Aortic heart defects: types and symptoms on auscultation

Reasons for development

As already noted, aortic defects can be congenital and acquired.

As for the first options, it is rarely when it is possible to identify a specific cause of the violation of embryogenesis. However, there are certain risk factors that every pregnant woman should be aware of:

• bad habits (smoking, alcoholism);
• infectious diseases (including such "harmless" ones as the flu);
• taking medications;
• strong psycho-emotional and physical stress;
• polluted environment;
• X-ray examinations.

In this case, the pathogenesis of the disease is as follows:

• one flap may be underdeveloped;
• a hole is formed in one of the valves;
• a bicuspid valve is formed instead of a tricuspid one.

Acquired defects usually develop as a result of past illnesses.

Infectious diseases (sepsis, tonsillitis, syphilis and other sexually transmitted diseases). In this case, bacteria, getting into the endocardium with the blood flow, damage the structure of the valves

Autoimmune pathologies (rheumatism, systemic lupus erythematosus). The defect is formed due to the fact that immune cells begin to attack their own body, in this case, the aortic tissue. As a result, a degenerative process develops and valve damage occurs.

Atherosclerosis. It develops in the elderly, while calcium salts settle on the valve flaps and plaques form. As a result, their mobility is reduced.

Chest trauma. The reason is rare, but it still takes place. The valves are deformed due to direct mechanical action.

It is worth noting that these factors can also cause the development of other defects, such as mitral (bicuspid valve defect) or tricuspid.

Classification of violations

There are two fundamentally different groups of aortic valve defects.

The first includes stenosis of the aortic valve. This term means that the flaps have lost their elasticity and cannot fully open. There is a restriction due to which the ventricles are unable to push all the blood into the aorta.

There is also valve failure. In a normal state, after allowing blood to flow into the aorta, the flaps close in order to prevent the return flow to the heart (the so-called regurgitation). In pathology, this mechanism does not work, a small gap remains between the valves and part of the blood returns to the ventricles.

It is important to know that these forms are found both in isolation and in the form of a combined (mitral-aortic) defect. Usually there is a predominance of a defect in one of the structures. Combined aortic heart disease is a simultaneous combination of insufficiency and stenosis.

Failure is classified by the volume of blood that returns to the left ventricle:

• I degree - regurgitates up to 15%;
• II degree - 15-30%;
• III degree - 30-50%;
• IV degree - more than 50%.

Clinical manifestations

Isolated forms may not appear for a long period of time, while a combined aortic heart defect gives a pronounced clinical picture.

Also, the symptomatology of the disease depends on the type of lesion. The pathogenesis of stenosis is primarily characterized by an increase in resistance to blood flow, which is manifested by the following signs:

• myocardial ischemia (constricting pain in the region of the heart);
• cardiopalmus;
• shortness of breath, cardiac asthma;
• dizziness;
• fainting;
• cyanosis (blue discoloration) of the limbs.

In case of insufficiency, cardiac output is significantly reduced (due to the fact that part of the blood returns back). In this case, the following symptoms occur:

• tachycardia;
• pain in the heart like angina pectoris;
• swelling of the neck veins;
• noise in ears;
• dizziness;
• pain and heaviness in the right hypochondrium;
• dyspnea.

Diagnostics

Due to the rather vague picture of the disease, a thorough examination should be carried out in order to accurately establish the cause of the disease. First of all, the doctor must collect a detailed history.

Physical diagnostic methods (auscultation)

On examination, pallor of the skin, cyanosis, increased pulsation, swelling of the veins of the neck are found.

On palpation (and in some cases visually), a "heart hump" is determined - a protrusion of the chest wall due to heart hypertrophy.

A specific symptom of stenosis is "feline systolic purring." In this case, there is a tremor of the chest wall in the projection of the left ventricle.

Percussion determines the increase in the size of the heart.

With stenosis, there is a predominant decrease in systolic pressure, with insufficiency - diastolic.

Auscultation with stenosis is determined by a systolic murmur (due to the obstructed passage of blood). Failure is characterized by noise during diastole (since regurgitation occurs when the ventricles relax.)

Instrumental methods

Identification of the above signs requires further examination. The "gold standard" in the diagnosis of valvular defects is ECHO-KG with Doppler sonography. This method allows you to study in detail the structure and work of the heart. An electrocardiogram and a chest x-ray should be done.

In rare cases, with inaccurate results, additional studies are performed using MRI, CT, angiography.

Treatment options for a patient with aortic defect

In the absence of symptoms and in milder stages, treatment is usually not given. Patients are recommended to undergo additional examination every six months.

Drug treatment

Conservative therapy does not provide complete recovery of patients with aortic defects. The goal of pharmacological treatment is only to improve symptoms and prevent complications. In addition, medications are prescribed in preparation for operations.

In this case, the following groups of medicines are used:

• calcium antagonists (verapamil, nifedipine) - used for arrhythmias and arterial hypertension;
• diuretics (torasemide, spironolactone) - reduce the stress on the heart;
• beta-blockers (atenolol, propranolol) - lower blood pressure, improve hemodynamics;
• ACE inhibitors (enalapril, lisinopril) - have a hypotensive effect.
• antianginal drugs (Sustak, Nitrong).

If the disease is caused by an infection or an autoimmune process, drugs are used for etiotropic (i.e., directed at the cause) therapy:

• antibiotics (penicillins, carbapenems, fluoroquinolones and others) - for infectious diseases;
• glucocorticosteroids (prednisone, dexamethasone) - for systemic autoimmune diseases such as rheumatism;
• anti-sclerotic drugs (levostatin, atorvastatin).

However, the main treatment for valvular defects is still surgery.

Operations are shown in the following cases:

• severe stage of the defect, which leads to the development of heart failure;
• combined defects;
• the presence of concomitant factors that can lead to decompensation;
• reduction in ejection fraction even in the absence of complaints.

Contraindications are:

• age over 70;
• the presence of severe comorbid pathologies (renal, hepatic, respiratory failure, diabetes mellitus, etc.)

In congenital anomalies, organ-sparing valvuloplasty is more often used. If this method is used for acquired defects, relapses may occur. The technique is the excision and suturing of valve defects. In some cases, they resort to balloon valvuloplasty. In this case, the aortic opening is expanded with a special device. An important feature of this operation is its minimally invasiveness.

In the case of acquired pathologies, valve replacement is used. Implants are made from both synthetic materials (silicone) and natural (bioprostheses from one's own tissues or from a deceased person).

Patient monitoring

Valvular defects are a very insidious disease that can hardly appear and then lead to the development of heart failure. In addition, the blurred clinical picture makes it difficult to make a correct diagnosis.

Auscultation of aortic heart defects is the simplest screening method. When listening to pathological noises, the patient should be immediately sent for further examination.

Therefore, if you have found this pathology, you need to be as responsible as possible about preventive examinations. You should undergo echocardiography and other examinations prescribed by the attending physician at least every six months.

Conclusions

Aortic valve disease is a fairly common disease that can be either congenital or acquired. Disruption of blood flow due to damage to the leaflets can lead to the development of chronic heart failure.

Symptoms arising from aortic valve disease are not specific enough, however, modern diagnostic methods can easily cope with their detection.

In the absence of significant contraindications, surgical treatment of this disease gives a good result. The prognosis for life and work ability is favorable.