hormonal agents;
• in the event of acute attacks, oxygen inhalations are carried out;
• in some cases, antiarrhythmic drugs;
• in some cases, drugs may be prescribed to reduce blood clotting.

Folk remedies

1. Beet juice. In combination with honey 2:1, it helps to support cardiac activity.
2. A mixture of coltsfoot can be prepared by pouring 20 g of leaves into 1 liter of boiling water. You need to insist the remedy for several days in a dry, dark place. Then the infusion is filtered and taken after meals 2 times a day. A single dose is from 10 to 20 ml. The entire course of treatment should last about a month.

There are a lot of options for surgical intervention for congenital and acquired defects. These include:

• plastic defects with a patch;
• prosthetics of artificial valves;
• excision of the stenotic opening;
• in severe cases, transplantation of the heart-lung complex.

What kind of operation will be performed is decided by the cardiac surgeon on an individual basis. The patient is followed up after surgery for 2–3 years.

After any surgical operation for heart defects, patients are in rehabilitation centers until they have completed the entire course of therapeutic rehabilitation therapy with the prevention of thrombosis, improved myocardial nutrition and treatment of atherosclerosis.

Despite the fact that the stage of compensation (without clinical manifestations) of some heart defects is calculated for decades, the total life expectancy can be reduced, since the heart inevitably "wears out", heart failure develops with impaired blood supply and nutrition of all organs and tissues, which leads to death. exodus.

With surgical correction of the defect, the prognosis for life is favorable, provided that medications are taken as prescribed by the doctor and the development of complications is prevented.

How many people live with heart disease?

Many people who hear such a terrible diagnosis immediately ask the question - “How many people live with such defects? ". There is no single answer to this question, since all people are different and clinical situations are also different. They live as long as their heart can work after conservative or surgical treatment.

If heart defects develop, prevention and rehabilitation measures include a system of exercises that increase the level of the functional state of the body. The system of recreational physical education is aimed at raising the level of the patient's physical condition to safe values. It is prescribed for the prevention of cardiovascular diseases.

Drawing conclusions

Heart attacks and strokes are the cause of almost 70% of all deaths in the world. Seven out of ten people die due to blockage of the arteries of the heart or brain.

Especially terrible is the fact that the mass of people do not suspect at all that they have hypertension. And they miss the opportunity to fix something, simply dooming themselves to death.

• Headache
• Increased heart rate
• Black dots before the eyes (flies)
• Apathy, irritability, drowsiness
• blurred vision
• sweating
• Chronic fatigue
• swelling of the face
• Numbness and chills in fingers
• Pressure surges

Even one of these symptoms should make you think. And if there are two of them, then do not hesitate - you have hypertension.

How to treat hypertension when there are a large number of drugs that cost a lot of money?

Most medicines won't do any good, and some can even hurt! At the moment, the only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension is Giperium.

Before The Institute of Cardiology together with the Ministry of Health is implementing a program » without hypertension". Within which Giperium is available is free, to all residents of the city and region!

From this article you will learn: what pathologies are called heart disease, how they appear. The most common congenital and acquired malformations, causes of disorders and factors that increase the risk of development. Symptoms of congenital and acquired defects, methods of treatment and prognosis for recovery.

Heart disease is a group of diseases associated with a congenital or acquired dysfunction and anatomical structure of the heart and coronary vessels (large vessels that supply the heart), due to which various hemodynamic deficiencies (blood flow through the vessels) develop.

What happens in pathology? For various reasons (deficiencies in intrauterine organ formation, aortic stenosis, valve insufficiency), when blood moves from one department to another (from the atrium to the ventricles, from the ventricles to the vascular system), stagnation is formed (with valve insufficiency, vasoconstriction), hypertrophy (increase in thickness ) myocardium and dilatation of the heart.

All hemodynamic disorders (blood flow through the vessels and inside the heart) due to heart defects have the same consequences: as a result, heart failure develops, oxygen starvation of organs and tissues (myocardial ischemia, brain, pulmonary insufficiency), metabolic disorders and complications caused by these states.

There are many heart defects, anatomical or acquired defects can be localized in the valves (mitral, tricuspid, pulmonary artery, aortic), interatrial and interventricular septa, coronary vessels (coarctation of the aorta - narrowing of the aorta).

They are divided into two large groups:

1. Congenital malformations, in which the formation of anatomical defects or features of work occurs in the prenatal period, manifests itself after birth and accompanies the patient throughout life (ventricular septal defects, aortic coarctation).
2. Acquired defects are formed slowly, at any age. They usually have a long period of asymptomatic course, pronounced signs appear only at the stage when the changes reach a critical level (narrowing of the aorta by more than 50% with stenosis).

The general condition of the patient depends on the form of the defect:

• defects without pronounced changes in hemodynamics have almost no effect on the general condition of the patient, are not dangerous, are asymptomatic and do not threaten the development of fatal complications;
• moderate can occur with minimal manifestations of disorders, but in 50% of cases immediately or gradually become the cause of severe heart failure and metabolic disorders;
• severe heart disease is a dangerous, life-threatening condition, heart failure is manifested by numerous symptoms that worsen the prognosis, the quality of life of the patient and in 70% end in death within a short period of time.

Usually, acquired defects develop against the background of serious diseases, which result in organic and functional changes in myocardial tissues. It is completely impossible to cure them, but with the help of various surgical operations and drug therapy, it is possible to improve the prognosis and prolong the life of the patient.

Some congenital heart defects do not need treatment (a small hole in the interventricular septum), others almost (in 98%) cannot be corrected (Fallot's tetrad). However, the majority of moderate pathologies (85%) are successfully cured by surgical methods.

Patients with congenital or acquired heart defects are observed by a cardiologist, surgical treatment is performed by a cardiac surgeon.

The most common types of defects

Reasons for the appearance

A number of factors contribute to the appearance of congenital and acquired heart defects:

viral and bacterial infections (rubella, viral hepatitis B, C, tuberculosis, syphilis, herpes, etc.) suffered by the mother during pregnancy

Risk factors

Symptoms of congenital and acquired defects

The patient's condition is directly dependent on the severity of the defect and hemodynamic disorders:

• Light congenital (a small hole in the interventricular septum) and acquired malformations in the early stages of development (narrowing of the aortic lumen up to 30%) proceed unnoticed and do not affect the quality of life.
• With moderate defects in both groups, the symptoms of heart failure are more pronounced, shortness of breath bothers after excessive or moderate physical exertion, passes at rest and is accompanied by weakness, fatigue, dizziness.
• In severe congenital (tetralogy of Fallot) and acquired (narrowing of the aortic lumen by more than 70% in combination with valvular insufficiency), signs of acute heart failure appear. Any physical activity causes shortness of breath, which persists at rest and is accompanied by severe weakness, fatigue, fainting, attacks of cardiac asthma and other symptoms of oxygen starvation of organs and tissues.

All moderate and severe birth defects significantly retard physical development and growth, greatly weaken the immune system. Symptoms of heart disease indicate that heart failure is developing rapidly and can become complicated.

Narrowing of the aortic lumen on angiography (indicated by arrows)

Rhythm disturbances (tachycardia)

Paleness of the skin

Fainting when changing positions

Paleness of the skin

Cough with hemoptysis

Attacks of cardiac asthma (lack of air when inhaling)

Numbness and cramps in the limbs

Pulsating neck veins

protrusion of the chest (thoracic hump)

Rhythm disturbances (tachycardia)

Blueness or cyanosis of the skin, especially the upper half of the body

Paleness of the skin, turning into cyanosis at moments of tension (sucking, crying)

Pulsating neck veins

Underweight

Blueness or cyanosis of the skin

Possible respiratory arrest and coma

After the appearance of severe heart failure (shortness of breath, arrhythmias), the acquired defects progress rapidly and are complicated by myocardial infarction, attacks of cardiac asthma and pulmonary edema, cerebral ischemia, and the development of fatal complications (sudden cardiac death).

Acrocyanosis (blueness of the fingertips)

Pain and heaviness in the right hypochondrium

Pulsating neck veins

Fainting when changing body position

Pulsating neck veins

Nocturnal attacks of suffocation

Severe pallor of the skin

Ascites (accumulation of fluid in the abdomen)

Pain and heaviness in the right hypochondrium

Pulsating neck veins

Blueness of the skin

Pulsating neck veins

Blueness of the skin

Heart and headaches

Fainting when changing positions

Severe pallor of the skin

Attacks of nocturnal suffocation and cardiac asthma

Acrocyanosis (cyanosis of the fingertips and toes)

Bright spots of blush on the cheeks

Treatment Methods

Acquired heart defects develop more than one day, in the initial stages in 90% they are completely asymptomatic and appear against the background of serious organic damage to the heart tissues. It is completely impossible to cure them, but in 85% of cases it is possible to greatly improve the prognosis and prolong the life of the patient (10 years for 70% of those operated on for aortic stenosis).

Moderate congenital heart defects in 85% are successfully cured by surgical methods, however, after the operation, the patient must follow the recommendations of the attending cardiologist until the end of his life.

Drug treatment is ineffective, it is prescribed to eliminate the symptoms of heart failure (shortness of breath, palpitations, edema, dizziness, attacks of cardiac asthma).

Surgical treatments

Surgical treatment of congenital or acquired heart defects is carried out in the same way. The difference lies only in the age of the patients: most children with severe pathologies are operated on in the first year of life in order to prevent the development of fatal complications.

Patients with acquired malformations are usually operated on after 40 years, at stages when the condition becomes threatening (stenosis of the valves or openings by more than 50%).

Currently, many of the heart defects are amenable to surgical treatment, which provides the possibility of further normal life.

What it is?

A normal heart is a strong, relentless muscle pump. It is slightly larger than a human fist.

The heart has four chambers: the top two are called the atria and the bottom two are called the ventricles. Blood flows sequentially from the atria to the ventricles, and then to the main arteries thanks to four heart valves. Valves open and close, allowing blood to flow in only one direction.

Heart defects are congenital or acquired changes in the structures of the heart (valves, partitions, walls, outgoing vessels) that disrupt the movement of blood inside the heart or through the systemic and pulmonary circulation.

Why does this happen?

All heart defects are divided into two groups: congenital and acquired.

Congenital heart defects occur between the second and eighth weeks of pregnancy and occur in 5-8 out of a thousand newborns.

The causes of most congenital malformations of the cardiovascular system are still unknown. True, it is known that if there is one child with a heart defect in the family, the risk of having other children with this kind of defect increases somewhat, but still remains quite low - from 1 to 5 percent. Congenital heart defects can also be caused by exposure of the mother to radiation, be the result of alcohol, drugs, and certain drugs (lithium, warfarin) during pregnancy. Also dangerous are viral and other infections carried by a woman in the first trimester of pregnancy (rubella, influenza, hepatitis B).

Recent studies have shown that children of overweight or obese women are 36 percent more likely to be born with congenital heart disease and other cardiovascular disorders than children of normal weight women. The reason for the association between a mother's weight and the risk of heart disease in their unborn children has not yet been established.

The most common causes of acquired heart disease are rheumatism and infective endocarditis, less often - atherosclerosis, trauma or syphilis.

What are heart defects?

The most common and heaviest birth defects can be divided into two main groups. The first group includes heart defects caused by the presence of bypasses (shunts), due to which oxygen-rich blood coming from the lungs is pumped back into the lungs. This increases the load on both the right ventricle and the vessels that carry blood to the lungs. These types of faults include:

• cleft of the ductus arteriosus - a vessel through which the fetus's blood bypasses the lungs that are not yet working;
• atrial septal defect (preservation of the hole between the two atria at the time of birth);
• ventricular septal defect (gap between the left and right ventricles).

Another group of defects is associated with the presence of obstructions to blood flow, leading to an increase in the workload on the heart. These include, for example, coarctation (narrowing) of the aorta or narrowing (stenosis) of the pulmonary or aortic valves of the heart.

Valvular insufficiency (widening of the valve opening, in which the closed leaflets of the valve do not close completely, allowing blood to flow in the opposite direction) in adults can manifest itself due to the gradual degeneration of the valves in two types of congenital disorders:

• in 1 percent of people, the arterial valve has not three, but only two cusps,
• mitral valve prolapse occurs in 5-20 percent. This non-life-threatening disease rarely leads to serious valve insufficiency.

On top of these heart troubles, many types of congenital disorders of the heart and blood vessels occur not only separately, but also in various combinations. For example, tetralogy of Fallot, the most common cause of cyanosis (cyanosis) in a child, is a combination of four heart defects at once: ventricular septal defect, narrowing of the exit from the right ventricle (stenosis of the pulmonary artery mouth), enlargement (hypertrophy) of the right ventricle and displacement of the aorta.

Acquired defects are formed in the form of stenosis or insufficiency of one of the heart valves. Most often, the mitral valve (located between the left atrium and ventricle) is affected, less often the aortic valve (between the left ventricle and the aorta), even less often the tricuspid valve (between the right atrium and the ventricle) and the pulmonary valve (between the right ventricle and the pulmonary artery).

Valve defects can also be combined (when 2 or more valves are affected) and combined (when both stenosis and insufficiency are present in one valve).

How are vices manifested?

Having a congenital heart disease, for some time after birth, the baby may look outwardly quite healthy. However, such imaginary well-being rarely lasts longer than until the third year of life. Subsequently, the disease begins to manifest itself: the child lags behind in physical development, shortness of breath appears during physical exertion, pallor or even cyanosis of the skin.

The so-called "blue defects" are characterized by seizures that occur suddenly: anxiety appears, the child is agitated, shortness of breath and cyanosis of the skin (cyanosis) increase, loss of consciousness is possible. Such attacks are more often observed in young children (up to two years). They also have a favorite squatting posture.

"Pale" defects are manifested by a lag in the development of the lower half of the body and the appearance at the age of 8-12 years of complaints of headache, shortness of breath, dizziness, pain in the heart, abdomen and legs.

Diagnostics

Diagnosis of heart defects is carried out by a cardiologist and a cardiac surgeon. The echocardiography method allows using ultrasound to examine the condition of the heart muscles and valves, to assess the speed of blood movement in the cavities of the heart. To clarify the condition of the heart, an x-ray examination (chest image) and ventriculography are used - an x-ray using a special contrast agent.

When studying the activity of the heart, an ECG electrocardiogram is an obligatory method), methods based on it are often used: stress ECG (veloergometry, treadmill test) - recording an electrocardiogram during exercise and ECG Holter monitoring - this is an ECG recording that is carried out during the day.

Currently, many of the heart defects are amenable to surgical treatment, which provides the possibility of further normal life. Most of these operations are performed on a stopped heart using a heart-lung machine (ABC). In people with acquired heart defects, the main methods of surgical treatment are mitral commissurotomy and valve replacement.

Prevention

There are no preventive measures that are guaranteed to save you from heart disease. However, it is possible to significantly reduce the risk of acquiring a defect by the prevention and timely treatment of streptococcal infections (which is most often angina), because it is on their soil that rheumatism develops. If a rheumatic attack has already occurred, do not neglect the bicillin prophylaxis prescribed by the attending physician.

People at risk of infective endocarditis (for example, those who have had a rheumatic attack in the past or who have mitral valve prolapse) need to take certain antibiotics prophylactically before various procedures, such as tooth extraction, tonsils, adenoids, and other operations. Such prevention requires a serious attitude, because it is much easier to prevent heart disease than to cure it. Moreover, no matter how the technique of operations improves, a healthy heart works much better than an operated one.

In contact with

Heart disease is a disease that affects the heart valves, as well as blood circulation. Pathology can be both congenital and acquired throughout life. Acquired defects have a different degree of danger, as well as different symptomatic manifestations. Today, in an adult, congenital heart pathology is extremely rare, since after birth, upon confirmation of this diagnosis, surgery immediately follows, eliminating the disease. However, if the defect was not noticed at an early age, then its diagnosis will occur already in maturity.

The congenital nature of the pathology is explained by a violation of intrauterine development, as well as a genetic predisposition to the disease.

Attention! There are many more root causes that explain the development of an acquired disease, and most of them can be easily prevented by careful attitude to health.

Why is there an acquired defect?

1. A person abuses various bad habits (the influence of nicotine, alcohol, drugs).
2. Cardiovascular diseases of a chronic nature can also affect the formation of the defect.
3. A predisposition to the disease can develop a history of hepatitis virus.
4. Heart disease can develop against the background of the consequences of past illnesses - influenza, rubella, HPV.
5. Due to damage to the body by some dermatological diseases.
6. The result of infection with sexually transmitted diseases, namely syphilis and gonorrhea.
7. Sequelae of atherosclerosis.
8. Injury to the neck and spine, damage to the heart muscles.

It is important! All of the above factors are capable of provoking the development of heart disease throughout life. The complexity of the pathology lies in the fact that it cannot be eliminated with the help of a therapeutic effect, the only way to cure is surgery.

With a careful attitude to health and preventive measures under the supervision of a cardiologist, you can significantly reduce the risk of this heart disease. At the same time, it is very important not to forget about physical education, as well as to eliminate heavy physical exertion and completely abandon bad habits. At the same time, it is extremely important to pay attention to disturbing symptoms and begin timely treatment.

Symptoms in adults

The symptom complex depends on the severity and type of heart disease. For example, the detection of pathology can occur immediately upon the manifestation of symptoms. But, sometimes the disease is not detected in a newborn child, and subsequently develops asymptomatically. Congenital pathology is characterized by the following symptoms, which can occur in both older children and adults:

1. Constant shortness of breath.
2. Heart murmurs are heard.
3. The person often loses consciousness.
4. Atypically frequent SARS are observed.
5. There is no appetite.
6. Slow growth and weight gain (a sign is typical for children).
7. The occurrence of such a sign as blueness of certain areas (ears, nose, mouth).
8. A state of constant lethargy and exhaustion.

Symptoms of congenital pathology can be divided into 4 groups.

Reference! UPUs are divided into two atypical types - blue and white. In the blue form, venous and arterial blood is mixed, and in the second, without mixing the blood.

Symptoms of the blue species are found in the first years of life. Pathology makes itself felt with a sudden attack, which is characterized by the occurrence of shortness of breath, overexcitation, cyanosis, and sometimes fainting. Signs of the white type of pathology also appear in childhood, but a little later (after 8-9 years), it can be determined by a clear developmental delay, this is especially noticeable in the lower part of the body.

Characteristics of acquired pathology

We will talk about valve defects that occur throughout life. Most often manifested in the form of stenosis or heart failure. Such defects significantly impair normal blood flow. The development of an anomaly of an acquired nature occurs as a result of the consequences of various diseases, excessive physical exertion on the heart, and expansion of the heart chambers. The defect can easily be provoked by an inflammatory process, autoimmune or infectious diseases.

Symptoms

The manifestations of the defect will directly depend on the severity, as well as the type of illness. Thus, the definition of symptoms will depend on the location of the lesion and the number of affected valves. In addition, the symptom complex depends on the functional form of the pathology (more on this in the table).

Special attention should be paid to combined defects. In this case, not only one, but several valves are affected at once. In medical practice, there are pathologies when two defects are observed in one heart valve. Thus, the symptoms will manifest themselves depending on the prevalence of the defect.

cardiac surgeon

Higher education:

cardiac surgeon

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBGU)

Level of education - Specialist

Additional education:

Certification cycle for the program "Clinical Cardiology"

Moscow Medical Academy. THEM. Sechenov

Heart disease, what is it and how dangerous is it? If a person does not know what a particular disease is, he begins to panic, make hasty decisions that can lead to a deterioration in his health. The presence of even shallow, but correct knowledge about the dangers of heart disease in adults or children, will help to make adequate decisions in emerging situations, which will help maintain health and prevent the development of more serious complications.

What is this disease?

In order to understand what heart disease is, it is necessary to understand what function the indicated organ performs in the body, and what structure it has. The heart is one of the main elements of the circulatory system, which ensures the movement of blood. When the heart contracts, blood is pushed through, which first enters the large vessels, and then into the smaller ones.

If there is a violation in the structure of the specified organ, and this can be both before the birth of a person, that is, a congenital defect, and already during life as a complication after an illness, then we can talk about the development of a defect. If the degree of circulatory insufficiency is high, then a person may be given a disability.

If we talk about what constitutes such a heart disease, the defect will be a deviation from the norm, which does not allow for normal blood circulation or does not allow the blood to be normally saturated with oxygen and carbon dioxide. As a result of the development of such a disease, extraneous noises appear in the heart, and all organs and systems of the body begin to suffer to one degree or another.

To understand what this disease is, you need to understand what structure the heart has and how it works. In humans, this organ has 2 parts, one of which pumps arterial and the second venous blood. If everything is normal, and there are no pathologies, then the cardiac septum has no holes, so venous and arterial blood do not mix in the heart cavity.

The circulatory system looks like a vicious circle; in the human body, blood moves in a large and small circle. The large vessels that enter this organ are called veins, and those that leave it are called arteries; during the normal development of the body, they do not intersect with each other, and therefore there is no mixing of blood.

There are valves in the heart, most often the problem is with the mitral valve, less often with the aortic, tricuspid, and very rarely with the pulmonic valve. Usually problems in the operation of the valves are manifested in acquired defects. With a high degree of insufficiency of blood supply, disability can be given.

Types of vices

There is the following, understandable for patients, classification of this pathology:

• congenital and acquired, in this case, changes in the structure of the heart and its vessels, as well as in the position of the indicated organ, occurred before the birth of the child or appeared already in the process of his life, and in both cases, depending on the severity of the disease, can be given disability;
• changes can be single or multiple, therefore, isolated and combined diseases are distinguished;
• with cyanosis, in which case the skin becomes bluish or without cyanosis, then the skin color remains natural. Cyanosis can be general, in such cases usually give a disability, and local, when the ears, fingertips, lips and tip of the nose turn blue.

Congenital malformations are formed in a child in the womb, their qualification will be as follows:

• congenital pathology with an increase in pulmonary blood flow, in this case there may or may not be cyanosis;
• defect with normal pulmonary blood flow;
• pathology with reduced pulmonary blood flow, which may also be with or without cyanosis.

Cells of heart defects - alveolar macrophages - appear during the development of a lung infarction, during a hemorrhage, or when blood stagnation occurs in the pulmonary circulation.

Hemodynamics is disturbed in case of heart defects, which are accompanied by valve insufficiency, stenosis, pathologies of communication between the large and small circles of blood circulation.

birth defects

If he talks about congenital malformations, then most often among them there are problems of the interventricular septum, in this case the blood from the left ventricle enters the right one, and thus the load on the small circle increases. When conducting an x-ray, such a pathology looks like a ball, which is associated with an increase in the muscle wall.

If such a hole is small, then the operation is not required. If the hole is large, then such a defect is sutured, after which patients live normally until old age, disability in such cases is usually not given.

If the septal defect is large, or if there is no septal defect at all, this leads to mixing of the blood and poor oxygenation. In such patients, the hump of the heart is visible during x-rays, noises are heard to reduce shortness of breath, they often squat. If the operation is not done in time, then such people rarely live to be 25-30 years old.

There may be a congenital pathology in the form of an open oval hole, if it is small, then such people practically do not feel discomfort and live normally. If the defect is large, then the person suffers from shortness of breath.

If a combined pathology develops, along with the hole, a narrowing of the mitral or aortic valves appears, which causes pallor of the skin and shortness of breath, extraneous noises are heard.

If such a heart disease develops, the operation is performed with serious defects, if the defect is isolated, then the prognosis of its treatment will be positive, if it is combined, then it all depends on the degree of circulatory disturbance.

If after birth the baby has a message between the pulmonary artery and the aorta, then this pathology is called ductus arteriosus occlusion. In this case, the load on the pulmonary circulation also increases, shortness of breath and cyanosis appear.

If the size of the defect is small, then such a pathology may not make itself felt and does not pose a danger to the patient's life. If the defect is large, then the operation is inevitable, and the prognosis is mostly negative.

With narrowing of the aorta, blood does not flow normally down, which leads to the appearance of additional vessels. In this case, the symptoms of heart disease will be in the form of numbness in the legs, heaviness in the head and burning in the face, in the hands the pulse will be increased, and in the legs it will be weakened, the same applies to blood pressure.

Treatment is carried out by performing an operation, during which the narrowed section of the aorta is changed, after which people return to normal life, and they are not threatened with disability.

The most severe and most frequent congenital defect is Fallot's tetrad, its symptoms will be in the form of cyanosis, which appears even with small loads, extraneous noises are heard. There are disturbances in the work of the gastrointestinal tract, the nervous system, there are slowdowns in growth and development. If the case is not very severe, then an operation is performed, in difficult cases the prognosis will be unfavorable, and such children do not live long.

Narrowing of the orifice of the pulmonary artery is usually due to abnormal development of the valvular ring, in some cases causes of heart disease that lead to narrowing of the pulmonary artery, and sometimes the presence of a tumor or aortic aneurysm can lead to such a pathology.

Such children have a cyanotic complexion, they lag behind in development, noises are heard, in this case only an operation can help, the prognosis will depend on the severity of the disease.

Congenital malformations of the heart in most cases can be successfully treated both in childhood and in adults. Do not be afraid of the operation, and its result will depend on the severity of the disease and how timely it will be done. Modern surgeons have a high level of qualification and use modern equipment, which ensures a high level of achievement of positive results.

Acquired vices

From the moment of the birth of the child and the formation of problems in the development of the heart and large vessels, he is healthy. The main reason that leads to the development of an acquired defect is rheumatism and other diseases of the specified organ, large vessels that depart from it.

If there is a change in the valves, then this causes the development of stenosis and the formation of valve insufficiency. Depending on how the blood flow is disturbed, compensated and decompensated acquired defects are distinguished.

Mitral valve insufficiency is associated with incomplete closure of its valves, which develops as a result of inflammation. There is a reverse reflux of blood into the left atrium, which after a while leads to insufficiency of blood flow in a small circle, after which venous blood stagnates in a large circle, and congestive insufficiency develops.

In this case, if you put your hand on your chest, you feel a trembling of the chest, lips, nose, ears and fingers become bluish in color, a pinkish-blue blush appears on the cheeks, these symptoms occur with a decompensated defect, if a compensated defect develops, then they will not be .

If the disease is in the stage of compensation, then people may not be aware of its presence, in severe cases a valve replacement is required, and if this is done on time, the prognosis will be positive.

Mitral stenosis is diagnosed 2 times more often in women than in men. Usually this pathology is combined with problems of the tricuspid valve and the aortic valve.

In this case, bubbling breathing in the lungs will be noted, pink foam may be released from the mouth, and general cyanosis is noted. If such symptoms appear, it is necessary to urgently call a doctor, and before his arrival, a person must be planted, and if there is a diuretic in ampoules, then the drug should be injected intramuscularly, this will reduce the volume of fluid, which will reduce pressure in the small circle and relieve swelling.

If such a problem is not solved, then gas exchange in the lungs decreases over time. If the narrowing is small, then the patient lives with minimal discomfort, but if the diameter of the hole becomes less than 1.5 cm², then an operation is necessary.

In men, such a pathology as aortic valve insufficiency develops more often, and in half of the cases it is combined with mitral defects. This pathology leads to the development of stagnation of blood in the small circle and the development of hypertrophy of the muscle walls.

With the development of a decompensated defect, the lower pressure can drop to almost zero, the person is dizzy, the skin becomes pale. If the defect is compensated, then preventive treatment is carried out, if necessary, an artificial valve is sewn in.

If the exit of blood from the left ventricle is difficult, then stenosis of the aortic mouth develops, the smaller this hole is, the more pronounced the defect will be.

The patient has dizziness, pallor of the skin, pain in the heart. If severe circulatory insufficiency is not detected, then general strengthening therapy is carried out, physical activity is reduced, and the person lives normally. In case of serious violations, the valve is replaced or its leaflets are dissected.

With the development of combined aortic malformation, the signs will be the same as with stenosis, but less noticeable. Preventive and symptomatic therapy is carried out. If the case is severe, then during the operation the aortic valve is changed or the fused leaflets are dissected. If the treatment is carried out on time, then the prognosis will be positive.

With the development of tricuspid valve insufficiency, there will be an increased pulsation of the veins in the neck, cyanosis and a decrease in blood pressure. If a severe case develops, then swelling and accumulation of fluid in the abdominal cavity are noted, conservative therapy is carried out, which is aimed at eliminating blood stasis in the veins.

Stenosis of the right atrioventricular opening leads to stagnation of blood in the liver, which leads to an increase in its size, edema and ascites appear, cyanosis will be with a yellowish tint, pain and heaviness appear in the right hypochondrium, blood pressure decreases, veins in the neck pulsate intensely.

It is not worth delaying the operation, and with moderate exertion, a person will feel fine.

Carrying out prevention

If heart defects develop, prevention and rehabilitation measures include a system of exercises that increase the level of the functional state of the body.

The system of recreational physical education is aimed at raising the level of the patient's physical condition to safe values. It is prescribed for the prevention of cardiovascular diseases.

Depending on the age and development of the patient, the doctor selects the method of training and load. During training, cyclic aerobic exercises are performed, which can increase the overall endurance of the body. Aerobic-anaerobic exercises are prescribed, which develop speed endurance and acyclic exercises, aimed at developing strength endurance.

The treatment of such patients cannot be carried out without endurance training, but the exercises are carried out with a gradual increase in load and an increase in its duration. After a person undergoes rehabilitation in a specialized institution, he needs to do health-improving gymnastics at home, which will ensure the normal functioning of his body.

Summarizing

Usually acquired defects are rheumatic, their treatment is to eliminate the underlying disease and reduce the consequences that have arisen after the development of the defect. If serious circulatory decompensation has occurred, then in such situations, an operation is a prerequisite.

A much greater chance of successful treatment of such pathologies will be with timely seeking medical help. It is not necessary to wait until you have signs of the development of the disease, it is recommended to periodically undergo preventive examinations with a doctor and then it will be possible to identify the development of the disease at its initial stage. This allows for effective treatment, and the consequences of the disease will not be dangerous.

Heart disease - This is a pathological structural change in the structure of the heart or large vessels, characterized by damage or defect in one of the four heart valves: the left atrioventricular (mitral) valve, the aortic valve, the right atrioventricular (tricuspid) valve, or the pulmonary valve. The left and right atrioventricular valves control the flow of blood between the atria and ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve controls the flow of blood between the heart and the aorta and blood vessels in the rest of the body. The mitral valve and aortic valve are the most commonly affected.

The normal functioning of the valves ensures that the blood flows with the right force in the right direction and at the right time. In valvular heart disease, the valves become too narrow and either do not open completely or do not close. Narrowed valves cause blood to pool in the adjacent chamber of the heart, while a leaky valve allows blood to leak back into the chamber from which it was just emptied. To compensate for the poor performance of the heart, the heart muscle enlarges and becomes thicker, losing its elasticity and becoming less efficient. Also, in some cases, when the blood that accumulates in the chambers of the heart tends to clot, the risk of stroke or pulmonary embolism is increased.

The degree of heart disease varies. In mild cases, there may be no symptoms, while in severe cases, heart disease can lead to congestive heart failure and other complications. Treatment depends on the severity of the disease.

Symptoms

Symptoms of congestive heart failure: shortness of breath and wheezing after limited exercise; swelling of the legs, arms, or abdomen.

palpitations; chest pain (may be mild).

Fatigue.

Dizziness or weakness (with aortic stenosis).

Fever (with bacterial endocarditis).

The reasons

Rheumatism can cause heart disease. Bacterial endocarditis, infections of the heart muscle and heart valves are the cause of heart disease.

High blood pressure and atherosclerosis can damage the aortic valve.

A heart attack can damage the muscles that control the heart valves.

There may be a congenital anomaly of the heart valves.

Heart valve tissue may degenerate with age.

Other diseases, such as cancer, rheumatoid arthritis, systemic lupus erythematosus, or syphilis, can damage one or more heart valves (see the sections on these diseases for more information).

Methysergide, a medicine commonly used for migraines, and some weight loss drugs can contribute to heart disease.

Radiation therapy (usually used to treat cancer) may be linked to heart disease.

Diagnostics

Medical history and physical examination. The doctor hears a variety of heart sounds, known as heart murmurs, that indicate heart disease.

An electrocardiogram is needed to measure the electrical activity of the heart, the regularity of the heartbeat, thickening of the heart muscle, and damage to the heart muscle as a result of coronary heart disease.

Examination after exercise (measurement of blood pressure, heart rate, changes in the cardiogram and respiratory rate when the patient walks on the simulator).

Chest x-ray.

Echocardiogram (use of ultrasound waves to see the valve in motion during the heartbeat).

Insertion of a catheter into the chambers of the heart to measure pressure abnormalities on the valves (to detect their narrowing) or to detect on x-ray the backflow of the injected dye (to detect a valve that is not completely closing).

Treatment

Do not smoke; lead a healthy lifestyle. Avoid excessive alcohol, salt, and diet pills as these can all cause high blood pressure.

In the case of mild symptoms or their absence, the doctor may take a wait-and-see attitude.

People with heart disease are given a course of antibiotics before surgery or dental treatment to prevent bacterial endocarditis.

Anti-clotting drugs such as aspirin or ticlopidine may be prescribed for patients with heart disease who have had an unexplained transient cerebrovascular accident.

More powerful anticoagulants such as warfarin may be prescribed for patients with atrial fibrillation (a common complication of heart disease) or for those who continue to experience transient cerebrovascular accident despite treatment. Long-term use of anticoagulants may be necessary after valve replacement surgery because artificial valves are associated with a higher risk of blood clots.

To widen a narrowed valve, an air balloon can be used, inserted with a catheter into the bottleneck and then inflated.

Surgery may be needed to repair or replace a damaged valve. New valves can be artificial (prostheses) or made from animal tissue (bioprostheses). The type of valve depends on the age of the patient, the condition and type of valve damage.

Congenital heart defects

Congenital heart defects- this is a violation of the development of the heart and large vessels, leading to a change in blood flow, overload and insufficiency of the myocardium of the chambers of the heart. Congenital heart defects are various defects of the heart and blood vessels resulting from a violation of intrauterine development of the fetus. Typical for many congenital malformations, signs of general underdevelopment and a sharp cyanosis of the skin. With severe cyanosis, Fallot's tetrad, the Eisenmenger complex, and the transposition of large vessels proceed.

The causes of congenital heart defects remain largely unknown. It is noted that various viral diseases (rubella, measles), the use of drugs that can have a pathological effect, etc., may be adversely affected by the mother in the first 3 months of pregnancy. Defects are often combined with other congenital defects of the body, such intestinal tract, lungs, developmental defects of the limbs. A certain (but far from decisive role) may be played by hereditary factors. As a rule, the diagnosis of a defect is carried out in a child immediately after birth, but there are also such options when the manifestations of the defect are detected as the body grows, that is, when the heart is not able to provide adequate blood flow to the growing body.

Congenital heart defects often occur as a result of improper discharge of large vessels of the heart or the presence of defects in the walls of the heart. In such cases, during ventricular contraction, part of the blood from the left ventricle, which contains arterial, oxygen-rich blood, rushes to the right heart. There it mixes with venous, oxygen-poor blood and returns from there to the lungs. Another option is also possible; when part of the venous blood from the right heart, bypassing the lungs, enters the left ventricle, and then into the aorta and body tissues. Oxygen-poor blood is not able to provide nutrition to organs and tissues.

Among the most common congenital heart defects, it should be noted an open ductus arteriosus, ventricular septal defect, atrial septal defect, coarctation (narrowing) of the aorta, etc.

With an open ductus arteriosus, a pathological communication remains between the aorta and the pulmonary artery. This leads to the fact that part of the blood enters from the aorta into the pulmonary artery, and thereby increases the load on both ventricles. Complaints of patients are usually associated with poor exercise tolerance.

With a pronounced defect, there may be low endurance to physical exertion, developmental delay, and a tendency to pulmonary infections. In uncomplicated cases, surgical treatment is indicated, the essence of which is the ligation of the duct. Untreated patients die either from progressive heart failure at a young age, or from septic endocarditis.

The essence of the ventricular septal defect is clear from its name. With this defect, the discharge of blood is carried out from the left to the right parts of the heart; therefore, the right (less powerful) ventricle has to work with a constantly increased volume of blood. This leads to severe changes in the vascular bed of the lungs. A minor malformation may be asymptomatic, ie. not give any clinical manifestations. With a pronounced defect, cyanosis develops (cyanosis of the tip of the nose, ears, lips), shortness of breath; edema, liver enlargement, etc. are possible. With a small defect, the prognosis is favorable, and the defect does not require any special treatment. With a large defect, mandatory surgical treatment is indicated, otherwise severe circulatory failure and infective endocarditis may develop.

The essence of atrial septal defect is clear from its name. With this defect, at its initial stages, blood is discharged from the left atrium to the right, i.e. arterial blood mixes with venous blood. However, as the disease progresses, the direction of the discharge may change - and part of the blood from the right atrium will enter the left ventricle. This is due to the fact that the pressure in the lungs rises sharply, which becomes higher than the pressure in the left ventricle. Patients in the initial period of the disease may not have complaints. After changing the direction of discharge, cyanosis of the skin, poor exercise tolerance, and a tendency to respiratory infections appear. The treatment for this type of heart disease is surgery. The essence of the operation is to suture the defect. The operation is most effective before a pronounced rise in pressure in the right atrium and lungs. The operation is advisable to perform in childhood.

Coarctation of the aorta is usually noted at the site of its departure from the left ventricle. In the event that the narrowing of the aorta is sufficiently pronounced, the left ventricle is overloaded, blood pressure rises in the upper half of the body and sharply narrows in the lower. Complaints of patients, their severity depend on the degree of narrowing of the aorta and, as a result, on the increase in blood pressure in the upper half of the body. Patients feel headache, malaise, dizziness, flashing flies before their eyes. Surgical treatment of patients with coarctation of the aorta. The cardiac surgeon after additional research determines the possibility of performing the operation. Medicines aimed at lowering the level of pressure do not give a lasting effect.

mitral stenosis- narrowing, fusion of the valve leaflets, located between the left ventricle and the left atrium. As a result of stenosis, the left atrium has to pump blood through the narrowed opening. The left atrium is a weak muscular formation of the heart; consequently, its compensatory possibilities are small, it is rather quickly depleted and decompensated. As a result, this atrium is not able to pump all the blood coming from the lungs, which leads to stagnation of blood in the lungs. Stretching of the atrium may be accompanied by the formation of parietal thrombi. These blood clots can break off and clog the vessels of the brain, kidneys and other organs. Mitral stenosis is characterized by the development of atrial fibrillation.

If the defect is small, then the patient's health may remain satisfactory. In typical cases, the early complaint is shortness of breath with the usual physical activity before the disease. There may be attacks of cardiac asthma, shortness of breath at rest, hemoptysis, cough, palpitations, as well as dizziness and fainting. The appearance of the patient, as a rule, is characteristic:

cyanosis of the lips, tips of the ears and nose, as well as a bluish blush of the cheeks, are noted. The auscultatory picture of the heart is of decisive importance for the diagnosis of mitral stenosis. As methods that can finally establish the diagnosis of mitral stenosis, use phonocardiography (recording of sound vibrations of the heart) and an ultrasound method that allows visualization of the heart valve.

In addition to conservative methods of treatment, in each individual case, it is necessary to weigh the feasibility of surgical intervention.

Commissurotomy is used as an operative method of treatment. The essence of this method is to separate the fused leaflets of the mitral valve. The operation is done in patients with isolated mitral stenosis, without a significant increase in the heart, the activity of which is reduced due to shortness of breath.

Patients with mitral stenosis are contraindicated in work associated with physical and psycho-emotional stress, as well as hypothermia. With the development of complications or severe circulatory failure, patients, as a rule, are unable to work.

Prognosis: mitral stenosis, even small, is prone to progression due to repeated attacks of rheumatism; correct and complex conservative therapy, timely surgical treatment, postoperative management of patients significantly improve the prognosis; however, there remains a high risk of death from complications or progressive circulatory failure.

Mitral insufficiency - insufficiency of the mitral valve. This defect is characterized by the fact that the leaflets of the mitral valve shrink and are not able to close the hole between the left atrium and the left ventricle. As a result, during the period when the left ventricle contracts, part of the blood returns to the left atrium. Thus, overflow of the atrium and ventricle occurs, as a result of which both of these parts of the heart are stretched, increase in size, and then their decompensation occurs.

For a number of years, the defect may not be accompanied by any ailment. In the future, the patient begins to be disturbed by palpitations, shortness of breath during physical exertion, nocturnal attacks of cardiac asthma. There is a cyanosis of the skin. In the later stages, an increase in the liver, swelling on the legs are possible. To confirm the diagnosis, phonocardiographic and ultrasound examinations are performed, if necessary, cardiac probing.

Treatment is carried out mainly for complications of the defect. Currently, surgical methods are increasingly being used, the essence of which is to replace the valve with an artificial one. The issue of indications for surgery is decided with a cardiac surgeon.

With unexpressed mitral insufficiency, patients are able-bodied, active and can perform minor physical activity. As heart failure progresses, work associated with physical and psycho-emotional stress is contraindicated.

The prognosis for mitral regurgitation depends on the progression of the disease. Various complications can worsen the prognosis of the disease.

Aortic insufficiency- insufficiency of the semilunar valves of the aorta. This defect most often develops due to rheumatism. However, other causes are also possible: septic endocarditis, syphilis, rheumatoid arthritis, etc.

Incomplete closure of the aortic valve during contraction and then relaxation of the left ventricle results in some blood returning from the aorta to the left ventricle; this leads to an overload of the ventricle, its stretching, and an increase in its muscle mass. Since the left ventricle is the most powerful part of the heart, which has great compensatory capabilities, this allows it to maintain a sufficient volume of blood circulation for many years. Aortic insufficiency proceeds for a long time without causing any subjective sensations in the patient. One of the earliest symptoms of this defect is a feeling of increased heart contractions in the chest, as well as a peripheral pulse in the head, arms, along the spine, especially when lying down. With severe aortic insufficiency, dizziness, a tendency to faint, and an increase in heart rate at rest are noted. There may be pain in the heart, which resemble angina pectoris. Many patients are pale, their limbs are warm. On examination, pronounced pulsation of the carotid arteries may be noticeable. Diagnosis is based on auscultation of the heart, phonocardiogram and ultrasound examination.

Treatment of aortic insufficiency is carried out during the development of complications of the disease. Treatment of emerging heart failure is ineffective, since the left ventricle is not able to provide the necessary blood flow. Currently, the surgical method of treating the defect is widely used: the affected valve is replaced with an artificial one. The operation is performed before the development of severe circulatory failure, otherwise it is ineffective.

Many patients with aortic insufficiency are able to perform strenuous physical activity and even play sports. However, all this can accelerate the onset of decompensation.

The prognosis for aortic insufficiency depends on the ability of the left ventricle to work with an increased volume of blood. Usually decompensation develops late. However, once it develops, it develops rapidly and can be extremely difficult to suppress with drugs. Possible complications in the form of cardiac arrhythmias.

aortic stenosis- stenosis, fusion of the valves separating the left ventricle and aorta. Aortic stenosis can be rheumatic or congenital. As a result of the development of stenosis, the left ventricle is forced to pump blood through a sharply narrowed aortic opening. As a result, the left ventricle is overloaded, and the organs and tissues do not receive enough blood. As with aortic insufficiency, the left ventricle, due to its internal reserves, copes with excess load for a long time, but eventually becomes exhausted, which leads to heart failure.

Aortic stenosis is characterized by a long asymptomatic course. If the defect is isolated, then it manifests itself provided that the cross-sectional area of ​​the valve decreases as a result of stenosis to 25% of the original value. The main complaints that a patient with aortic stenosis makes are primarily associated with insufficient blood flow to the internal organs and brain. Patients complain of dizziness, darkening of the eyes, loss of consciousness, shortness of breath, pain in the region of the heart. As with other heart defects, an important place in the diagnosis of aortic stenosis belongs to auscultation of the heart, phonocardiography and ultrasound examination of the heart.

In the absence of signs of circulatory failure, only the underlying disease that caused the defect is treated. In the stage of decompensation, treatment of heart failure is prescribed, carefully using cardiac glycosides, since an increase in the contractility of the left ventricle will not improve the blood supply to the internal organs. The issue of surgical treatment is decided together with a cardiac surgeon. It is possible to perform a commissurotomy (separation of adhesions between the leaflets of the heart valves) or replace the valve with an artificial one. Surgical treatment (commissurotomy) should be carried out at a young age, before the development of severe manifestations of circulatory failure

Patients with aortic stenosis can work for a long time, performing physical activity. With the development of heart failure, the working capacity of patients is limited or lost.

Defects of the tricuspid valve and the valve of the pulmonary artery are extremely rare in isolated form. As a rule, they are combined with defects of the mitral and aortic valves.

Tetralogy of Fallot

Tetralogy of Fallot - a combination of narrowing of the pulmonary artery, ventricular septal defect, aortic discharge from both ventricles, right ventricular hypertrophy. The defect is detected in early childhood. Cyanosis is pronounced, the growth of the child is slowed down, shortness of breath occurs at the slightest exertion. On examination, fingers are revealed in the form of drumsticks, systolic murmur, especially intense in the pulmonary artery. With the help of instrumental methods, an increase and hypertrophy of the right ventricle is detected. The diagnosis is clarified by cardiac catheterization by radiopaque examination. Secondary erythrocytosis usually occurs.

Surgical treatment, without which children live on average up to 15 years.

Eisenmenger complex

The Eisenmenger complex is characterized by a large ventricular septal defect, transposition of the aorta with its origin from both ventricles, and pulmonary hypertension with right ventricular hypertrophy. The disease is found most often in childhood. At the same time, a loud systolic murmur is heard in the third - fourth intercostal space at the edge of the sternum. Cyanosis and shortness of breath may be mild. Life expectancy without timely surgical intervention is 25-30 years.

Ventricular septal defect (Tolochinov-Roger disease)

A ventricular septal defect (Tolochinov-Roger disease) is manifested by a rough prolonged systolic murmur in the third or fourth intercostal space at the left edge of the sternum as a result of blood flow from the left ventricle to the right. On palpation of the same area, systolic trembling is determined, the size of the heart remains normal for a long time. A relatively small septal defect does not cause major hemodynamic disturbances for a long time and does not limit life expectancy. However, sometimes these patients develop severe pulmonary hypertension with shortness of breath on slight exertion and right ventricular hypertrophy. In such patients, surgical intervention is advisable. The disease can be complicated by prolonged septic endocarditis.

Atrial septal defect

An atrial septal defect results in shunting of blood from the left atrium to the right. The disease can be asymptomatic for a long time. Systolic murmur in the second - third intercostal space to the left of the sternum can be moderately pronounced. Clinical manifestations arise in connection with the development of hypertension in the pulmonary artery with hypertrophy of the right ventricle and the subsequent development of heart failure in the systemic circulation. Most often, difficulties arise in the differential diagnosis of this pathology with primary pulmonary hypertension. The latter also proceeds with shortness of breath and cyanosis. Cardiac sounding data are crucial for the diagnosis. With timely surgical treatment, hemodynamic disturbances are eliminated, and the prognosis improves significantly.

Non-closure of the arterial (botallova) duct

Non-closure of the arterial (bothalla) duct is a relatively common congenital defect. The ductus arteriosus connects the pulmonary artery to the aortic arch. When it is not closed, there is a constant flow of blood from the aorta to the pulmonary artery with overflow of blood in the lungs and an increase in the work of both ventricles of the heart. Symptoms of the disease depend on the width of the duct and the magnitude of the discharge of blood. This defect can proceed without complaints and is sometimes found during an accidental medical examination. A loud, blowing noise is characteristic, heard primarily during systole, but also persists during diastole. Noise is recorded in the second or third intercostal space to the left of the sternum, there is an accent of the II tone on the pulmonary artery. Pulse pressure may be elevated. The ventricles of the heart are usually hypertrophied and dilated. At the same time, the initial part of the pulmonary artery also expands. Cyanosis is often absent, but there may be dizziness, a tendency to faint, and stunting. The diagnosis is confirmed by angiocardiography data. The average life expectancy without surgery reaches 35 years.

Surgical treatment - ligation of the arterial duct, which is relatively simple and gives a good result.

Narrowing of the pulmonary artery

This defect is characterized by cyanosis, physical underdevelopment. There may be complaints of shortness of breath, pain in the region of the heart, a tendency to faint, dizziness; often the fingers look like drumsticks. Examination of the heart reveals signs of hypertrophy of the right ventricle, which has to overcome the resistance caused by pulmonary stenosis. There is an increased cardiac impulse, the heart is enlarged to the right, a cardiac hump is possible. In the second intercostal space on the left side of the sternum, a systolic murmur is heard, the II tone on the pulmonary artery is weakened. Hypertrophy and overload of the right ventricle are also confirmed by instrumental methods. Possible right ventricular failure with circulatory disorders in a large circle. Average life expectancy is 20 years. Patients often die from the addition of pulmonary tuberculosis. Timely surgical treatment, indicated for severe stenosis, significantly improves the prognosis.

subaortic stenosis

Subaortic stenosis is a narrowing of the output section of the left ventricle due to the annular fibrous film. The aortic valve remains unchanged. The disease sometimes manifests itself only at a more mature age. There may be shortness of breath, fatigue, pain in the region of the heart, and sometimes fainting. During the examination, an increase and hypertrophy of the left ventricle, an increase in the apex beat, an expansion of the borders of the heart to the left are found. In the second intercostal space to the right of the sternum, systolic murmur and systolic trembling are determined. Noise is usually carried out on the vessels of the neck. On the aorta II tone remains normal or weakened. Early diastolic murmur, indicating aortic insufficiency, is not uncommon. On x-ray, the ascending aorta is usually normal or slightly dilated. With moderate stenosis, the disease can proceed favorably for a long time, without complaints. Severe stenosis requires surgery.

Coarctation of the aorta

Coarctation of the aorta is a narrowing of the aortic isthmus immediately after the left subclavian artery departs from it. Therefore, the main manifestation of the disease is an increase in blood pressure in the arteries of the upper half of the body and a decrease in it in the arteries of the lower extremities. With a sufficiently pronounced narrowing, there is a pulsation in the head, headache, less often nausea, vomiting, impaired vision and an increase in pressure when measuring it on the hands. At the same time, due to a lack of blood supply to the legs, there is numbness, heaviness, weakness when walking, a decrease in pressure when measuring it on the legs. In this regard, in cases of hypertension of unknown origin, it is necessary to measure the pressure not only on the arms, but also on the legs. To do this, the cuff is placed on the lower third of the thigh and listened to tones in the popliteal fossa [normally, systolic pressure at the same time exceeds the pressure on the shoulder by 2.67 kPa (20 mm Hg), with coarctation of the aorta, the pressure on the hands may exceed the pressure on the femoral arteries up to 13.3 kPa (100 mm Hg)]. Usually, at the same time, mild signs of hypertrophy and expansion of the left ventricle are determined, a relatively quiet systolic murmur in the second - fourth intercostal space at the edge of the sternum and behind between the shoulder blades. Coarctation of the aorta may be indicated by the presence of collaterals in the form of pulsating intercostal arteries enlarged by the eye or in the form of uneven contours of the ribs as a result of compression of the bone tissue by the arteries. This heart disease can be complicated by a cerebral stroke due to arterial hypertension, as well as the early development of atherosclerosis of the aorta and coronary arteries. The average life expectancy is 35 years. In this regard, surgery is recommended at the age of 20-30 years. In rare cases, patients with this defect can live up to 70-80 years.

Acquired heart defects

Acquired heart defects are most often caused by rheumatism, less often by prolonged septic endocarditis, atherosclerosis, syphilis. Heart defects can be associated with a narrowing of the opening between the chambers of the heart or insufficiency of the valves, in the latter case, their leaflets do not completely cover the openings. There are defects of individual valves and combined defects, in which two or more valves of the heart are affected.

Acquired vices more often they touch the mitral valve, less often - the aortic valve, even less often - the tricuspid valve and the pulmonary artery valve.

The valves of the heart (there are only four of them) are located between the atria and ventricles (mitral - between the left ventricle and the left atrium, tricuspid - between the right ventricle and the right atrium) and the vessels extending from them (aortic - between the left ventricle and the aorta, pulmonary - between the right ventricle and pulmonary artery). The mitral and tricuspid valves open during atrial systole, i.e. when blood flows from the atria to the ventricles. At the moment when the ventricles pump blood (left - into the aorta, right - into the pulmonary artery), these valves close and prevent blood from flowing back into the atria. At this moment, the aortic valve and the pulmonary valve open, which allow blood to pass into the corresponding vessels. Once the pressure in the vessels becomes high, these valves close and prevent blood from returning to the ventricles. Thus, the valves of the heart ensure both the correct flow of blood in the heart and the phasing of the work of the atria and ventricles.

Damage to the heart valves during the formation of defects is observed mainly in two variants. In the event that, as a result of rheumatic or other damage, wrinkling of the valve leaflets or their destruction occurs, insufficiency of one or another valve develops. The modified leaflets are not able to completely close the corresponding opening between the chambers of the heart. As a result, during the work of the heart, the blood partially returns to those departments from which it came. This puts additional stress on the heart muscle (extra volume load), which leads to an increase in heart muscle mass (hypertrophy) and then to its depletion.

The second variant of damage to the heart valves is the fusion of the valve leaflets, which leads to a narrowing of the corresponding hole between the chambers of the heart. Altered fused valve leaflets fail to fully open. This leads to the fact that the parts of the heart (ventricles or atria) work with an increased load: they have to pump blood through narrowed holes. This defect is called stenosis. As a result, as in the first case, thickening of the heart muscle and its fatigue occur. In actual clinical practice, isolated insufficiency or isolated stenosis is extremely rare; as a rule, they are combined with the predominance of one or another lesion. In severe cases, multiple heart valves may be affected.

Recently, rheumatism - a disease that most often causes heart defects - is hidden and is not manifested by pain in the joints, fever and other symptoms. The freemen do not know that they have suffered rheumatism, and for the first time they go to the doctor already with a formed heart disease. The fact that a patient with a heart disease for many years may not know about his disease is explained by the fact that the heart has large reserve capabilities that allow it to compensate for the existing defect due to the increased work of the corresponding parts of the heart. At this stage, the heart disease is called compensated.

As the disease progresses, signs of heart failure appear, i.e. such a condition when the heart muscle can no longer work hard and provide normal blood flow. At this stage, heart disease is called decompensated. The development of decompensation occurs over time with severe heart defects.

However, this process can be accelerated by repeated attacks of rheumatism, which lead not only to increased deformation of the valve leaflets, but also to damage to the heart muscle itself. The course of the process can be aggravated by great physical exertion, infectious and other diseases, pregnancy and childbirth. In most cases, decompensation processes are relatively reversible. With timely started and comprehensive treatment, they can be suspended and maintained in a state of compensation for years.

mitral valve insufficiency

Mitral valve insufficiency is a defect in which, during the contraction of the left ventricle, part of the blood returns to the left atrium due to incomplete closure of the mitral orifice. Mitral valve insufficiency may be relative: while the valves are not changed, but due to the expansion of the left ventricle and the atrioventricular orifice, the mitral valve leaflets do not close completely. Organic mitral valve insufficiency is usually observed in combination with some narrowing of the mitral orifice and is more often caused by rheumatic endocarditis.

Symptoms. Patients may complain of shortness of breath with physical exertion, palpitations, weakness, which is associated with heart failure. An increase in the heart upwards and to the left is noted, which is best detected by fluoroscopy. In the first oblique position, the esophagus deviates along an arc of a large radius (10 cm) due to an increase in the left atrium. An important symptom of mitral insufficiency is a systolic murmur at the apex with conduction most often to the left axillary region. The I tone is weakened, the II tone on a pulmonary artery is strengthened. With an increase in congestion in the pulmonary circulation, an increase in the right ventricle is later detected, and then signs of its insufficiency with stagnation in the systemic circulation. On the ECG, signs of an increase in the left ventricle and a change in the P wave (expansion, serration) due to damage to the left atrium are noted, later signs of an increase in the right ventricle are added.

Systolic murmur at the top of the part is due to functional changes in the heart and occurs in 1/3 of healthy children and adolescents, somewhat less often in adults. At the same time, difficulties arise in the differential diagnosis with mitral valve insufficiency. For the diagnosis of rheumatic heart disease, in addition to the presence of a rheumatic history, it is necessary to pay attention to the weakening of the first tone at the apex of the heart, radiological signs of an increase in the left ventricle and atrium, the intensity of the systolic murmur, its duration. The diagnosis of defect is especially convincing in the presence of signs of at least a slight mitral stenosis.

Treatment. Therapy of active rheumatic heart disease with the appearance of heart failure is the appointment of cardiac glycosides and diuretics. At the expressed defect prosthetics of the mitral valve is possible.

Stenosis of the left venous opening

Stenosis of the left venous orifice (mitral stenosis) is a narrowing of the left atrioventricular orifice with difficulty and reduced blood flow into the left ventricle from the left atrium. This heart disease is usually caused by rheumatism. With it, there is an expansion of the left atrium with an increase in pressure in it and in the veins flowing into it. This leads reflexively to a spasm of the arterioles of the small circle, to an increase in pressure in the pulmonary artery. As a result, the load on the right ventricle of the heart also increases.

Symptoms. Complaints of shortness of breath with a relatively small load, cough, hemoptysis are characteristic. However, sometimes quite pronounced mitral stenosis proceeds for a long time without complaints. Patients often have a cyanotic-pink coloration of the cheeks (mitral flush). There are signs of stagnation in the lungs: moist rales in the lower sections. A tendency to attacks of cardiac asthma and even pulmonary edema is characteristic. An increase and hypertrophy of the right ventricle is noted with the appearance of a pulsation in the epigastric region, a displacement of the border of the heart to the right, as well as an increase in the left atrium with a displacement of the upper border to the II rib. In typical cases, a presystolic murmur is heard at the apex of the heart, and often a protodiastolic murmur, a loud 1st tone and an additional tone immediately following the 2nd tone (mitral valve opening tone). The presence of an additional tone causes a peculiar three-term rhythm (“quail rhythm”). The ECG shows signs of right ventricular hypertrophy and an increase in the left atrium (enlarged and broadened P1-2 wave). Mitral stenosis is one of the most important causes of atrial fibrillation. With severe pulmonary hypertension, patients develop stagnation in the systemic circulation.

Treatment of rheumatic heart disease and heart failure with this defect is carried out according to general rules. With severe mitral stenosis, commissurotomy is performed, and when combined with mitral insufficiency, mitral valve replacement is performed.

Aortic valve insufficiency

Aortic valve insufficiency is a defect in which during diastole there is no complete closure of the aortic valves, as a result of which part of the blood ejected into the aorta returns back to the left ventricle. The defect is caused by rheumatism, prolonged septic endocarditis, syphilis, atherosclerosis, rheumatoid arthritis.

Symptoms. The disease can proceed for a long time without complaints. Often there are pains in the heart of a different nature, sometimes prolonged, especially during exercise. There are palpitations, pulsation in the neck, later shortness of breath. Characterized by pallor, pulsation of the arteries of the neck ("dance of the carotid"). The left ventricle is significantly hypertrophied and enlarged. This is manifested by a shift of the apex beat to the left and down into the sixth - seventh intercostal space, its significant increase. On x-ray, the heart acquires an aortic configuration with an enlarged left ventricle and a pronounced waist. The most typical appearance of diastolic noise in the third - fourth intercostal space to the left of the sternum (Botkin's point), as well as in the second intercostal space to the right of the sternum (aortic point). A functional systolic murmur may also be heard above the aorta. Pulse pressure is increased, diastolic pressure may be zero, and systolic pressure is usually elevated. In this regard, the pulse is fast, frequent, high. ECG revealed signs of left ventricular hypertrophy. In the late stage of the defect, the expansion of the left ventricle leads to the development of relative insufficiency of the mitral valve, stagnation of blood in the lungs with increasing shortness of breath. With syphilitic defect, diastolic murmur is heard more clearly in the second and first intercostal spaces to the right of the sternum, often angina pectoris in the heart, while changes in the ascending aorta are observed during X-ray examination.

Treatment of heart failure, with this defect, is carried out according to general rules. However, diuretics should be preferred, since the use of digitalis is usually ineffective due to the fact that it helps to slow down the rhythm and lengthen the diastolic pauses, during which blood returns to the left ventricle. It is possible to radically eliminate the defect - aortic valve replacement.

Aortic stenosis

Aortic stenosis is a defect in which, due to the narrowing of the aortic orifice, the ejection of blood from the left ventricle is difficult. The defect is of rheumatic origin. First of all, left ventricular hypertrophy develops. The course of the disease depends largely on the degree of stenosis.

Symptoms. After a certain period of favorable course, patients develop pain in the region of the heart, fainting, shortness of breath and palpitations. Examination reveals an increase in the heart to the left with a displacement of the apex beat outwards and downwards. The data of the instrumental study confirm the increase and hypertrophy of the left ventricle. Sometimes an X-ray examination reveals calcification of the aortic valves. The most characteristic is a rough systolic murmur heard in the second intercostal space on the right side of the sternum. Noise is carried out on the vessels of the neck, sometimes throughout the chest. On the phonocardiogram, it has a diamond shape. Often there is systolic trembling over the aorta. The pulse is small and slow, pulse blood pressure is reduced. This defect is often combined with insufficiency of the aortic valve. The course of the defect can be complicated by the addition of angina pectoris due to insufficient coronary blood supply with a decrease in blood ejection into the aorta. The prognosis deteriorates sharply due to the addition of heart failure with circulatory disorders of the left ventricular type with shortness of breath, cardiac asthma.

Treatment of heart failure and rheumatic heart disease with this defect is carried out according to general rules. With severe aortic stenosis, surgery is indicated.

Tricuspid valve insufficiency

Tricuspid valve insufficiency is a defect in which, during the period of contraction of the right ventricle, part of the blood returns to the right atrium as a result of incomplete closure of the atrioventricular orifice by sclerosed valve leaflets. This defect occurs usually in combination with mitral or aortic defect. In this case, relative insufficiency of the tricuspid valve is often encountered due to stretching of the atrioventricular orifice as a result of expansion of the right ventricle.

Symptoms. On examination, the expansion of the cervical veins with their pulsation, synchronous with the pulsation of the arteries, is revealed. The right border of the heart is displaced to the right due to an increase in its right sections. A characteristic auscultatory sign is a long systolic murmur at the base of the sternum. Patients develop early heart failure with congestion in the systemic circulation: liver enlargement, edema, ascites, increased venous pressure. There may be pulsation of the liver.

Treatment. The first step is to treat heart failure.

Combined metral-aortic defect

Combined metral-aortic defect is characterized by damage to two valves, often with predominant stenosis or insufficiency of one of them. Most often there is a combination of mitral defect with a predominance of stenosis of the orifice with insufficiency of the aortic valve. At the same time, along with signs of mitral stenosis, diastolic murmur at the Botkin point is noted, but it is less intense than with isolated aortic valve insufficiency. When mitral stenosis is combined with aortic stenosis, the signs of the latter are more moderately expressed due to reduced filling of the left ventricle. With severe aortic valve insufficiency, the diagnosis of mitral stenosis can be difficult, since a presystolic murmur at the apex is also observed in isolated aortic insufficiency (Flint's murmur). At the same time, detection of the opening tone of the mitral valve and radiographic signs of mitral stenosis acquire diagnostic value.

Mitral-tricuspid and mitral-aortic-tricuspid malformations

Mitral-tricuspid and mitral-aortic-tricuspid defects are detected on the basis of the signs described above, characteristic of each of them. A multivalvular lesion should be considered with a long active course of rheumatic heart disease.

The combination of mitral stenosis with insufficiency of the bicuspid valve

The combination of mitral stenosis with insufficiency of the bicuspid valve is the most common heart disease. You should always strive to clarify the presence of a predominance of one or another vice. With the predominance of stenosis, a clapping I tone is usually preserved, with the predominance of insufficiency, it weakens. With this defect, both the left ventricle can increase due to valve insufficiency, and the right one, which is more characteristic of mitral stenosis. Both systolic and diastolic murmurs are usually heard. Thorough x-ray examination, as well as echocardiography, help clarify the diagnosis. Taking into account the development of cardiac surgery and the possibility of eliminating combined and concomitant heart defects, cardioangiography and cardiac sounding are shown to patients to clarify the indications for surgery.

Segmental massage technique

Then it is necessary to act on the intercostal space using:

a) rubbing the costal arches, with a special effort on the left half, b) light percussion techniques, c) concussion of the chest.

And also massage the front surface of the chest as a whole, paying special attention to the massage of the sternum:

a) stroking, b) rubbing, c) kneading, d) slight vibration.

When moving to a massage of the projection area of ​​the heart, the following are used:

a) stroking, b) rubbing, c) kneading, d) labile vibration intermittent and continuous, d) breathing exercises.

At the end of the session, the patient assumes a supine position, and the masseur acts on the lower and upper limbs for 3-5 minutes, conducting:

a) stroking, b) kneading, c) passive and active movements in the joints.

The course of the entire massage in the treatment of heart disease consists of 12 procedures performed at intervals of one day for 15-20 minutes each.

Prevention

A healthy lifestyle helps reduce the risk of high blood pressure, atherosclerosis, and heart attack.

Call your doctor if you experience persistent shortness of breath, palpitations, or dizziness.

Attention! Call 911 if you experience severe chest pain.

All medical measures for heart defects are carried out by a doctor. These measures depend on the type of defect and the reasons that caused it. First of all, it is necessary to treat the disease that caused the defect or contributes to its progression. The most common cause of acquired heart disease is rheumatism.

In the complex of therapeutic therapy of heart defects, a special place is occupied by general hygienic measures. They are aimed at improving the performance of the heart and compensating for circulatory disorders. For this purpose, a sparing work regimen and a sufficient rest regimen are established for the patient. Professional activity should be adequate to the capabilities of the patient and not lead to overload of the heart. It is necessary to avoid such physical and psycho-emotional stresses that can cause shortness of breath, palpitations, interruptions in the heart area. At the same time, physiotherapy exercises are shown, in which exercises specially recommended by the doctor are performed.

With the appearance of pronounced signs of circulatory insufficiency, the regimen restrictions become more stringent, and in some cases bed rest is indicated. Patients with heart defects feel better with a raised headboard and lowered legs.

It is necessary to follow medical recommendations regarding the diet, which should be complete. The amount of food is limited to one meal, because overeating leads to difficulty in the work of the heart. You should not eat before bed. It is necessary to limit the amount of fluid consumed (up to 1.0-1.5 liters per day) and salt (up to 2-5 g). It should be remembered that salt leads to fluid retention in the body, and this can increase signs of circulatory failure.

Drug therapy should be continuous. Self-cancellation of drugs, changing their dosages is strictly prohibited, because this can cause severe, often irreversible changes.

During the compensation period, you can use spa treatment.

Patients with heart defects should be under dynamic medical supervision, with a doctor's examination at least once every six months. Women, before deciding on the birth of a child, should definitely consult a doctor, since pregnancy and childbirth are the heaviest burden on the cardiovascular system.

The doctor determines the indications and contraindications for surgical treatment of heart disease. In clinical practice, there are often situations when a patient in the stage of compensation refuses surgical intervention, and in the stage of decompensation, when therapy becomes ineffective, the risk of surgery increases so much that surgical treatment cannot be performed or it is ineffective. Therefore, the decision on the timing of the operation is very responsible and is taken by doctors collectively.

With the right choice of profession, observance of the regime of work and rest, timely and systematic treatment of a patient with heart disease, a patient with heart disease can live a full life and remain able to work for many years.