Combined aortic heart disease: light, combined

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Combined aortic heart disease refers to acquired defects. Most often they suffer from men. In the absence of adequate treatment, it can have very undesirable consequences. Combined heart defects are often confused with combined, but this is not correct. How to overcome a combined aortic valve defect, read in this article.

Features of a combined aortic heart disease

Combined aortic heart disease is a pathology that combines disturbances in the structure and work of the main circulatory organ. The first violation is associated with a decrease in the aortic duct when it leaves the heart, called stenosis of the aortic orifice. The second concerns the valve of the aorta, which carries the function of carrying out the blood barrier at its reverse current. Valve flaps are unable to completely collapse and blood can rush back to the heart. Such functional pathology is observed in the phase of ventricular diastole in the left part of the heart.

• Associated aortic heart disease develops in men after the onset of rheumatic diseases of organ systems with predominance of inflammation in the heart.
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• Women are more prone to other varieties of aortic malformations.

Typology of the disease

The disease progresses with the predominance of one or another type of pathology, which is the basis for the isolation of two forms of the disease:

• combined aortic disorder with predominant development of aortic stenosis with a narrow aortic lumen or normal;
• combined aortic malformation with predominant development of regurgitation( aortic valve insufficiency) with severe aortic narrowing or without a change in the lumen of the trunk.

The pathology of the combined defect has 5 stages of progress:

1. The first stage is characterized by full compensation of the defect. The patient has no complaints, when studying the condition of the left ventricle, his moderate hypertrophy is revealed, there is no hyperplastic condition.
2. In the second stage, the patient does not feel pain and discomfort in the heart area, but anatomical disorders occur: left ventricular hypertrophy is quite pronounced, the size of the left ventricle is larger than that of a healthy person.
3. If the left ventricular hypertrophy is expressed in a sharp degree, and the size of the heart chamber has a clear increase, the patient is diagnosed with the third stage of a combined aortic malformation with moderate coronary insufficiency.
4. Cardiologists set the fourth stage for left ventricular failure. The patient swells lungs at this stage of a combined aortic defect, there are frequent attacks of bronchial asthma. Mitral valve insufficiency is noted.
5. The last, the fifth stage ascertains decompensation in the whole large circle of the patient's blood circulation.

You can find out how the bivalve valve looks when combined with aortic heart disease, from the following video:

Causes of the development of the pathology of

. The cases of detection of concomitant spleen of the heart do not have any recorded record of the inherent nature of the pathology, i.e. The acquired character of pathology has an absolute value. The appearance of this type of blemish may be caused by the following reasons:

• disorders in the functioning of internal organs with predominant heart damage of rheumatic character;
• inflammation of the inner membrane of the heart of an infectious nature - infectious endocarditis;
• deposition on the inner wall of the aorta of atherosclerotic plaques - atherosclerosis of the aorta;
• with syphilis( an infectious disease that has a source of infection - a pale treponem via the genital tract) in the initial stages of the disease, the skin and mucous membranes are affected. When untimely treatment of the disease occurs the formation of nodes with pale treponema in the center and surrounding connective tissue membranes in the nervous system, internal organs. One of these nodes can penetrate the aorta, forming a larger growth and causing, in time, a combined aortic defect.

Signs of the disease

Complaints of patients with a combined aortic defect are associated with signs of both narrowing of the artery( stenosis) and deformation of the valves of the aortic valve. The load in the reverse flow of blood and the problems of its movement from the heart to the aorta at the initial stages of the disease is left to the left ventricle, which is able to withstand such an increase in work, without letting the body know the pain and discomfort. Symptoms of a developing defect with predominance of aortic or valve damage are determined by the form of the disease. With pronounced signs of one of the violations in the cardiologist's task is the discovery of another disorder, symptomatically manifested less rapidly and intensely.

Common symptoms of co-morbidity can be as follows:

• sensation of increased heart beats and pulsations in the cervical region. This symptom is associated with excess ventricular ejection( the amount of blood ejected is normal plus the returned blood from the aorta and the not completely closed aortic valve);
• due to direct and reverse passage of blood through the aorta, the blood flow is disturbed not only in the aorta and left ventricle, but also in the coronary arteries of the heart that feed the organ itself. The lack of coronary blood supply causes pain in the pressing region of a pressing nature;
• feelings of fatigue and malaise are associated with an incorrect redistribution of arterial blood in the body;
• tachycardia develops as an adaptive mechanism of reducing the time for reverse flow of blood into the left ventricle;
• with the return flow of blood through the aorta and its reduction in the lumen of the brain cells do not receive sufficient oxygen supply, resulting in fainting, clouding of consciousness, headaches.

Diagnosis

If the patient is suspected of a combined aortic disorder, the following types of examination are prescribed to the patient:

• collection of anamnesis from patient complaints of pain localization, limitation of their detection, etc.;
• anamnesis of the patient's life with a detailed explanation of the causes of the disease: the presence in the past of infectious diseases and what, whether a diagnosis of rheumatic fever, whether a tumor was found in him and his relatives, etc.;
• physical examination of the patient with pulse measurement in the ascending aorta, listening and heart rate percussion, measurements of systolic and diastolic pressure, examination of the skin in the nail and forehead, etc.;
• blood and urine test;
• magnetic resonance imaging and spiral computed tomography with obtaining radiographic images in different layers;
• chest x-ray with thoracic examination;
• coronary cardiography;
• electrocardiography;
• echocardiography;
• phonocardiography;
• level of creatine, glucose, cholesterol, uric acid in a unit of blood volume;
• immunological blood test.

Treatment

General therapy

Patients with an identified disability are recommended to reduce physical activity. Strong physical load is fraught with an increase in blood flowing backward to the left ventricle, which threatens to rupture the aorta in the narrowed part with a combined aortic defect. The increased need for blood supply can not be satisfied, as a result, the patient is likely to receive ischemic stroke and acute myocardial infarction.

The cause of the combined vice should be eliminated during medical treatment.

Medicated

If the disease is acute, the following types of drugs are prescribed:

• vasodilators, taking the risk of increasing blood pressure, normalizing blood flow, slowing down the action of angiotensin converting enzyme;
• preparations for blockade of angiotensin receptors;
• means for excretion of calcium compounds from the cells reduce arrhythmia, increase the work of the heart;
• beta blockers are used only in cases of predominance of aortic stenosis. The pronounced insufficiency of the aortic valve should exclude the action of blockers;
• Verapamil and its analogues are calcium antagonists.

In the presence of complications or concomitant heart diseases, the treatment regimen is selected individually for the patient.

Surgical

An operative treatment route for a patient with a combined aortic defect is indicated with a low efficiency of conservative treatment and stages of the disease, which create a risk for the life of the patient. Operations are performed in two ways:

• transdermally( through the skin an endoscope is inserted into the aorta with devices for surgery), the patient's chest is not opened;
• with the opening of the chest and the connection of the system of artificial circulation.

The following methods are distinguished by the type of operations:

• aortic enlargement with its stenosis( commissurotomy);
• plastic surgery to restore the normal structure and functionality of the aortic valve;
• implantation of prostheses instead of aortic valve of two types: biological( for children and women of childbearing age) and metal( for other patients);
• complex application of plastics and commissurotomy;
• heart transplantation in the presence of a donor.

Prevention

Preventive measures to prevent the development of a combined aortic defect suggest:

1. Primary prevention, when a healthy lifestyle is being maintained, harmful habits are eradicated, infectious diseases are cured in a timely manner, casual sexual relations are excluded, and the organism is tempered from childhood.
2. Secondary prophylaxis, when the defect is already detected, but it is necessary to reduce the effect of the causes that caused it and prevent the recurrence of rheumatic processes.

Complications

Complications that may occur with EPS:

• with prolonged absence of treatment of the disease may decrease the ability of the left ventricle, and with it, and develop mitral valve insufficiency;
• blood flow in the arteries of the heart can be disturbed, and this threatens with acute infarction;
• cases of development of secondary infective endocarditis are not uncommon;
• , atrial fibrillation and similar heart rhythm disturbances are common.

After the operation,

• thromboembolism may appear;
• thrombosis of the prosthesis or its destruction( for products from animal vessels) or calcification;
• infective endocarditis;
• Paravalvular fistulae.

Forecast

In this case, do any predictions can only be based on the severity of the ailment that caused the development of the defect, as well as the state of the myocardium. So, if such a disease has become:

• atherosclerosis or rheumatism, then the prognosis is quite favorable;
• syphilis or infective endocarditis, then, alas, the prognosis is rarely positive.

Usually, from the moment of revealing of an illness patients live more than 5 years. At the same time:

• moderate severity of SAP does not reduce the patient's working capacity, he does not feel bad;
• the expressed degree and accompanying "troubles" often pour out in heart failure.