Heart defects short description. Heart defects: their types and treatment. Pulmonary blood flow close to normal

Lecture in internal medicine for the 4th course.

TOPIC: HEART DEFECTS.

Classification.

congenital - are usually diagnosed in childhood (newborns).

acquired - a person teaches them at a young, usually adolescence.

Congenital heart defects include:

ventricular septal defect (VSD) - in the membranous or muscular part of it

patent ductus arteriosus (PDA)

vessel disposition

valvular anomalies

Acquired heart defects (APD). The vast majority of them are valvular defects, also include perforation of the interventricular septum due to AMI or infective endocarditis.

When making a diagnosis of heart disease, it must be taken into account that any defect has direct symptoms, that is, directly associated with a violation of blood flow, which creates noise and trembling, as well as indirect symptoms that are associated either with changes in the heart itself (hypertrophy, dilation) and symptoms associated with a feature peripheral circulatory disorders (that is, those complaints with which the patient comes to the doctor). Each isolated defect has its own classification, but today a general classification for all heart defects has been proposed and is widely used in practice, which was proposed by the New York Association of Cardiac Surgeons.

According to this classification, all vices can be divided into 4 classes.

The first functional class - there is a defect, but there are no changes in the parts of the heart (the defect is insignificant). example of mitral valve prolapse.

The second functional class - there are changes in the heart, but they are reversible. There are no changes in other organs. Operation success 100%.

The third functional class - there are irreversible changes in the heart and reversible changes in other organs.

The fourth functional class is characterized by the appearance of irreversible changes from other organs and systems.

This classification allows you to evaluate the prognosis of working capacity, give recommendations regarding physical activity. In fact, the diagnosis can be formulated as follows:

vice (name)

etiology of the defect

functional vice class

functional class of heart failure.

Acquired heart defects.

Etiology.

rheumatism - more than ½ cases (in young patients in 95-97%)

infective endocarditis

atherosclerosis and calcification

syphilis - causes malformation aortic valve

myocardial infarction

other rare causes.

Clinic and diagnostics.

Let us consider isolated defects, although in practice combined defects (2 types of defects in one valve) and complex defects (when several valves are simultaneously affected) are more often observed.

MITRAL STENOSIS.

Etiology: usually rheumatic, 0.5% of cases - other causes.

Pathomorphology. Predominantly proliferative inflammation at the base of the valve, narrowing of the opening itself and fusion of the leaflets.

Pathophysiology. As a result of the narrowing of the AV hole, the atrium needs to create more pressure (shortness of breath and tachycardia appear during exercise, which is often explained by lack of training). Further, the left atrium either dilates or leads to atrial fibrillation. Both lead to a sharp decrease in the contractility of the left atrium, as a result of which there is an increase in pressure in the veins, the Kitaev reflex occurs, and hence shortness of breath. The pressure in the arteries of the small circle increases and hypertrophy of the right ventricle occurs, as a result of which the small circle overflows with blood and a clinic of left ventricular failure occurs, which in itself is malignant. Then the right ventricle dilates and changes occur in the systemic circulation. The normal area of ​​the mitral orifice is 4.5 cubic cm, the critical area is 1.5 cm. Thus, 1/3 of the area of ​​the orifice still leaves room for compensation, followed by persistent decompensation.

Clinic. In addition to palpitations, complaints of interruptions in the work of the heart, shortness of breath and episodes of suffocation, hemoptysis should be noted. Weakness and fatigue are also common.

infantilism (that is, the patient looks a little younger than his age)

facies mitralis - a bright blush of the cheeks against the background of general pallor, is one of the manifestations of peripheral cyanosis (since cardiac output)

on palpation, asymmetry of pulse and pressure, since the enlarged left atrium compresses the vascular bundle: on the left, the pulse is less frequent, blood pressure is lower than on the right

on percussion, the heart is enlarged to the left and upward.

atrial fibrillation - often contributes to thromboembolism

a sharp increase in the first tone (clapping). This is due to insufficient filling of the left ventricle, its systole is shorter than normal.

the appearance of a click of the opening of the mitral valve (immediately follows the second tone)

noise appears in diastole: against the background of sinus rhythm, presystolic murmur appears, which is caused by contraction of the left atrium; the murmur may be diastolic.

This symptomatology is best heard at the apex, at the Botkin point and in the axillary region in the patient's position on the left side. There may be an emphasis of the second tone on a. pulmonalis as a result of pulmonary hypertension.

ECG: signs of hypertrophy of the right ventricle and left atrium. If atrial fibrillation occurs, the ECG pattern is characteristic

FCG - actually gives data about what we hear. Allows you to evaluate the interval 2 tone - mitral click. The shorter the interval, the more severe the stenosis.

EchoCG - allows you to assess the size of the heart, the area of ​​the mitral orifice. Having a Doppler transducer, it is possible to record the speed of blood movement through the mitral orifice.

X-ray of the chest cavity: an increase in the heart to the left and up. Signs of pulmonary hypertension.

Catheterization of the cavities of the heart, measurement of pressure in them. There is an increase in pressure in the left atrium from 25 mm Hg. up to 80 -100-110 mm Hg

TREATMENT. Radical - surgical.

1.balloon valvuloplasty is the most atraumatic operation, it can be used only in the early stages of the defect.

2. commissurotomy - the leaflets of the mitral valve are cut through the left atrium. These operations are not radical, they translate stenosis into insufficiency, which flows more favorably. After 10 years, restenosis appears in the vast majority of patients.

3. Radical treatment is mitral valve replacement

Therapy, if the operation is not possible: vasodilators (direct and ACE inhibitors), diuretics, cardiac glycosides for atrial fibrillation (tachysystolic form).

MITRAL INSUFFICIENCY.

Etiology: infective endocarditis, papillary muscle infarction, mitral valve prolapse.

Pathophysiology: in systole, blood is shunted into the left atrium. To compensate, dilatation and hypertrophy of the left ventricle occurs. There is a load on the volume of the atrium - it dilates, the pressure in the small circle increases - the right ventricle hypertrophies, but the compensatory capabilities of the left ventricle are better than the right one, which is why the right ventricle dilates faster than the left one. As a result, the patient develops heart failure with circulatory failure in the systemic circulation.

Clinic. It is characterized by complaints associated primarily with heart failure (shortness of breath, fatigue, edema, fights in the right hypochondrium, etc.)

Inspection. There are no pathognomonic signs.

Palpation: the borders of the heart are shifted down to the left. Auscultation: the first tone at the top weakens until it disappears completely. Systolic murmur occurs immediately after the first tone, occupies the entire systole. It is heard as well as possible at the apex, as well as in the axillary region in the position of the patient on the left side.

Additional research methods.

ECG - signs of hypertrophy predominantly of the left ventricle

EchoCG - gives an idea of ​​​​the movement of the valves (the size of the hole). Dopplerography allows you to assess the degree of regurgitation.

Radiography. Signs of left ventricular hypertrophy.

Conservative - treatment of heart failure according to generally accepted schemes.

Operative: valvuloplasty (sew chords, etc.); mitral valve replacement.

AORTIC STENOSIS.

Etiology: rheumatism, calcification, less often - hypertrophy of the interventricular septum, myxoma.

Pathological anatomy: proliferative inflammation at the base of the valve, fusion of its leaflets.

Pathological physiology: the left ventricle is forced to create pressure in order to ensure the flow of blood through the narrowed aortic valve into the aorta. In response to this, his concentric hypertrophy of the left ventricle appears. The rate of development of the defect is slow, so the defect remains compensated for 20-30 years and there are no complaints. When the left ventricle dilates, decompensation develops rapidly. The normal area of ​​the aortic orifice is 3 cm, the critical area of ​​the defect is 1 cm.

Clinic. Appears during the period of decompensation. The initial clinic is associated with the fact that stenosis limits cardiac output under conditions of physical activity - headaches, fatigue, weakness. At rest, the heart compensates for cerebral ischemia.

Further, patients develop pain in the projection of the heart during exercise (very similar to an anginal attack, but it occurs and goes away gradually, they are associated with myocardial ischemia). There are syncope (fainting) during physical exertion. The latter is a manifestation in the patient of signs of left ventricular failure (shortness of breath, pulmonary edema).

compensation period. On examination - increased apex beat, on auscultation - a typical rhomboid systolic murmur. It is heard over the entire surface of the heart, is carried out on the vessels of the neck and in the interscapular region. It breaks off in the region of the apex of the heart, it is better heard above the aorta. There are also signs of left ventricular hypertrophy, which reaches enormous proportions.

period of decompensation. Pulse pressure sharply decreases. There is a clinic of left ventricular failure.

Treatment: nitrates, beta-blockers, diuretics. Beta-blockers are shown only at the stage of compensation. Surgical treatment - only prosthetics.

Heart disease is a kind of a series of structural anomalies and deformations of valves, septa, holes 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. According to etiological factors, heart disease can be of congenital origin and acquired.

Heart defects with congenital etiology are divided into defects that are an anomaly of the embryonic formation of C.S.S. and for heart defects that develop as a result of endocardial pathologies during fetal development. Given the morphological lesions, this category of heart disease occurs with anomalies in the location of the heart, in the pathological structure of the partitions, both between the ventricles and between the atria.

There is also a defect in the arterial duct, valvular apparatus of the heart, aorta and the movement of significant vessels. For heart disease with an acquired etiology, development is characteristic of rheumatic heart disease, atherosclerosis, and sometimes after past injuries and syphilis.

Heart disease causes

The formation of heart disease of congenital etiology can be influenced by gene mutations, various infectious processes, endogenous as well as exogenous intoxications during pregnancy. In addition, this category of heart defects is characterized by various violations in the chromosome set.

Of the characteristic changes, trisomy 21 is noted in Down syndrome. Almost 50% of patients with such a genetic pathology are born with CHD (), namely, these are ventricular septal or atrioventricular defects. Sometimes mutations occur in several genes at once, contributing to the development of heart disease. Mutations such as in TBX 5 are found in many patients diagnosed with Holt-Oram syndrome, which is an autosomal type disease with septal defects. The cause of the development of supravalvular aortic stenosis is mutations that occur in the elastin gene, but changes in NKX lead to the development of heart disease.

In addition, heart disease can occur as a result of various pathological processes occurring in the body. For example, in 85% of cases, the development of mitral stenosis and in 26% of the damage to the aortic valve is affected by rheumatism. It can also contribute to the formation of various combinations of insufficient work of some valves and stenosis. The formation of heart defects acquired throughout life can lead to sepsis, an infectious nature, trauma, and in some cases, Libman-Sacks endocarditis, rheumatoid, causing visceral lesions and.

Sometimes different degenerative changes cause the development of isolated mitral and aortic insufficiency, aortic stenosis, which are characterized by non-rheumatic origin.

Heart disease symptoms

Any organic lesions heart valves or its structures, which become the causes characteristic violations, are in the general group called "heart disease".

The characteristic signs of these anomalies are the main indicators by which it is possible to diagnose a certain heart disease, as well as at what stage of development it is. At the same time, there is a symptomatology with a congenital etiology, which is determined almost immediately from the moment of birth, but for acquired cardiac anomalies, a poor clinic is characteristic, especially in the compensatory stage of the disease.

As a rule, the clinical symptoms of heart disease can be conditionally divided into common features diseases and specific For some disorders in the structure of the heart or blood vessels, a certain specificity of symptoms is characteristic, but the general signs are characteristic of many diseases of the entire circulatory system. Therefore, heart disease, for example, in infants has more non-specific symptoms, in contrast to the symptoms of a certain type of disturbance in the blood flow system.

Children's heart disease is differentiated by type of color skin. With cyanotic coloration of the skin, blue defects are considered, and a pale shade is characteristic of white defects. With white heart defects, venous blood does not enter the ventricle located on the left side of the heart or its outlet narrows, as well as the aorta parallel to the arch. And with blue defects, mixing of blood or transposition of vessels is noted. It is very rare to observe the appearance of rapidly developing skin cyanosis in a child, which makes it possible to assume that the existing heart disease is not in singular. An additional examination is required to confirm this diagnosis.

The symptoms of general manifestations include the appearance of signs in the form of dizziness, frequent heartbeat, increase or decrease in blood pressure, shortness of breath, cyanosis of the skin, pulmonary edema, muscle weakness, fainting, etc. All these symptoms cannot accurately indicate an existing heart disease, so an accurate diagnosis of the disease is possible after a thorough examination. For example, an acquired heart disease can be identified after an audition, especially if the patient has a history of characteristic disorders. The mechanism of hemodynamic disorders makes it possible to immediately reliably and quickly determine the type of heart disease, but the stage of development is much more difficult to identify. This can be done when signs of a non-specific disease appear. The greatest number of clinical symptoms is characteristic of heart defects in combination or combined form.

With a subjective assessment of congenital heart defects, an insignificant intensity of symptomatic manifestations is noted, while acquired ones are characterized by severity in such stages as decompensation and subcompensation.

The clinical symptoms of stenosis are more pronounced than valve insufficiency. Mitral stenosis manifests itself in the form of diastolic cat's purring, lagging pulse on the artery of the left hand as a result of compression of the subclavian artery on the left, acrocyanosis, in the form of a heart hump, cyanosis in the nasolabial triangle.

In the subcompensation and decompensation stages, PH develops, leading to difficulty breathing, the appearance of a dry cough with scanty white sputum. These symptoms increase each time and lead to the progression of the disease, which causes the appearance of a worsened condition and weakness in the body.

With absolute decompensation of heart disease, patients develop edema in some parts of the body and pulmonary edema. For stenotic disease of the first degree, affecting the mitral valve, when performing physical exertion, shortness of breath with a feeling of heartbeat and a dry cough is characteristic. Valve deformity is noted on both the aortic and tricuspid valves. With an aortic lesion, a systolic murmur is detected in the form of purring, palpation weak pulse with the presence of a heart hump between the fourth and fifth ribs. With an anomaly of the tricuspid valve, edema appears, heaviness in the liver, which is a sign of complete filling of the vessels. Sometimes the veins on the lower extremities expand.

The symptomatology of insufficient functioning of the aortic valve consists of changes in pulse and blood pressure. AT this case the pulse is very tense, the size of the pupil changes in diastole and systole, and an Quincke pulse of capillary origin is also observed. For the period of decompensation, the pressure is at low numbers. In addition, this heart disease is characterized by its progression, and the changes that occur in the myocardium very quickly become the cause of HF (heart failure).

In patients over young age, as well as among children with heart defects of congenital etiology or early acquired, the formation of a heart hump is noted as a result of high blood pressure enlarged and altered myocardium of the left side of the ventricle on the anterior wall of the chest.

In congenital heart anomalies, frequent beating hearts and efficient blood circulation which are characteristic from birth. Very often, with such defects, it is found due to a septal defect between the atrium or between the ventricle, transposition of the aorta, stenosis of the entrance to the right ventricle and its hypertrophy. All these symptomatic signs are also possessed by such a heart disease as Fallot's tetrad, which very often develops in newborns.

Heart disease in children

Cardiac pathology, which is characterized by defects in the valvular apparatus, as well as in its walls, is called heart disease. In the future, it leads to the development of cardiovascular insufficiency.

In children, heart defects are congenital etiology or can be acquired during life. The reasons for the formation of congenital malformations in the form of defects in the heart and adjacent vessels are considered to be violations in the processes of embryogenesis. Such heart defects include: defects between the partitions, both between the ventricles and between the atria; a defect in the form of an open arterial duct; aortic stenosis; tetrad of Fallot; stenosis of the pulmonary artery of an isolated nature; coarctation of the aorta. All these cardiac pathologies in the form of heart defects are laid even in the prenatal period, which can be detected using ultrasound of the heart, and on early stages development using electrocardiography or dopplerometry.

The main reasons for the development of heart disease in children include: a hereditary factor, smoking and drinking during pregnancy, an environmentally unfavorable area, a woman's history of miscarriages or stillborn children, as well as an infectious disease such as rubella during pregnancy.

Acquired heart defects are characterized by abnormalities in the area of ​​the valves, in the form of stenosis or insufficient work of the heart. These heart defects in childhood develop as a result of certain diseases. These include infective endocarditis, mitral valve prolapse, and rheumatism.

To determine the heart disease in a child, first of all, pay attention to the noise during auscultation of the heart. Available organic noises are indicative of presumed heart disease. A child with such a diagnosis gains very little weight every month, about 400 grams, he has shortness of breath, and he quickly gets tired. As a rule, these symptoms appear during feeding. At the same time, heart disease is characterized by tachycardia and cyanosis of the skin.

Mostly clear answer in treatment childish vice the heart does not exist. Many factors play a role in the choice of therapeutic approach. This is the nature of the disease, the age of the child and his condition. It is important to take into account such a moment that heart disease in children can go away on their own, after reaching fifteen or sixteen years. All this refers to heart defects with congenital etiology. Very often, the initial treatment of the disease that caused the development of heart disease in children or contributed to its progression is started. In this case, preventive and drug treatment is used. But the acquired cardiac pathology often ends with a surgical operation. In this case, it is a commissurotomy, which is performed with isolated mitral stenosis.

Surgical intervention in the presence of mitral insufficiency is prescribed in cases of complications or deterioration in the child's well-being. The operation is performed with the replacement of the valve with an artificial one. For therapeutic therapy of heart disease, an appropriate protein diet with water and salt restriction, various general hygiene measures, as well as constant exercise therapy are prescribed. A child with heart disease is taught to perform certain physical activities that constantly train the heart muscle. First of all, it is walking, which helps to increase blood circulation and prepares the muscles for the next exercise. Then perform a set of exercises that straighten the spine and chest. Of course, an integral part of the classes is gymnastics for the respiratory system.

Heart disease in newborns

In newborns, heart disease can be based on certain genetic causes, as well as environment can greatly influence its formation, especially in the first trimester of pregnancy.

In addition, if the expectant mother used certain drugs, narcotic drugs, alcohol, smoked, or had certain viral or bacterial etiology, then there is huge probability development of heart disease, first in the fetus, and then in the newborn. Some types of heart defects develop for reasons of hereditary etiology. All these pathologies can be determined even when examining pregnant women on ultrasound, and sometimes with late diagnosis, but then heart defects manifest themselves at different ages.

In newborns, heart defects are a common pathology and a very serious problem. They are divided into heart defects characterized by shunting and without shunting. Clinical symptoms are most pronounced in the first variant of heart disease, when there is a defect between the atrial septa. In this case, blood without oxygen enrichment enters such a circle of blood circulation as a large one, so the newborn develops cyanosis or a bluish coloration of the skin. A characteristic cyanosis is visible on the lips, so there is medical term « blue baby". Cyanosis also appears with a septal defect between the ventricles. This is due to a defect, as a result of which the heart and the small circle are overloaded due to pressure in different departments hearts.

For heart defects of congenital origin, but without blood shedding, coartation of the aorta is more characteristic. In this case, a cyanotic tint does not appear on the skin, but with a different level of development of the defect, cyanosis may form.

The most common neonatal malformations are tetralogy of Fallot and coartation of the aorta. But of the most common defects, atrial and ventricular septal defects are distinguished.

The defect of Fallot's tetrad is formed in the fourth to sixth weeks of pregnancy as a result of disturbances in the development of the heart. A significant role belongs to heredity, but risk factors also play an important role. Most often, this defect occurs in newborns with. The tetrad of Fallot is characterized by a septal defect between the ventricles, the position of the aorta changes, the pulmonary aorta narrows and the right ventricle enlarges. At the same time, a rustling in the heart is heard, shortness of breath is noted, and lips and fingers turn blue.

Aortic coartation in newborns is characterized by narrowing of the aorta itself. Depending on this constriction, there are two types: postductal and preductal. The last cardiac type refers to a very severe pathology incompatible with life. In this case, surgical intervention is necessary, since this heart defect leads to a bluish lower body.

Heart valve disease of congenital origin is presented in the form of protruding parts of the endocardium, which lines inner part hearts. With such defects, the blood circulates in only one direction. The most common heart defects in this category are aortic and pulmonary defects. The symptomatology of this pathology consists of a certain heart rustle, difficulty breathing, swelling of the limbs, chest pain, lethargy and loss of consciousness. To clarify the diagnosis, electrocardiography is used, and one of possible methods treatment is surgery.

Diagnosis of heart defects in newborns consists in identifying this pathology even before birth, that is, the method of prenatal diagnosis is used. There are invasive and non-invasive examinations. The first diagnostic method includes cordocentesis, chorion biopsy and amniocentesis. The second examination method includes a blood test for a biopsy in the mother, an ultrasound scan of a pregnant woman in the first half of pregnancy, and a second ultrasound examination to clarify the diagnosis.

A certain group of heart defects in infants in some cases is simply life-threatening, therefore, in this case, an emergency surgical operation is prescribed. For example, with such a heart disease as coartation of the aorta, the narrowed area is surgically removed. In other cases, surgery is delayed for certain period time, if possible without surgery.

Acquired heart defects

This pathology in the structure and functioning of the heart valves, which are formed throughout a person's life under the influence of certain factors, leads to violations of the heart. The formation of acquired heart defects is influenced by infectious lesions or various inflammatory processes, as well as certain overloads of the heart chambers.

A heart defect that a person has acquired during life is also called valvular heart disease. It is characterized by stenosis or insufficient functioning of the valve, and at some points it manifests itself as a combined heart defect. When making this diagnosis, a violation in the work of the mitral valve is revealed, which is unable to regulate blood flow and causes stagnation in both circles of blood circulation. And the overload of some cardiac departments leads to their hypertrophy, and this, in turn, changes the entire structure of the heart.

Acquired heart defects are rarely timely diagnosis which distinguishes them from the VPS. Very often people endure many infectious diseases"on the legs", and this can cause rheumatism or myocarditis. Acquired heart defects can also be caused by inappropriate treatment.

In addition, this category of cardiac pathology is classified according to etiological signs into heart defects with syphilitic origin, atherosclerotic, rheumatic, and also as a consequence of bacterial endocarditis.

Acquired heart defects are characterized by a high or moderate degree of hemodynamic disturbances inside the heart; there are also such defects that this dynamics does not affect at all. Depending on this hemodynamics, several types of acquired defects are distinguished, namely compensated, decompensated and subcompensated.

An important point to diagnose the type of defect, its localization is taken into account. Heart defects such as monovalvular include mitral, aortic, and tricuspid heart disease. In this case, only one valve is subjected to deformation. If both are affected, they speak of combined valvular heart disease. This category includes mitral-tricuspid, mitral-aortic, aortic-mitral-tricuspid defects, etc.

With minor heart defects, the symptoms of the disease may not manifest themselves for a long time. But hemodynamically significant acquired heart defects are characterized by shortness of breath, cyanosis, edema, rapid heartbeat, pain in this area and cough. characteristic clinical sign any kind of defect is a heart murmur. For a more accurate diagnosis, a consultation with a cardiologist is prescribed, who conducts an examination using palpation, percussion, auscultation, which makes it possible to listen to a clearer heartbeat and the murmur present in the heart. In addition, methods of ECHO-cardioscopy and Dopplerography are used. All this will help to assess how a certain heart disease has severity, as well as its decompensation degree.

Making such a diagnosis as heart disease requires a person to be more responsible for their health. First of all, it is necessary to limit the performance of heavy physical exertion, especially in professional sports. It is also important to follow correct image life with rational nutrition and the regime of the day, regularly carry out the prevention of endocarditis, cardiac arrhythmias and insufficient functioning of blood circulation, as there are prerequisites for the formation of defects in this category of patients. In addition, timely treatment of infectious diseases with the prevention of rheumatism and endocarditis of bacterial etiology can prevent the development of acquired heart defects.

To date, two methods of treatment of the acquired category of this cardiac pathology are used. These include surgical method treatment and medication. Sometimes this anomaly becomes completely compensated, which allows the patient to forget about his diagnosis in the form of a heart disease of acquired origin. However, for this an important point remains the timely diagnosis of the disease and the correct treatment.

AT therapeutic methods treatment includes stopping the process of inflammation in the heart, then surgery to correct heart disease. As a rule, surgery is performed on the open heart and the effectiveness of the operation largely depends on the early timing of its implementation. But such complications of heart defects as insufficient work of blood circulation or disturbed heart rhythm can be eliminated without a surgical operation.

Aortic heart disease

This disease is divided into stenosis and insufficiency of the aorta. Today, aortic stenosis, among acquired heart defects, is most often detected in North America and Europe. About 7% are diagnosed with calcific aortic stenosis in people over 65 years of age and mainly among the male half of the population. Only 11% falls on such an etiological factor as rheumatism in the formation of aortic stenosis. In the most developed countries, the cause of the development of this heart disease is almost 82% of the degenerative calcification process that occurs on the aortic valve.

One third of patients suffer from bicuspid aortic valve disease, where valvular fibrosis progresses as a result of damage to the valve tissues themselves and atherogenic processes are accelerated, and this is precisely what causes the formation of aortic malformation in the form of stenosis. And such provoking factors as smoking, dyslipidemia, the age of the patient, a significantly increased cholesterol level can accelerate fibrotic processes and the formation of aortic malformation in the heart.

Depending on the severity of the disease, several of its degrees are distinguished. These include: aortic stenosis with slight narrowing, moderate and severe.

The symptomatic picture of aortic heart disease depends on the anatomical changes in the aortic valve. With minor lesions, most patients live and work for a long time in their usual rhythm of life and do not show certain complaints that would indicate aortic defect. In some cases, heart failure (HF) is the first symptom of aortic valve disease. Hemodynamic disorders represent increased fatigue, which is associated with the centralization of blood flow. All this causes the development of dizziness and fainting in patients. Almost 35% of patients have pain characterized by angina pectoris. With decompensation of the defect, shortness of breath appears after any physical exertion. But as a result of inadequate physical activity, pulmonary edema can occur. Symptoms such as cardiac-type asthma and angina attacks are unfavorable forecasts diseases.

Visually, during the examination of the patient, pallor is noted, and with severe stenosis, the pulse of small and slow filling, and the pressure of systole and pulse is reduced. The heart impulse at the top is heard in the form of a powerful tone, spilled, rising with a shift to the left and down. When applying the palm to the handle of the sternum, a pronounced trembling of systole is felt. During percussion, the border of cardiac dullness with a shift in left side and down almost 20 mm, and sometimes more. During auscultation, a weakened second tone between the ribs is heard, as well as a systolic murmur, which is carried out to all parts of the heart, to the back and cervical vessels. Sometimes auscultatory noise is heard remotely. And with the disappearance of the second aortic tone, one can speak with full confidence about severe aortic stenosis.

Aortic heart disease is characterized by five stages of flow.

The first stage is absolute compensation. Patients do not show characteristic complaints, the defect is detected during auscultation. Using ECHO-cardiography, a slight systole pressure gradient across the aortic valve (about 40 mm Hg) is determined. Surgical treatment is not carried out.

The second stage of the disease is the latent insufficient work of the heart. Here there is fatigue, shortness of breath against the background of physical exertion,. In addition to signs of aortic stenosis during auscultation, a characteristic sign of left ventricular hypertrophy is detected using X-ray and electrocardiographic studies. When conducting ECHO-cardiography, it is possible to determine a moderate systolic pressure on the aortic valve (about 70 mm Hg) and an operation is simply necessary here.

The third stage is characterized by relative coronary insufficiency, which is manifested by pain resembling angina pectoris; shortness of breath progresses; become more frequent fainting and dizziness on the background of minor physical exertion. The borders of the heart are distinctly enlarged due to the left ventricle. On the electrocardiogram, there are all signs of an increase in the ventricle in the left side of the heart and hypoxia of the heart muscle. With ECHO-cardiography, the systole pressure is maximally increased above 60 mm Hg. Art. In such a state, an urgent operation is prescribed.

At the fourth stage of aortic heart disease, left ventricular failure is expressed. Complaints of patients are the same as in the third stage of the disease, but pain and other sensations are much stronger. Sometimes attacks of shortness of breath of a paroxysmal nature appear with periodicity and mainly at night; ; the liver enlarges and pulmonary edema occurs. The electrocardiogram shows all disorders associated with coronary circulation and atrial fibrillation. And ECHO-cardiographic examination reveals calcification of the aortic valve. An x-ray shows an enlarged ventricle in the left side of the heart, as well as congestion in the lungs. Recommendations bed rest and the appointment of conservative methods of therapy temporarily improve the general condition of some patients. In this case, the surgical method of treatment is basically simply impossible. Everything is decided on an individual basis.

And last stage aortic heart disease is terminal. It is characterized by the progression of RV and LV insufficiency. At this stage, all signs of the disease are quite pronounced. The patients are in an extremely serious condition Therefore, treatment in this case is no longer effective and surgical operations are also not performed.

Aortic insufficiency refers to one of the varieties of aortic defects. The frequency of its detection, as a rule, is directly dependent on the methods diagnostic studies. The prevalence of this type of defect increases with a person's age, and all clinical signs of a severe form of insufficiency are much more often detected in males.

One of the most common causes of this pathology is aortic aneurysm ascending part, as well as the bicuspid aortic valve. In some cases, the cause of the pathology in almost 50% is due to degenerative disorders of the aortic valve. In 15%, the etiological factor is rheumatism and atherosclerosis, and in 8% - endocarditis of infectious origin.

As with aortic stenosis, there are three degrees of severity of aortic heart disease: initial, moderate, and severe.

Symptoms of aortic insufficiency consist of the rate of formation and size of valvular defects. In the compensatory phase, there are no subjective signs of the disease. The development of aortic heart disease proceeds calmly, even with a significant amount of aortic regurgitation.

With the rapid formation of extensive defects, the symptoms are gaining progression, and this becomes the cause of insufficient heart function (HF). A certain number of patients become dizzy and feel their heart beat. In addition, in almost half of patients diagnosed with aortic insufficiency, the causes of which are atherosclerosis or, angina pectoris is the main symptom of the disease.

Attacks of difficulty breathing develop at the beginning of the pathological process with increased physical exertion, and with the formation of left ventricular failure, shortness of breath appears at rest and is characterized by symptoms of cardiac asthma. Sometimes everything is complicated by the addition of pulmonary edema. In addition, the patients are very pale, their carotid, brachial, and temporal arteries pulsate strongly, and the symptoms of Musset, Landolfi, Muller, and Quincke are observed. On examination, Corrigan's pulse is observed, during auscultation, a very strong and somewhat diffuse shock is heard at the apex of the heart, and its boundaries are significantly enlarged in left side and down. Above the vessels of a large structure, a Traube tone of a double character is noted, and when pressing on the area iliac artery Durozier noise appears. Systolic pressure rises to 170 mm Hg. Art., and for indicators of diastolic pressure is characterized by a decrease to almost 40 mm Hg. Art.

This pathology develops from the appearance of the first signs until the death of the patient, on average, this takes about seven years. Insufficient work of the heart is formed very quickly in the process of tearing off the leaflet or a rather severe valve lesion in endocarditis. Such patients live a little more than a year. A more favorable prognosis is characterized by aortic heart disease against the background of atherosclerotic origin, which rarely leads to significant changes in the valves.

Mitral heart disease

This category of diseases includes stenosis and insufficient function of the mitral valve. In the first case, stenosis is considered a frequent rheumatic heart disease, the cause of which is long-term rheumatic endocarditis. As a rule, this type of cardiac pathology is more common among the younger generation and affects the female half of the population in 80% of cases. Very rarely, the mitral orifice narrows as a result of carcinoid syndrome, rheumatoid arthritis, and lupus erythematosus. And 13% of cases are due to degenerative valve changes.

Mitral stenosis can be minor, moderate, or significant.

All clinical symptoms mitral heart disease in the form of stenosis has a certain dependence on the stage of this pathology, and the state of the blood circulation. With a small area of ​​the hole, the defect does not manifest itself clinically, but this only applies to the state of rest. But with an increase in pressure in such a circle of blood circulation as a small one, shortness of breath appears, and patients complain of a strong heartbeat when performing minor physical exertion. In cases sharp increase capillary pressure develops cardiac asthma, dry cough, and sometimes with sputum and even in the form of hemoptysis.

With LG ( pulmonary hypertension) patients become weak and get tired quickly. At severe symptoms stenosis, there are signs of a mitral blush in the cheeks with a pale complexion, cyanosis on the lips, tip of the nose and ears.

During visual inspection with mitral heart disease, there is a strong protrusion of the sternum of the lower section and pulsation as a result of the formation of the hump of the heart, which is the result of increased blows of the pancreas against the chest wall in front. In the region of the cardiac apex, diastolic trembling is determined in the form of a cat's purr. During auscultation, an increase in the first tone in the upper part of the heart and a click when the mitral valve opens are heard.

Mitral stenosis can occur in several stages. The first is full compensation, in which you can do without the use of surgical treatment. The second is stagnation in the LH (pulmonary artery). In this case surgical treatment carried out strictly according to indications. The third is insufficient work of the pancreas. Are celebrated absolute indicators for surgical intervention. The fourth stage is characterized by dystrophic changes. With the use of drug therapy, it is possible to achieve an insignificant, short-term effect. At this stage, operations can be performed, however, for a short time increasing the life expectancy of patients. For the last one terminal stage, any treatment does not give any effectiveness, neither medication nor surgery.

Mitral valve insufficiency is considered the second type of mitral heart disease. Today, in the modern world, 61% of this disease is due to degenerative mitral insufficiency and only 14% is rheumatic pathology. Other causes in the development of this heart disease include systemic scleroderma, endocarditis of infectious etiology and coronary artery disease.

This disease is classified into initial severity, moderate and severe.

In compensation, this type of heart disease is accidentally detected during a medical examination. With reduced work of LV contractions, attacks of labored breathing develop when performing certain work and heartbeat. Then edema is formed on the legs, pain in the hypochondrium on the right side, cardiac asthma and even shortness of breath in the state of absolute yet.

Many patients are diagnosed with aching, stabbing, pressing pain in the heart, which can appear without physical exertion. With significant processes of regurgitation in the left side of the sternum, the formation of a heart hump is noted in patients, a push is heard in the upper part of the heart of an enhanced and diffuse character, which is localized under the fifth rib. On auscultation, the first heart tone, over the LA the second tone is very often split and at the top - a deaf third tone.

With mitral insufficiency, five stages of the disease are also distinguished. The first is the stage of compensation, without indications for operational methods treatment. The second is the subcompensation stage, which requires surgical intervention. The third stage of mitral insufficiency proceeds with pancreatic decompensation. The operation is also scheduled here. The fourth is dystrophic changes in the heart. In this case, surgical intervention is still possible. The fifth stage is the terminal stage, in which surgical treatment is no longer performed.

Prognostic parameters of poor outcomes include patient age, the presence of certain symptoms and atrial fibrillation, progressive PH processes, and low ejection fraction.

Heart disease treatment

As a rule, the treatment of heart disease is divided into medical methods and surgical methods. In the phase of compensation of heart defects, no special treatment is prescribed. It is recommended to reduce physical exercise and mental fatigue. An important point is the exercise in the LF group. But in the decompensation period, antihypertensive drugs are prescribed to prevent pulmonary bleeding; beta-adrenergic blockers and Endothelin, which reduces the resulting functional heart failure, which also allows you to endure physical activity. Anticoagulants are used in the development of fibrillation and atrial flutter.

With decompensated heart disease, such as mitral valve disease, digitalis preparations are used; with aortic defects - Strofantin. But basically, with the ineffectiveness of conservative methods of treatment, they resort to surgical operations for various heart defects.

In order to prevent the development of acquired heart defects, it is necessary to treat diseases such as atherosclerosis, rheumatism, syphilis in a timely and thorough manner, eliminate infectious foci in the oral cavity and pharynx, and also not to overwork and prevent nervous overload. In addition, it is important to observe sanitary and hygienic rules in everyday life and work, to combat dampness and hypothermia.

In order for the heart disease not to go into the stage of decompensation, it is necessary not to overeat, it is necessary to rationally distribute the time of work and rest with sufficient time for sleep. Various hard types of work, for people with heart defects, are completely contraindicated. Such patients are constantly registered with cardiologists.

Heart disease operation

In certain cardiac surgery clinics, for the treatment of heart defects, various methods surgical interventions. With insufficient functioning of the valves, in some cases, resort to organ-preserving operations. In this case, the adhesions are cut or spliced. And when minor constrictions produces their partial expansion. This is performed using a probe, and the method belongs to endovasal surgery.

For more severe cases, a technique is used to completely replace the heart valves with artificial ones. With large forms of aortic stenosis and when it is not possible to expand the aorta, a resection is performed and a certain area of ​​the aorta is replaced with a synthetic Dacron prosthesis.

When diagnosing insufficiency of the coronary circulation, the method of bypass arteries that have lesions is simultaneously used.

There is also a modern method of surgical treatment of heart disease, which is developed and widely used in Israel. This is the rotablater method, which is characterized by the use of a small drill that allows you to restore the lumen of the vessels. Very often, heart defects are accompanied by rhythm disturbances, i.e. blockages occur. Thus, valve replacement surgery is always accompanied by the implantation of artificial control and regulation of the heart rhythm.

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

After discharge, patients periodically undergo examinations prescribed by a cardiologist or cardiac surgeon with preventive treatment Twice a year.

Heart disease is a kind of a series of structural anomalies and deformations of valves, septa, holes 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, it will lead to disability or even death.

What is a heart defect?

Heart disease is a group of diseases associated with congenital or acquired dysfunction and anatomical structure of the heart and coronary vessels(large vessels supplying the heart), which develop various disadvantages hemodynamics (the movement of blood through the vessels).

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 moderate cases may not have any symptoms, while at pronounced development heart disease can lead to congestive heart failure and other complications. Treatment depends on the severity of the disease.

The reasons

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 provides positive outcome diseases.

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

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

Causes of acquired defects:

• Infectious or rheumatic endocarditis (75%);
• Rheumatism;
• (5–7%);
• Systemic connective tissue diseases (collagenoses);
• Injuries;
• Sepsis ( total defeat 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

Classification divides heart defects into two large groups by the mechanism of occurrence: acquired and congenital.

• Acquired - occur at any age. The most common cause is rheumatism, syphilis, hypertension and ischemic disease, severe atherosclerosis of blood vessels, 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.

Also distinguished:

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

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 defects, then most often among them there are problems of the interventricular septum, in this case, 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 - trauma, tumors.

Heart disease symptoms

The defect that has arisen 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 the following symptoms, which can manifest itself in both older children and adults:

• Constant shortness of breath.
• Heart murmurs are heard.
• The person often loses consciousness.
• Observed atypically frequent.
• 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;
• increase in sleep 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).

Diagnostics

If, after reviewing the list of symptoms, you find matches with 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, which 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.

Treatment

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 when 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. coltsfoot mix 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.

Operation

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%).

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 carried out, 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.

Forecast

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

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 live with such vices?". 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.

The heart is one of principal organs 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, you need to do short review his devices. 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. AT right side venous blood enters 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). valve between the right ventricle and 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. 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. CHD occurs 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 mothers (diabetes mellitus, phenylketonuria, autoimmune diseases), big number history of abortion. 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 arterial blood 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 fabrics.

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 big circle 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 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 a we are talking about congenital pathologies, 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 undetected until the onset of 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, in initial stage may not show any symptoms. 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 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 causing endocarditis).

An important role in the treatment of defect is played by the regulation of the regime physical activity. Patients are contraindicated in high physical activity, stress. The doctor may prescribe a diet and physiotherapy. Patients are recommended regular walks, control of cholesterol levels in the blood.

Prevention

The main causes of malformations are rheumatism, infections, myocardial diseases and of cardio-vascular 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 rational regime labor and rest.

Heart defects - a group of diseases characterized by a violation of the anatomical structure of the heart valves or partitions. They are usually manifested by hemodynamic disturbances.

These diseases occur in both adults and children and may be associated with a number of factors. To understand what a vice is, you need to know not only the causes of this disease, but also how it affects the overall functioning of the body.

Classification

The structure of the heart

To understand what heart defects are, you need to know their classification. To begin with, it should be said that there are congenital and acquired defects.

Depending on the location of the lesion, there are the following types of defects:

• valve pathologies.
• Partition pathologies.

According to the number of affected structures, the following types of heart defects are distinguished:

• Simple. One valve failure.
• Complex. Damage to multiple valves.
• Combined. The combination of insufficiency and stenosis in one valve.

The classification of heart defects also takes into account the level of general hypoxia of the body. Depending on this factor, the following types are distinguished:

• White. Sufficient supply of tissues and organs with oxygen. Cyanosis is not formed.
• Blue. early manifestation hypoxia, the formation of central cyanosis.

Also, for the correct classification of congenital forms, the Marder table is used:

Causes

The etiology of congenital forms is represented by various chromosomal disorders. Also play a role environmental factors. In the event that the mother had rubella during pregnancy, the child has the following three syndromes:

1. Cataract.
2. Deafness.
3. Congenital anomalies of the heart. Most often it can be Fallot's tetrad (a combined congenital defect, which includes stenosis of the outflow tract of the right ventricle, aortic displacement, right ventricular hypertrophy).
4. In addition to rubella, the following infectious agents have an impact on the embryonic development of the cardiovascular system:

• Herpes simplex virus.
• adenovirus.
• Cytomegalovirus.
• Mycoplasma.
• Toxoplasma.
• Pale treponema.
• Listeria.

The etiology of congenital malformations is quite wide. It includes the use of alcohol and drugs by a pregnant woman. The teratogenic effect on the fetus of amphetamines has been proven.

Despite the fact that defects are not inherited, the presence of a family history of cardiovascular pathologies increases the risk of valvular heart disease in children. Also, some experts talk about possible development congenital malformation in the next generations in a closely related marriage.

The most common cause is acute rheumatic fever. In addition, the etiology includes the following diseases:

• Atherosclerosis.
• Syphilis.
• Autoimmune diseases.
• Heart injury.

Main manifestations

The pathophysiology of congenital heart defects to a greater extent lies in the disruption of normal blood circulation. Most often this contributes to:

1. Increased resistance to blood flow, leading to hypertrophy of the corresponding cardiac section.
2. Creation of a vicious communication between both circles of blood circulation.

Very often both of these pathogenetic mechanism can be combined. In this regard, the following signs of heart defects can be distinguished:

• Dyspnea.
• pathological noises.
• Fainting states.
• Cyanosis.
• Palpitation.
• Rhythm disturbance.
• Peripheral edema in the legs.
• Ascites (accumulation of fluid in the abdominal cavity).
• Hydrothorax (accumulation of fluid in the pleural cavity).

It is worth noting that compensated defects are most often asymptomatic and are detected during a routine examination. The main symptoms of heart defects appear when the body can no longer cope with hemodynamic disorders on its own.

Diagnostics

Based only on the symptoms identified during the examination, the diagnosis of "heart disease" is impossible. To do this, the doctor needs to conduct a number of physical and instrumental methods. Directly at the first visit to a specialist, propaedeutics of internal diseases plays an important role, in particular, auscultation and palpation examination.

To understand how to determine heart disease, it is important to know the basic instrumental methods used in diagnosis. similar diseases. The following studies are applied:

1. Electrocardiography. An electrocardiogram will help detect changes in the work of the heart. ECG does not play with heart defects big role and most often helps to identify the consequences of the disease.
2. Echocardiography. it ultrasound diagnostics designed for a thorough study of the functional and morphological features hearts.
3. Phonocardiography is a technique that allows you to display heart sounds in a graphical form.
4. X-ray. Allows you to identify the configuration of the heart, as well as to detect the transposition of blood vessels.

Modern Pediatrics special place in the definition of congenital anomalies assigns prenatal detection. Such a diagnosis of heart defects is carried out in several stages. The initial stage lies on the shoulders of a regular gynecologist, and after suspicion of changes, the pregnant woman is referred to a specialist in fetal echocardiography.

Therapeutic measures

The main method of therapy for most heart defects is surgery. Nevertheless, in order to reduce the intensity of the progression of the disease, as well as normalize blood circulation, the following groups of drugs are used:

1. Anticoagulants. Their use is explained by the need to reduce the risk of thrombosis.
2. Diuretics. Diuretics are needed to relieve edematous syndrome, as well as to compensate for heart failure.
3. β-blockers. Necessary to reduce the load on the heart and normalize blood pressure.
4. ACE inhibitors. Like previous drugs, they are needed to combat arterial hypertension.
5. Antiarrhythmic drugs. They are used for defects during which there is a violation of the heart rhythm.
6. Vasodilators. Reduce stress on the heart.

About how to treat heart disease in each case, only a doctor can answer, having previously made a diagnosis. It is extremely important to follow all medical recommendations and use drugs strictly in the indicated dosage.

Methods of surgical treatment of heart disease in adults and children are quite diverse. Treatment is used for both acquired and congenital malformations. Indications for surgical intervention directly depend on the degree of hemodynamic disturbance. In congenital forms and in the presence of an obstruction to blood flow, the following interventions to fix it:

• Dissection of the valvular constriction in the pulmonary trunk.
• Excision of narrowed areas in the aorta.

In the event that the defect is accompanied by overflow of the small circle, it is necessary to eliminate the pathological discharge of blood. This is achieved through the following activities:

• Ligation of the open aortic duct.
• Sewing up an existing atrial or interventricular septal defect.

In addition to the above, in congenital forms, the following operations of heart defects are used:

1. valve plastic.
2. Prosthetics.
3. Reconstruction.

Reconstruction is used for complex pathologies, which are accompanied not only by a violation of the valvular apparatus, but also by the incorrect location of large vessels.

For a long time, it was believed that surgical treatment of congenital heart defects should be carried out at the age of five or even later. However, the level of medicine currently allows for surgical correction in the first years of life.

With acquired pathologies of the valvular apparatus, the main surgical intervention is prosthetics. The patient is replaced by an artificial valve in place of the damaged one.

With acquired stenoses, in order to eliminate the existing obstacle, valve plastic surgery is performed.

Complications

To understand why heart disease is dangerous, you need to know what consequences can occur. The main complications are associated with the formation of circulatory failure. The following types are distinguished:

1. Left ventricular failure.
2. Right ventricular failure.

One of the main signs of severe left ventricular failure is shortness of breath, accompanied by the release of bloody frothy sputum. Its color is due to the presence of special cells. Cells of heart defects are represented by alveolar macrophages containing hemosiderin. The presence of these cells is observed in pulmonary infarction or stagnation in the pulmonary circulation. And it is precisely because of them that sputum with these pathologies has a “rusty” color.

Nursing Process

The nursing process for heart defects plays an important role in improving the patient's quality of life. This process has the following goals:

1. Improving the quality of life of the patient to an acceptable level.
2. Minimization of emerging problems.
3. Help the patient and his family in adapting to the disease.
4. Support for the patient's basic needs or their full recovery.

For heart defects this process is carried out in several stages. At the first stage, the nurse must determine the basic needs of the patient. The second stage consists in making a nursing diagnosis and identifying the main problems of the patient, among which the following should be highlighted:

• Physiological. This group includes all complications of the main diagnosis.
• Psychological. Anxiety about changes in the quality of life, as well as the fear of worsening the prognosis of the disease. It also includes a lack of knowledge and skills in general health care.
• Security issues. Attention should be paid increased risk infection, misuse of prescribed medicines, as well as the risk of falls if fainting occurs.

The third stage is to determine the goals that the nurse should set for herself in order to alleviate the general condition of the patient. The fourth stage includes the implementation of all nursing interventions that must be carried out according to the protocol for the treatment and diagnosis of the defect. Final stage- an assessment of how effectively the nursing care, carried out not only nurse, but also by her immediate superiors, as well as by the patients themselves.

Preventive actions

Prevention of heart defects is an extremely important set of measures to reduce the risk of violations in the operation of the valvular apparatus of the heart. It is worth noting that in order to prevent congenital malformations, the expectant mother must follow the following recommendations:

1. Timely registration.
2. Regular visits to the gynecologist at the scheduled time for a preventive examination.
3. Proper nutrition.
4. Exclusion of bad habits.
5. Correction of concomitant diseases.
6. If not vaccinated against rubella virus, vaccinate approximately 6 months before planned conception.
7. Prophylactic intake of folic acid.

The main cause of acquired heart defects is rheumatism. That is why one of the main preventive measures is to prevent the development of acute rheumatic fever.

• Leading a healthy lifestyle.
• Proper nutrition.
• Timely treatment of exacerbations of chronic pathologies.
• Sanitation of infectious foci.

After treatment of adults and adolescents for rheumatism, bicillin prophylaxis is recommended.

Also, in order to reduce the manifestations of the rheumatic process, as well as to prevent possible consequences massage is recommended for heart defects. There are the following indications for massage:

• inactive stage of the disease.
• The period of reduction of the main manifestations.
• Formed circulatory failure.

During the period of active inflammatory changes in the cardiac membranes, the use of massage is not allowed.