If, as a result of a pathological process, deformation of the valve tissue occurs and the hole through which blood enters the next part of the heart narrows, then such a defect is called stenosis. Deformation can lead to the heart valves not closing due to changes in shape, shortening them as a result of scarring of the affected tissues; this defect is called insufficiency. Valve insufficiency can be functional, resulting from stretching of the chambers of the heart; the area of the unchanged valve is not enough to close the enlarged hole - the leaflets sag (prolapse).
The work of the heart is restructured depending on the changes that have occurred and the needs of blood flow in the body.
Classification of heart defects
Depending on different criteria, PPPs vary:
- By etiology (cause of occurrence):
- rheumatic;
due to bacterial endocarditis;
- syphilitic;
- due to expansion of the heart chambers in heart failure;
- traumatic - during injury or surgery;
- after radiation therapy, oranosis of the chest or mediastinum.
- According to the nature of damage to the heart valves:
- valve narrowing - insufficient opening, preventing the movement of blood from one chamber to another;
valve insufficiency, incomplete closure, blood returns to the heart chamber;
- combined – disruption of several valves;
- isolated – changes in the operation of one valve;
- combined - when the valve does not close tightly enough (valve insufficiency) and does not open completely (stenosis or narrowing of the valve) occur simultaneously in one valve.
- By localization of defects:
- mitral valve;
tricuspid valve;
- pulmonary valve;
- aortic valve.
- For functional impairment:
- prolapse;
failure;
- stenosis.
- According to the state of the cardiovascular system:
- compensated – there is no circulatory failure;
subcompensated - temporary disruption of blood flow (with increased physical activity, during pregnancy, with increased temperature);
- decompensated - there is a circulatory disorder with the slightest effort and at rest.
Classification of valve problems
There are several criteria for classifying heart defects. Below are some of them.
According to the causes of occurrence (etiological factor), defects are distinguished:
- rheumatic (in patients with rheumatoid arthritis and other diseases of this group, these pathologies cause almost all acquired heart defects in children and most of them in adults);
- atherosclerotic (valve deformation due to the atherosclerotic process in adults);
- syphilitic;
- after endocarditis (inflammation of the inner lining of the heart, the derivatives of which are the valves).
According to the degree of hemodynamic disturbance (circulatory function) inside the heart:
- with minor hemodynamic impairment;
- with moderate impairments;
- with severe impairments.
By disturbance of general hemodynamics (on the scale of the whole organism):
- compensated;
- subcompensated;
- decompensated.
According to the location of the valvular lesion:
- monovalve – with isolated damage to the mitral, tricuspid or aortic valve;
- combined - a combination of damage to several valves (two or more), possible mitral-tricuspid, aortic-mitral, mitral-aortic, aortic-tricuspid defects;
- three-valve - involving three structures at once - mitral-aortic-tricuspid and aortic-mitral-tricuspid.
According to the form of functional impairment:
- simple – stenosis or insufficiency;
- combined – stenosis and insufficiency on several valves at once;
- combined – insufficiency and stenosis on one valve.
Diagram of the structure and operation of the aortic valve
Symptoms of acquired heart disease
Depending on the type of disease, symptoms may vary, but there are several ailments that are common to most heart defects:
- dyspnea;
- fast fatiguability;
- pressing pain in the heart area (especially during physical activity);
- dizziness;
- swelling of the lower extremities;
- change in skin color;
- dry cough and hemoptysis;
- interruptions in heart function;
- loss of consciousness.
If you notice similar symptoms, consult your doctor immediately. PPPs are very dangerous and can lead to serious consequences. Including heart failure. There is no need to wait until the disease goes away on its own or try to cope with it on your own. Contact the specialists of the cardiology center of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, and we will conduct the necessary examination
Main causes of PPP
The following conditions may act as etiological factors for acquired heart defects in adults and children:
- Bacterial endocarditis. One of the outcomes of this disease, manifested by inflammatory processes in the endocardium, is the formation of heart defects.
- Rheumatism. An acute inflammatory disease of a systemic nature, mainly affecting the articular and cardiovascular systems. The cardiac form of rheumatism is explained by the toxic effect of streptococcal enzymes (the causative agent of this disease) and the formation of autoimmune reactions that affect the endocardium and myocardium.
- Syphilis. One of the manifestations of this systemic disease is damage to the valvular apparatus of the heart and aorta.
- Atherosclerosis. A chronic pathology manifested by the formation of plaques on the walls of blood vessels, causing them to narrow.
- Injuries. The outcome of bruises and wounds of the heart can be formed defects.
- Sepsis. Any generalized infection can lead to disruption of the heart valve apparatus.
Separately, it should be said about acquired heart defects and pregnancy. In the second and third trimesters, expectant mothers have an increased risk of exacerbation of chronic pathologies. Therefore, pregnancy may also be one of the factors that increases the likelihood of the formation of valvular lesions.
Diagnostics
When diagnosing, it is important to collect as much information as possible about the patient: complaints, symptoms, chronic, hereditary or past infectious diseases. Next, the doctor performs a physical examination: the heart and lungs are listened to, blood pressure is measured, and the liver is palpated and measured.
If, after an initial examination and history taking, the doctor discovers characteristic symptoms of heart defects, the patient is referred for additional instrumental studies:
- ECG;
- daily ECG monitoring;
- Echocardiography – ultrasound examination of the heart;
- chest x-ray;
- CT scan of the heart;
- MRI of the heart.
Surgery
It is carried out in cases where the patient has a subcompensated or decompensated heart defect. Depending on the indications, a suitable technique is selected from the following possible ones:
- Plastic surgery;
- valve-saving;
- angioplastic.
In severe cases, valve replacement may be required, which involves the installation of a mechanical or biological prosthesis. If necessary, aortic root reconstruction, atrioplasty, or restoration of normal rhythm can be performed.
All patients who have undergone surgery must undergo a rehabilitation course. It may consist of physical therapy, breathing exercises, and medication. During the rehabilitation period, tests and studies are carried out to monitor the patient’s well-being. This is especially necessary when using indirect coagulants in the postoperative period.
Prevention
Prevention of PPS involves treating the underlying disease that caused the valve damage. To prevent the development of defects, a cardiotrophic diet and lifestyle correction are additionally prescribed:
- refusal of salty, spicy, fatty foods;
- complete cessation of smoking and drinking alcohol;
- moderately active lifestyle;
- control of infectious diseases, including colds;
- annual monitoring by a cardiologist.
All prescriptions and dietary adjustments must be prescribed by your doctor during the treatment process. In our center, the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, several programs have been developed that will help identify whether you have a heart defect and determine the method of its treatment. You can learn more about the programs here.
Prevention and prognosis for PPS
There are no preventive measures that would protect one hundred percent from acquired heart disease. But there are a number of measures that will reduce the risk of developing heart defects. This means the following:
- timely treatment of infections caused by streptococcus (in particular tonsillitis);
- bicillin prophylaxis in the event of a rheumatic attack;
- taking antibiotics before surgical and dental procedures if there is a risk of infective endocarditis;
- prevention of syphilis, sepsis, rheumatism: sanitation of infectious foci, proper nutrition, work and rest schedule;
- rejection of bad habits;
- presence of moderate physical activity, accessible physical exercises;
- hardening.
The prognosis for the life and ability to work of people with heart defects depends on the general condition, fitness of the person, and physical endurance. If there are no symptoms of decompensation, a person can live and work as usual. If circulatory failure develops, work should either be lightened or stopped; sanatorium treatment at specialized resorts is indicated.
It is necessary to be observed by a cardiologist in order to monitor the dynamics of the process and, as the disease progresses, to promptly determine the indications for cardiac surgical treatment of heart disease.
How to treat acquired heart disease
Treatment of acquired heart defects is a comprehensive approach, including drug treatment, a special diet, and lifestyle adjustments. If conservative treatment is not enough, surgical intervention is resorted to.
When you contact the center of the Federal Scientific and Clinical Center of FMBA, our doctors will quickly diagnose your disease and prescribe therapeutic treatment. The center has a therapeutic department, where you will be under the constant supervision of specialists. If after the examination it is determined that surgical correction is needed, you will be referred for a consultation with a cardiac surgeon, who will determine whether you need surgery.
Surgical methods:
- Catheter balloon valvuloplasty is the expansion of a narrowed lumen by inserting a balloon catheter. As a result of the operation, the fusion between the valve leaflets is separated, and the obstruction to blood flow is eliminated;
- Valvotomy (commissurotomy) – dissection of fused valves;
- Valve replacement is the replacement of a damaged valve with an implant. Open heart surgery using a machine that temporarily replaces the work of the heart;
- Percutaneous aortic valve replacement.
The main thing in treatment is timely diagnosis. Don’t put off your health for later, seek advice right now.
Acquired heart disease - symptoms and treatment
There is no medicine that can reverse the process and restore the valve to its original state. With the help of medication, it is only possible to influence the cardiovascular system and reduce the risk of complications. In severe cases, surgical treatment methods are used.
Drug treatment
The goal of therapy is to eliminate the causes of circulatory failure, improve the functional state of the myocardium, restore normal blood circulation, microcirculation (transport of blood cells and substances to and from tissues) and prevent recurrent circulatory disorders. Treatment for chronic circulatory failure includes a complete balanced diet and drug therapy.
The main groups of drugs used for valve dysfunction:
1. ACE inhibitors (angiotensin-converting enzyme) - enalapril, lisinopril, ramipril, perindopril, fosinopril. The drugs block the conversion of the hormone angiotensin I to angiotensin II. Angiotensin II has a vasoconstrictor effect and causes a rapid increase in blood pressure. ACE inhibitors are used to treat hypertension and treat or prevent heart failure.
2. Beta blockers - carvedilol, bisoprolol, metoprolol. These drugs lower blood pressure and normalize heart rate. The action is caused by blocking beta-adrenergic receptors, which are responsible for the body's response to stress.
3. Mineralocorticoid receptor antagonists - spironolactone, eplerenone. The drugs lower blood pressure and have a diuretic effect, reducing fluid content in tissues.
There are different types of heart defects, and different combinations of drugs are used to treat each of them. Concomitant pathologies and individual characteristics of the patient are also taken into account.
For example, when congestion predominates, diuretics (furosemide, torsemide) are additionally prescribed, which reduce the volume of circulating blood, reducing congestion in the pulmonary and systemic circulation. If blood clots are present or there is a high risk of their occurrence, anticoagulants are used - drugs that reduce blood clotting (warfarin, rivaroxaban, dabigatran, apixaban).
Relatively recently, a new class of drugs was developed - angiotensin-neprilysin receptor inhibitors (sacubitril). Their main effect is to increase the amount of peptides cleaved by neprilysin. The drugs increase diuresis (urine volume), natriuresis (sodium excretion in the urine), cause relaxation of the myocardium and prevent processes of disruption of the structure and function of the heart.
If it is impossible to use beta blockers, it is recommended to replace them with If channel inhibitors (ivabradine), which also reduce the heart rate. If it is impossible to use ACE inhibitors, angiotensin receptor blockers (losartan, valsartan, candesartan, telmisartan, irbesartan, olmesartan) are used. They have properties similar to ACE inhibitors, but do not reduce the synthesis of angiotensin II, but block angiotensin receptors [6].
Surgery
If there are indications, the effectiveness of drug treatment is insufficient and there are no contraindications, surgical methods are used. Many patients are afraid of the need for heart surgery. In some cases, surgical methods do carry some risk, but there are fairly safe operations that are not open heart and without large incisions. Such operations include balloon commissurotomy for mitral valve stenosis. The method consists of widening the valve using a catheter passed through the artery.
Before surgery, the necessary laboratory and instrumental studies are carried out and the patient’s condition is stabilized with medications. When preparing for surgery, it is important to reduce shortness of breath, swelling, and normalize pulse and blood pressure.
A common surgical method is artificial or biological valve replacement. There are also valve-sparing operations, which involve plastic surgery of a damaged valve.
Surgical treatment significantly improves the quality of life, however, after surgery, medication continues, but is adjusted if necessary. In addition, after certain operations, such as artificial valve replacement, anticoagulant therapy is constantly taken. The drugs are necessary because the risk of thromboembolic complications (blockage of arteries with blood clots) increases [5].
Causes and symptoms
Heart valve defects can be congenital or acquired. The main causes of the development of heart valve defects are rheumatism, infections, myocardial and cardiovascular diseases.
Congenital heart valve defects develop before birth and depend on how the pregnancy progressed. Congenital heart valve defects are an extremely rare diagnosis, diagnosed only in 1% of cases. Congenital defects include defects of the aortic and pulmonary valves, which are treated by surgical intervention in the first years of the patient’s life.
Purchased . Acquired heart valve defects include transformations of the valve structure due to infections, inflammation, previous heart attacks, etc. Most of them arise as a result of a gradual change in the structure of the heart; in some cases, rheumatism leads to the defect. All congenital and acquired defects have related symptoms that can appear at any age:
- increased heart rate,
- dyspnea,
- swelling,
- other manifestations of heart failure.
Initially, they appear during physical activity, but as pathologies develop, they will begin to appear in a calm state. Among the types of heart valve defects, mitral valve prolapse is the most common. It occurs during heart contractions when the valve leaflets in the left atrium sag. The walls of the valve lose elasticity and it “leaks”. Prolapse can be primary or secondary:
- Primary prolapse refers to congenital valve defects. Connective tissue pathologies in this case are a genetic predisposition.
- Secondary prolapse is an acquired defect. It occurs due to chest injury, rheumatism or myocardial infarction.
Prolapse does not have serious health consequences, and its symptoms do not interfere with life. However, they may not appear for a long time and most often bother people in old age, which is why they are written off as “age-related.” If you do not pay attention to the symptoms in time, complications may arise, such as arrhythmia and heart failure.
Symptoms also include complaints of pain in the heart area. They arise against the background of anxiety, are not associated with physical activity and are not relieved with medication. The pain is not intense, but long-lasting, accompanied by anxiety and rapid heartbeat.
