Causes of aortic stenosis. Symptoms, diagnosis and treatment of aortic stenosis. Symptoms and external signs

aortic stenosis- this is a heart disease in which there is a narrowing of the aortic orifice, which creates an obstacle to the expulsion of blood into the aorta when the left ventricle contracts. The most common cause of aortic stenosis is rheumatic endocarditis. Less commonly, protracted septic endocarditis, atherosclerosis, idiopathic calcification (degenerative calcification of the aortic valve cusps of unknown etiology), and congenital narrowing of the aortic orifice lead to its development. With aortic stenosis, the valve leaflets become fused, thickened, and cicatricial narrowing of the aortic orifice.

Peculiarities of hemodynamics in aortic stenosis. A significant violation of hemodynamics is observed with a pronounced narrowing of the aortic orifice, when its cross section decreases to 1.0-0.5 cm 2 (normal - 3 cm 2).

With aortic stenosis, there are:

Obstruction of blood flow from the left ventricle to the aorta;

Systolic overload of the left ventricle, an increase in systolic pressure and a pressure gradient between the left ventricle and the aorta, which can be 50-100 mm Hg. and more (normally it is only a few millimeters of mercury);

An increase in diastolic filling of the left ventricle and an increase in pressure in it, followed by significant isolated hypertrophy, which is the main compensatory mechanism for aortic valve stenosis;

Decreased stroke volume of the left ventricle;

In the later stages of the disease - a slowdown in blood flow and an increase in pressure in the pulmonary circulation.

Conduct a survey of the patient, find out the complaints.

Patients with aortic stenosis do not complain for a long time (the stage of compensation of the cardiovascular system), later they develop pain in the heart area similar to angina pectoris, due to a decrease in blood supply to the hypertrophied muscle of the left ventricle due to insufficient ejection of blood into the arterial system, dizziness, fainting associated with deterioration of cerebral circulation, shortness of breath during exercise.

Conduct a general examination of the patient.

The general condition of patients with aortic stenosis is satisfactory in the absence of signs of circulatory failure. On examination, attention is drawn to the pallor of the skin, which occurs due to insufficient blood supply to the arterial system, as well as due to spasm of the skin vessels, which is a reaction to a small cardiac output.

Examine the area of the heart.

Determine the presence of a cardiac hump, apical impulse, cardiac impulse. When examining the region of the heart, a pronounced pulsation of the chest wall in the region of the apex beat can be detected. The apex beat is clearly visible to the eye, with severe heart disease it is localized in the VI intercostal space outward from the left midclavicular line.

Perform palpation of the heart area.

In patients with aortic stenosis, an abnormal apex beat is palpable (resistant, strong, diffuse, high, outwardly displaced, localized in the 5th, less often in the 6th intercostal space). The symptom of "cat's purr" (systolic trembling) is determined in the II intercostal space at the right edge of the sternum (2 auscultation point). Systolic trembling is more easily detected when holding the breath on exhalation, when the patient is tilted forward, tk. under these conditions, blood flow through the aorta increases. The appearance of the symptom of "cat's purr" in aortic stenosis is due to the eddies of blood as it passes through the narrowed aortic orifice. The intensity of systolic trembling depends on the degree of narrowing of the aortic orifice and the functional state of the myocardium.

Do a heart percussion.

Determine the boundaries of relative and absolute dullness of the heart, the configuration of the heart, the width of the vascular bundle. In patients with stenosis of the aortic mouth, there is an outward displacement of the left border of relative cardiac dullness, aortic configuration of the heart, and an increase in the size of the heart diameter due to the left component.

Perform auscultation of the heart.

At the listening points, determine the number of heart sounds, additional tones, evaluate the volume of each tone. In patients with aortic stenosis, pathological symptoms are detected during auscultation of the heart at the point of auscultation of the mitral valve (above the apex of the heart), at the point of auscultation of the aortic valve (in the II intercostal space at the right edge of the sternum).

Above the aorta (2 auscultation point):

- weakening of the II tone or its absence, due to stiffness of sclerotic, calcified aortic valves, as well as a decrease in pressure in the aorta, which leads to a small excursion and insufficient valve tension;

Systolic noise - loud, long, rough, low tone, having a characteristic timbre, defined as scraping, cutting, sawing, vibrating; appears shortly after tone I, increases in intensity and reaches a peak by the middle of the expulsion phase, after which it gradually decreases and disappears before the appearance of tone II;

the maximum noise is usually determined in the II intercostal space to the right of the sternum, it is carried out along the blood flow to the large arterial vessels and is well heard on the carotid, subclavian arteries, as well as in the interscapular space. Systolic murmur in aortic stenosis is better heard on exhalation when the torso is tilted forward. The murmur is caused by obstructed passage of blood through the narrowed aortic orifice during systole.

Above the apex (1 auscultation point):

- weakening of the I tone due to lengthening of the systole of the left ventricle, its slow contraction;

An ejection tone (early systolic click) is heard in some patients in the IV-V intercostal space along the left edge of the sternum, associated with the opening of sclerosed aortic valves.

Pulse. In patients with aortic stenosis, the pulse is small and slow, which is a consequence of low cardiac output, prolonged left ventricular systole, and slow blood flow to the aorta. Determined bradycardia is a compensatory reaction (lengthening of diastole prevents myocardial exhaustion, an increase in the duration of systole contributes to a more complete emptying of the left ventricle and blood flow to the aorta). Thus, with aortic stenosis, pulsus ranis, parvus, tardus are noted.

Arterial pressure. Systolic blood pressure is low, diastolic blood pressure is normal or high, pulse pressure is low.

Identify ECG signs of aortic stenosis.

ECG in patients with aortic stenosis reveals signs of left ventricular hypertrophy and blockade of the left branch of the His bundle.

Signs of left ventricular hypertrophy:

- deviation of the electrical axis of the heart to the left or its horizontal location;

R wave height increase in Vs-6 (R in V 5-6 > R in V 4);

An increase in the depth of the S waves in leads V 1-2;

Expansion of the QRS complex for more than 0.1 sec. in V 5-6;

Decreased or inverted T waves in leads V 5-6 ,

- shift of the ST segment below the isoline in leads V 5-6. A clear relationship is determined between the pressure in the left ventricle, the magnitude of the pressure gradient in the left ventricle and aorta, and the severity of ECG signs of left ventricular hypertrophy.

Signs of blockade of the left leg of the bundle of His.

- the QRS complex is expanded (more than 0.11 sec.);

The QRS complex is represented by a wide and serrated R wave in leads V 5-6 , I, aVL;

The QRS complex is represented by a wide and serrated S wave in leads V 1-2 , III, aVF and looks like rS;

The ST segment and the T wave are directed away from the main wave of the ventricular complex; in leads V 5-6, I, aVL the ST segment is below the isoline, and the T wave is negative; in leads V 1-2 , III, aVF the ST segment is above the isoline, the T wave is positive.

Identify FCG signs of aortic stenosis.

FCG in patients with aortic stenosis reveals changes above the apex of the heart and above the aorta.

Above the aorta:

- decrease in the amplitude of the II tone;

Systolic murmur - increasing-decreasing (diamond-shaped or spindle-shaped), prolonged, begins shortly after the first tone and ends before the beginning of the second tone, is recorded on all frequency channels (better on the low-frequency one).

Above the apex of the heart:

- decrease in the amplitude of oscillations of the first tone;

Ejection tone (detected in half of patients with aortic stenosis, more common with congenital valve damage). The ejection tone (or "systolic click") is a few short fluctuations recorded after 0.04-0.06 seconds. after I tone; determined on the high frequency channel. Its occurrence is associated with the opening of sclerosed aortic valves.

Look for radiological signs of aortic stenosis.

Pathological symptoms are detected by X-ray examination of the heart in direct and left oblique projections.

Direct projection:

- lengthening and bulging of the 4th arc of the left heart circuit due to an increase in the left ventricle;

Aortic configuration of the heart;

Bulging of the upper arches of the right and left contours of the heart due to post-stenotic expansion of the aorta caused by strong vortex blood flows;

Low level of the right atriovasal angle.

In the left oblique projection - posterior bulging of the left ventricle.

Identify signs of aortic stenosis according to echocardiography.

With echocardiography are determined;

Decrease in the degree of opening of the aortic valve cusps during systole;

Thickening of the valve leaflets;

Signs of left ventricular hypertrophy and its dilatation (in the late stages of the development of the defect).

Heart defects are currently a fairly common pathology of the cardiovascular system and are a serious problem, since they can be hidden for a long period of time, and during the manifestation period, the degree of damage to the heart valves goes so far that only surgical intervention may be required. Therefore, at the slightest sign, you should immediately visit a doctor to clarify the diagnosis. This is especially true for such a defect as stenosis of the aortic orifice, or aortic stenosis.

Aortic valve stenosis is one of those characterized by a narrowing of the portion of the aorta emerging from the left ventricle and an increase in the load on the myocardium of all parts of the heart.

The danger of aortic malformation is that when the lumen of the aorta narrows, the amount of blood necessary for the body does not enter the vessels, which leads to (lack of oxygen) the brain, kidneys and other vital organs. In addition, the heart, trying to push blood into the stenotic area, performs increased work, and prolonged work in such conditions inevitably leads to the development of circulatory failure.

Among other valve diseases, aortic stenosis is observed in 25-30%, and more often develops in males, and is combined mainly with.

Why does vice occur?

congenital stenosis - abnormally developed aortic valve

Depending on the anatomical features of the defect, supravalvular, valvular and subvalvular lesions of the aorta are distinguished. Each of them can be congenital or acquired, although valvular stenosis is more often caused precisely by acquired causes.

The main reason congenital aortic stenosis is a violation of normal embryogenesis(development in the prenatal period) of the heart and large vessels. This can happen in a fetus whose mother has bad habits, lives in environmentally unfavorable conditions, eats poorly and has a hereditary predisposition to cardiovascular diseases.

The reasons acquired aortic stenosis:

, or acute rheumatic fever with repeated attacks in the future - a disease that occurs as a result of a streptococcal infection and is characterized by a diffuse lesion of the connective tissue, especially located in the heart and joints,
, or inflammation of the inner lining of the heart, of various etiologies - caused by bacteria, fungi and other microorganisms that enter the systemic circulation during sepsis (“infection” of the blood), for example, in people with reduced immunity, intravenous drug addicts, etc.,
, in the leaflets of the aortic valve in the elderly with aortic atherosclerosis.

acquired stenosis - the aortic valve is damaged due to external factors

In adults and older children, aortic valve disease most often occurs as a result of rheumatism.

Video: the essence of aortic stenosis - medical animation

Symptoms in adults

In adults, symptoms in the initial stage of the disease, when the area of the opening of the aortic valve is narrowed slightly (less than 2.5 cm 2 but more than 1.2 cm 2), and the stenosis is moderate, may be absent or only slightly. The patient is concerned about shortness of breath during significant physical exertion, palpitations or rare pain behind the sternum.

Second degree aortic stenosis(opening area 0.75 - 1.2 cm 2) signs of stenosis are more pronounced. These include severe shortness of breath during exercise, pain in the heart of an angina pectoris, pallor, general weakness, increased fatigue, fainting associated with less blood expelled into the aorta, edema of the lower extremities, dry with asthma attacks, due to stagnation of blood in the vessels of the lungs.

With critical stenosis, or a pronounced degree of stenosis of the aortic orifice with an area of 0.5 - 0.75 cm 2, the symptoms disturb the patient even at rest. In addition, there are signs of severe - pronounced swelling of the legs, feet, thighs, abdomen or the whole body, shortness of breath and asthma attacks with minimal household activity, blue coloration of the skin of the face and fingers (), constant pain in the heart area (hemodynamic angina pectoris).

Symptoms in children

In newborns and infants, aortic valve disease is congenital. In older children and adolescents, aortic valve stenosis is usually acquired.

Symptoms of aortic stenosis in a newborn child is a sharp deterioration in the condition in the first three days after birth. The child becomes lethargic, poorly takes the chest, skin of the face, hands and feet. If the stenosis is not critical (more than 0.5 cm 2), in the first months the child may feel satisfactory, and deterioration is noted in the first year of life. The infant has poor weight gain and tachycardia (greater than 170 beats per minute) and dyspnoea (greater than 30 breaths per minute or more).

If any of these symptoms occur, parents should contact their pediatrician immediately. to clarify the condition of the child. If the doctor hears a heart murmur in the presence of a defect, he will prescribe additional examination methods.

Diagnosis of the disease

The diagnosis of aortic stenosis can be assumed even at the stage of questioning and examining the patient. Of the characteristic features attract attention:

Sharp pallor, weakness of the patient,
Swelling on the face and feet,
acrocyanosis,
May experience shortness of breath at rest
When listening to the chest with a stethoscope, noise is heard in the projection of the aortic valve (in the 2nd intercostal space to the right of the sternum), as well as wet or dry rales in the lungs.

To confirm or exclude the alleged diagnosis, additional examination methods are prescribed:

– allows not only to visualize the valvular apparatus of the heart, but also to evaluate important indicators, such as intracardiac hemodynamics (normally not lower than 55%), etc.,
ECG, if necessary with exercise, to assess the tolerance of the patient's motor activity,
Coronary angiography in patients with concomitant lesions of the coronary arteries (myocardial ischemia according to ECG, or angina pectoris clinically).

Treatment

The choice of treatment method is carried out strictly individually in each case. Apply conservative and surgical methods.

Medical therapy is reduced to the appointment of drugs that improve the contractility of the heart and blood flow from the left ventricle to the aorta. These include cardiac glycosides (digoxin, strophanthin, etc.). It is also necessary to facilitate the work of the heart with the help of diuretics, which remove excess fluid from the body, and thus improve the “pumping” of blood through the vessels. From this group, indapamide, diuver, lasix (furosemide), veroshpiron, etc. are used.

Surgical treatments aortic valvular stenosis are used in cases where the patient already has the first clinical manifestations of heart failure, but it has not yet had time to take a severe course. Therefore, it is very important for a cardiac surgeon to grasp the line when an operation is already indicated, but not yet contraindicated.

Operation types:

Indications for surgery for aortic stenosis:

The size of the aortic opening is less than 1 cm 2,
Stenosis in children of a congenital nature,
Critical stenosis in pregnant women (balloon valvuloplasty is used),
Left ventricular ejection fraction less than 50%,
Clinical manifestations of heart failure.

Contraindications for surgery:

Age over 70 years old,
End stage heart failure
Severe concomitant diseases (diabetes mellitus in the decompensation phase, bronchial asthma during severe exacerbation, etc.).

Lifestyle with aortic valve stenosis

Currently, heart disease, including aortic valve stenosis, is not a sentence. People with such a diagnosis live quietly, play sports, bear and give birth to healthy children.

Nevertheless, you should not forget about the pathology of the heart, and you should lead a certain lifestyle, the main recommendations for which include:

Compliance with the diet - the exclusion of fatty and fried foods; rejection of bad habits; eating large amounts of fruits, vegetables, cereals, dairy products; restriction of spices, coffee, chocolate, fatty meats and poultry;
Adequate physical activity - walking, hiking in the forest, inactive swimming, skiing (everything is agreed with the attending physician).

Pregnancy women with aortic stenosis are not contraindicated unless the stenosis is critical and severe circulatory failure develops. Termination of pregnancy is indicated only when the woman's condition worsens.

Disability is determined in the presence of circulatory failure 2B - 3 stages.

After operation physical activity should be excluded for the period of rehabilitation (1-2 months or more, depending on the condition of the heart). Children after surgery should not attend educational institutions for the period recommended by the doctor, and avoid crowded places to prevent infection with respiratory infections, which can dramatically worsen the condition of the child.

Complications

Complications without surgery are:

Progression of chronic heart failure to terminal with a fatal outcome,
Acute left ventricular failure (pulmonary edema),
Fatal arrhythmias (ventricular fibrillation, ventricular tachycardia),
Thromboembolic complications in the occurrence of atrial fibrillation.

Complications after operation are bleeding and suppuration of the postoperative wound, the prevention of which is careful hemostasis (cauterization of small and medium-sized vessels in the wound) during surgery, as well as regular dressings in the early postoperative period. In the long term, acute or repeated backendocarditis with valve damage and restenosis (re-fusion of valve leaflets) may develop. Prevention is antibiotic therapy.

Forecast

The prognosis without treatment is poor, especially in children. since 8.5% of children die without surgery in the first year of life. After surgery, the prognosis is favorable in the absence of complications and severe heart failure.

In the case of non-critical congenital aortic valve stenosis, under conditions of regular observation by the attending physician, survival without surgery reaches many years, and when the patient reaches the age of 18, the issue of surgical intervention is decided.

On the whole, it can be said that the capabilities of modern, including pediatric, cardiac surgery make it possible to correct the defect in such a way that the patient can live a long, happy, unclouded life.

Video: aortic valve stenosis in the program “Live Healthy”

The human heart is a complex and delicate, but vulnerable mechanism that controls the work of all organs and systems.

There are a number of negative factors, starting with genetic disorders and ending with an unhealthy lifestyle, that can cause malfunctions in this mechanism.

Their result is the development of diseases and pathologies of the heart, which include stenosis (narrowing) of the aortic orifice.

Aortic stenosis (aortic stenosis) is one of the most common heart defects in modern society. It is diagnosed in every fifth patient over the age of 55, with 80% of patients being men.

In patients with this diagnosis, there is a narrowing of the aortic valve opening, which leads to a violation of the blood flow going to the aorta from the left ventricle. As a result, the heart has to exert considerable effort to pump blood into the aorta through a smaller opening, which causes serious disruption.

Causes and risk factors

Aortic stenosis can be congenital (occurs as a result of abnormalities in fetal development), but is more common in humans. The causes of the disease include:

heart disease, which usually occurs as a consequence of acute rheumatic fever due to infections caused by a specific group of viruses (group A hemolytic streptococci);
aorta and valve - a violation that is associated with lipid metabolism disorders and the deposition of cholesterol in the vessels and valve cusps;
degenerative changes in the heart valves;
endocarditis.

Risk factors for the development of the disease include an unhealthy lifestyle (in particular, smoking), kidney failure, calcification of the aortic valve and the presence of its artificial substitute - the biological tissue from which they are made is largely susceptible to the development of stenosis.

Classification and stages

Aortic stenosis has several forms, which are distinguished according to different criteria (localization, degree of blood flow compensation, degree of narrowing of the aortic orifice).

according to the localization of the narrowing aortic stenosis may be valvular, supravalvular, or subvalvular;
by degree of compensation blood flow (according to how the heart manages to cope with the increased load) - compensated and decompensated;
according to the degree of narrowing aorta allocate moderate, expressed and critical forms.

The course of aortic stenosis is characterized by five stages:

I stage(full refund). Complaints and manifestations are absent, the defect can be determined only through special studies.
II stage(hidden insufficiency of blood flow). The patient is worried about mild malaise and fatigue, and signs of left ventricular hypertrophy are determined radiologically and.
III stage(relative coronary insufficiency). There are chest pains, fainting and other clinical manifestations, the heart increases in size due to, accompanied by signs of coronary insufficiency.
IV stage(severe left ventricular failure). Complaints of severe malaise, congestion in the lungs and a significant increase in the left heart.
V stage, or terminal. Patients have progressive insufficiency of both the left and right ventricles.

For more information about the disease, see this animation:

Is it scary? Danger and complications

Quality and life expectancy of a patient with aortic stenosis depends on the stage of the disease and the severity of clinical signs. In people with a compensated form without severe symptoms, there is no direct threat to life, but the symptoms of left ventricular hypertrophy are considered unfavorable prognostically.

Full compensation can be maintained for several decades, but as the stenosis develops, the patient begins to feel weakness, malaise, shortness of breath and other symptoms that increase over time.

In patients with the "classic triad" (angina pectoris, syncope, heart failure), life expectancy rarely exceeds five years. Besides, in the last stages of the disease there is a high risk of sudden death- Approximately 25% of patients diagnosed with aortic stenosis die suddenly from fatal ventricular arrhythmias (usually these include people with severe symptoms).

The most common complications of the disease include:

chronic and acute insufficiency of the left ventricle;
myocardial infarction;
atrioventcular blockade (comparatively rare, but can also lead to sudden death);
in the lungs;
systemic embolism caused by pieces of calcium from the valve can also cause visual impairment.

Symptoms

Often, signs of aortic stenosis do not manifest themselves for a long time. Among the symptoms that are characteristic of this disease, there are:

Shortness of breath. Initially, it appears only after physical exertion and is completely absent at rest. Over time, shortness of breath occurs at rest and intensifies in stressful situations.
Chest pain. Often they do not have an exact localization and appear mainly in the region of the heart. The sensations can be pressing or stabbing in nature, last no more than 5 minutes and are aggravated by physical exertion and stress. Pain of an angina pectoris (acute, radiating to the arm, shoulder, under the shoulder blade) can be noted even before the onset of pronounced symptoms and are the first signal of the development of the disease.
fainting. Usually observed during physical exertion, less often - in a calm state.
increased palpitations and dizziness.
severe fatigue, decreased performance, weakness.
Feeling of suffocation which may be exacerbated by lying down.

When should you see a doctor?

Often the disease is diagnosed incidentally(during preventive examinations) or in the later stages due to the fact that patients attribute symptoms to overwork, stress or adolescence.

It is important to understand that any signs of aortic stenosis (palpitations, pain, shortness of breath, discomfort during physical exertion) are a serious reason for consulting a cardiologist.

Diagnostics

Diagnosis of defect stenosis is complex and includes the following methods:

Treatment Methods

There is no specific therapy for aortic stenosis, so Treatment tactics are selected based on the stage of the disease and the severity of symptoms.. In any case, the patient should be registered with a cardiologist and be under strict supervision. It is recommended to undergo an ECG every six months, give up bad habits, diet and a strict daily routine.

Patients with stage I and II disease are prescribed drug therapy aimed at normalization of blood pressure, elimination of arrhythmia and slowing down the progression of stenosis. It usually includes taking diuretics, cardiac glycosides, drugs that lower blood pressure and heart rate.

Radical methods of the initial stages of aortic stenosis include cardiac surgery. Balloon valvuloplasty(a special balloon is inserted into the aortic opening, after which it is mechanically inflated) is considered a temporary and ineffective procedure, after which a relapse occurs in most cases.

In childhood, doctors usually resort to valvuloplasty(surgical valve repair) or Ross operations(transplantation of the pulmonary valve to the position of the aorta).

At stages III and IV of aortic stenosis, conservative drug treatment does not give the desired effect, so patients undergo aortic valve replacement. After the operation, the patient should take blood thinners throughout life that prevent the formation of blood clots.

If it is impossible to carry out surgical intervention, they resort to pharmacological therapy in combination with phytotherapy.

Prevention

There are no ways to prevent congenital aortic stenosis or its intrauterine diagnosis.

Preventive measures of acquired vice are in a healthy lifestyle, moderate physical activity and timely treatment of diseases that can provoke narrowing of the aorta (rheumatic heart disease, acute rheumatic fever).

Any heart disease, including aortic stenosis, is potentially life threatening. To prevent the development of cardiac pathologies and defects, it is very it is important to take responsibility for your health and lifestyle, as well as regularly undergo preventive examinations that can detect diseases at an early stage of their development.

Aortic valve disease ranks second in frequency after mitral valve disease among all acquired heart defects. In most cases, there is a combination of aortic stenosis with aortic valve insufficiency, while aortic stenosis is much less common in isolated form.

The aortic valve is formed by connective tissue and consists of three leaflets that open when blood moves from the left ventricle to the aorta (one of the largest blood vessels in the body, providing oxygen-rich blood to the entire body). Normally, the area of the aortic valve opening is three to four square centimeters. If any pathological process in the aortic orifice (the place where the aorta leaves the left ventricle) affects the valve leaflets, this leads to the development of cicatricial changes in them and to the formation of a narrowing (stenosis) of the valve opening.

Thus, aortic stenosis is a disease related to defects of the heart and large vessels, resulting from organic damage to the heart, which creates a pronounced obstacle to blood flow to the aorta, which affects the supply of arterial blood to vital organs and the whole body.

Allocate congenital and acquired aortic stenosis. In turn, congenital stenosis is supravalvular, valvular and subvalvular, and acquired is almost always localized in the valves (valvular stenosis). Below we review the main signs and treatment of acquired aortic valve stenosis.

Causes of Acquired Aortic Stenosis

In most cases (about 70 - 80%), aortic stenosis is caused by rheumatism and previous bacterial endocarditis (more often in young people). In the elderly, the development of atherosclerotic plaques on the walls of the aorta, as well as the deposition of calcium salts in the valve leaflets affected by atherosclerosis, can lead to stenosis of the aortic orifice.

Symptoms of aortic stenosis

The basis of clinical signs is a violation of hemodynamics (blood flow) both inside the heart and throughout the body. Much less blood flows into the aorta, and, consequently, into all internal organs, than in a normally working heart. This is manifested by such symptoms as frequent dizziness, pallor of the skin, pre-syncope, deep fainting, muscle weakness, pronounced fatigue, sensations of strong heartbeats.

Due to the fact that the muscle mass of the left ventricle increases to overcome resistance to blood flow (left ventricular hypertrophy occurs), and the coronary (own heart) vessels are unable to provide the heart muscle with oxygen, angina pectoris develops. In this case, the patient is disturbed by bouts of retrosternal pain, radiating to the left arm or shoulder blade, occurring during exercise or at rest.

As the heart muscle of other chambers of the heart (left atrium, right ventricle) grows, due to its inability to cope with resistance, there are signs of blood stagnation in the vessels of the lungs, liver, muscles, kidneys and other organs. The patient is concerned about shortness of breath when walking or at rest, attacks of "cardiac" asthma with episodes of pulmonary edema (severe shortness of breath at rest and in the supine position with bubbling shortness of breath), pain in the right hypochondrium, an increase in the abdomen due to accumulation of fluid in the abdominal cavity , swelling of the lower extremities. Rhythm disturbances are much less common than with mitral defects, and, as a rule, ventricular extrasystole is more often recorded.

All of these symptoms manifest themselves differently depending on the stage of the process.

Yes, in compensation stages the heart copes with the increased load on it, and symptoms do not appear for some period of time (for example, for decades, if the defect developed at a young age and the degree of narrowing is not very pronounced).

AT subcompensation stages(hidden heart failure) symptoms appear when performing significant physical activity, especially not familiar to the patient.

AT stages of decompensation- severe heart failure, severe heart failure and terminal - the above symptoms disturb the patient not only when performing the minimum household load, but also at rest.

AT terminal stage death occurs due to complications and irreversible changes in the cells of the heart and vital organs.

Diagnosis of aortic valve stenosis

Sometimes, in the absence of complaints, aortic stenosis can be diagnosed by chance during a routine examination of the patient. If there are complaints from the heart, the diagnosis is established in accordance with the following research methods:

- clinical examination: complaints, the history of the disease and the appearance of the patient are assessed, and auscultation (listening) of the chest is performed, in which the doctor catches a coarse systolic murmur at the projection point of the aortic valve - in the second intercostal space to the right of the sternum, moist rales in the lungs due to stagnation of blood in them , if any;
- laboratory research methods: when conducting general blood and urine tests, biochemical and immunological blood tests, signs of an inflammatory process are revealed, for example, repeated rheumatic attacks or sluggish bacterial endocarditis; signs of impaired liver and kidney function; signs of lipid metabolism disorders in atherosclerosis - an increase in cholesterol levels, an imbalance of high and low density triglycerides, etc.;
- instrumental research methods: ECG is performed (single or daily monitoring according to indications), phonocardiography (FCG is a research method that allows you to convert the sound signals of heart murmurs into electrical ones, record them on photographic paper and conduct a more complete analysis of sound phenomena in heart defects), chest x-ray, echocardiography (ultrasound of the heart). Ultrasound of the heart is the only non-invasive (without introduction into body tissues) methods that allow you to clarify the diagnosis. When carrying out this method, the number, structure, thickness and mobility of the valves, the degree of narrowing of the valve opening with the measurement of its area, the degree of hemodynamic disturbances are evaluated - left ventricular hypertrophy with an increase in its volume, an increase in pressure in the left ventricle and a decrease in the aorta, a decrease in stroke volume and fraction ejection (the amount of blood ejected into the aorta in one heartbeat).

Depending on the degree of narrowing of the valve ring at the mouth of the aorta, it is customary to distinguish three degrees of aortic stenosis:
1 degree - slight stenosis - the area of the opening of the valve ring is more than 1.6 square meters. cm.
Grade 2 - moderate stenosis - the area is 0.75 - 1.6 square meters. cm.
Grade 3 - severe stenosis - narrowing area less than 0.75 sq. cm.

In diagnostically unclear cases, as well as before valve surgery, catheterization of the heart chambers with measurement of the pressure difference in the left ventricle and in the aorta may be indicated. This pressure gradient is also the basis for the classification, while a slight stenosis corresponds to a gradient of less than 35 mm Hg, moderate stenosis - 36 - 65 mm Hg, severe stenosis - above 65 mm Hg, that is, the greater the stenosis and obstruction of blood flow, the higher pressure in the left ventricle and less in the aorta, which adversely affects the walls of the ventricle and the blood supply to the whole organism.

Treatment of aortic stenosis

The choice of the optimal method of treatment is determined individually by the attending physician for each individual patient. Medications, aortic valve surgery, and a combination of both are used.

Of the pharmacological groups of drugs, the following can be prescribed: diuretics (veroshpiron, indapamide, furosemide), cardiac glycosides (digitoxin, strophanthin), drugs that lower blood pressure (perindopril, lisinopril) and slow heart rate (concor, coronal). The listed drugs are prescribed strictly according to indications in connection with a possible significant decrease in blood pressure, and the attending physician should be notified about the occurrence of any deterioration in well-being.

Drugs that dilate peripheral vessels and are used in the treatment of pulmonary edema and angina pectoris (nitrates - nitroglycerin, nitrosorbide) are not always used and with extreme caution, since their use in angina pectoris due to aortic stenosis (relative coronary insufficiency), firstly, is ineffective, and secondly, it is fraught with a sharp decrease in pressure up to the development of a collapse with a restriction of blood flow to the organs and tissues of the body.

A radical way to cure aortic valve stenosis is cardiac surgery. The operation is indicated for moderate and severe degree of stenosis and the presence of hemodynamic disorders and/or clinical manifestations. With moderate stenosis, valvuloplasty (dissection of adhesions and adhesions in the valve leaflets) can be used, and with severe stenosis, especially if it is combined with insufficiency, valve replacement is possible (replacing it with an artificial mechanical or biological prosthesis).

Replacement of the aortic valve with a mechanical prosthesis

Lifestyle in aortic stenosis

Compliance with lifestyle recommendations for this defect is not much different from other cardiovascular diseases. The patient must exclude physical activity, limit fluid and salt intake, give up alcohol, smoking, fatty, fried, cholesterol-rich foods. You also need to constantly and regularly take prescribed medications and visit your doctor with the necessary diagnostic measures.

In the event of pregnancy with aortic stenosis, the doctor's tactics for maintaining pregnancy depends on the clinical stage of the process. In the stages of compensation and subcompensation, pregnancy can be prolonged, but decompensation of the defect is an indication for termination of pregnancy. This is due to the fact that during the gestation of the fetus, the load on the circulatory system of the pregnant woman increases, and this can lead to a deterioration in hemodynamic parameters, the development of complications from the mother and fetus (the threat of premature birth, fetoplacental insufficiency, and others).

Complications of aortic stenosis

Without treatment, this disease strictly goes through all five stages of its development, that is, sooner or later, dystrophic irreversible changes occur in the heart muscle, lungs, brain, liver, kidneys and other organs, which leads to death. According to some authors, more than half of patients who do not receive treatment die in the first two to three years after the onset of severe clinical symptoms. It is also quite likely that complications that threaten a person’s life will develop - fatal heart rhythm disturbances (for example, ventricular fibrillation, complete atrioventricular blockade, ventricular tachycardia), sudden cardiac death, acute heart failure, systemic thromboembolism (thrombus release into the vessels of the lungs, heart, brain, intestines, femoral arteries).

Complications can develop not only as a result of long-term aortic stenosis, but also during surgery on the aortic valve, in particular, the development of bacterial inflammation on the valve leaflets as a result of pathogens entering the blood - bacterial endocarditis, the formation of blood clots on the leaflets or in the cavities of the heart with possible their release into the blood vessels, cardiac arrhythmias, the occurrence of re-stenosis (restenosis) in the late postoperative period as a result of repeated rheumatic attacks. Prevention of such complications is the lifelong intake of anticoagulants and antiplatelet agents - drugs that "thinn" the blood and prevent increased thrombosis, for example, chimes, warfarin, clopidogrel, aspirin and many others. In addition, the development of infectious complications is prevented by the appointment of antibiotics in the early surgical period and during medical and diagnostic manipulations and minor operations in the subsequent life of the patient, for example, when extracting a tooth, examining the bladder with its catheterization, abortion, and so on.

Forecast

The prognosis without treatment is poor. After surgical correction of the defect, clinical and hemodynamic parameters improve, and the survival rate of this category of patients reaches about seventy out of a hundred within ten years after surgery, which is a fairly good criterion for successful cardiac surgical treatment of aortic stenosis.

Therapist Sazykina O.Yu.

Aortic stenosis, in other words, can be referred to as stenosis of the aortic orifice. The presented disease is congenital or acquired over time. It is characterized by a significant narrowing of the outflow tract of the left ventricle near the aortic valve.

Varieties of aortic stenosis

This disease can provoke a certain difficulty in the outflow of blood from the left ventricle, and also to some extent contributes to a sharp increase in the pressure gradient between the aorta and the ventricle. Aortic stenosis has several varieties:

Valve, which is congenital or acquired.
Supravalvular has only a congenital character.
Subvalvular - acquired or congenital.

What causes acquired aortic stenosis?

Today, a lot of people are facing the problem. Then the doctor diagnoses them with acquired aortic stenosis. There are several common reasons why a person begins to fight this disease:

atherosclerosis of the aorta.
Significant degenerative changes in the valve. In the future, calcification may occur.
Rheumatic affections of the valvular leaflets. Most often, people develop acquired aortic stenosis for this very reason.
Infective endocarditis.

Rheumatic valve leaflet disease or rheumatoid endocarditis contributes to the appearance of a significant reduction in the valve leaflet. For this reason, they may become rigid or tight. This is the main reason for the narrowing of the valve opening. Often, specialists have the opportunity to observe calcification of the aortic valve, which contributes to a significant increase in the mobility of the leaflets.

During the onset of infective endocarditis, a patient experiences a similar change, which in the future will lead to the appearance of such a disease as aortic stenosis. In this case, a primary degenerative change in the valve occurs. Congenital diseases often occur due to the formation of a defect and anomaly in the development of the valve. If we talk about the late stage of the development of the disease, then severe calcification can join the main symptoms. It contributes to the aggravation of the course of the disease.

Based on the above information, almost all patients at certain stages of aortic stenosis experience deformation of the aortic valve, as well as severe calcification.

Common Symptoms of Aortic Stenosis

Increasingly, doctors diagnose their patients with aortic stenosis. The symptoms of such a disease can be different, because the stage of the neglected state depends on the degree of the disease. Some patients do not experience discomfort or unusual sensations for a long time, so they do not even suspect that they are sick.

During a pronounced narrowing of the valve opening, people can observe the appearance of angina attacks. They also get tired quickly, feel weak during physical exertion, struggle with fainting, as well as dizziness with a quick change in body position. All these ailments indicate that a person is faced with a disease such as aortic stenosis. Its symptoms may be similar to other ailments, so it is necessary to be examined by a doctor. It is not uncommon for patients to experience shortness of breath while walking.

If we talk about severe cases, then a person may feel regular attacks of suffocation, which occur due to pulmonary edema or cardiac asthma. Patients with isolated aortic stenosis may complain of signs of right gastric failure. That is, they feel heaviness in the right hypochondrium and various edema.

All symptoms of aortic stenosis make themselves felt even with minor manifestations of pulmonary hypertension, which is caused by defects in the mitral valve along with aortic stenosis. Depending on the degree of aortic stenosis, the patient feels different signs and symptoms of the disease. During a general examination of the patient, pallor of the skin, characteristic of this disease, can be distinguished.

How can a disease be identified?

Doctors use several basic methods to make a correct diagnosis for a patient. The choice of one or another method depends on the degree of aortic stenosis.

Electrocardiogram.
X-ray examination.
Conducting echocardiography.
Cardiac catheterization.

For each patient, a general examination by a specialist is carried out, and all tests are assigned. Based on the results obtained, the doctor is able to make a diagnosis for the patient. Signs of aortic stenosis in children are severe health conditions in infancy. But usually small patients tolerate all the symptoms quite easily and well.

Treatment of aortic stenosis

Even this disease can be treated if it is detected in time and seek qualified help. The doctor will determine severe stenosis of the aortic valve, the treatment will be able to prescribe if the person asked for help not too late. Treatment of the last stage of the disease with medication will be impossible and ineffective. The only radical method of treatment is valve replacement. Once symptoms develop, the patient's chances of survival will decrease drastically. As medical practice shows, after the patient has increased symptoms of aortic stenosis, pain in the heart and left ventricular failure, fainting, he can live no more than five years. After determining the diagnosis of aortic valve stenosis, only the doctor who will operate will be able to prescribe treatment. The patient is advised to take preventive measures against infective endocarditis.

If a person does not observe the symptoms of the disease, then in this case appropriate drug treatment will be prescribed, aimed at constant support of sinus rhythm, normalization of blood pressure, and prevention of coronary artery disease. Aortic stenosis and insufficiency of the heart valve can be treated with medications to relieve congestion in the pulmonary circulation. The patient is prescribed diuresis, but if they are actively and regularly used, one may encounter the development of excessive diuresis, arterial hypotension, hypovolemia.

During the determination of aortic stenosis, the patient should never take vasodilators, because their use most often leads to fainting. But in a state of severe heart failure, the most careful treatment with sodium nitroprusside is quite acceptable.

Surgical method of treatment

Aortic disease with a predominance of stenosis is most effectively treated with the surgical method of aortic valve replacement. The process of prosthetics is assigned to patients who have experienced a severe degree of aortic stenosis, in such cases:

The appearance of severe fainting, heart failure, increasing angina pectoris.
Combination with coronary artery bypass grafting.
Combination of surgery on another valve.

Only a highly qualified surgeon can help a patient diagnosed with aortic valve stenosis. The operation can significantly improve overall health, as well as increase life expectancy. The presented method of treatment can be quite successfully carried out for people of advanced age. This reduces the risk of developing premature severe pathology. During prosthetics, doctors use autografts, allogeneic prostheses, allografts, mechanical prostheses, as well as porcine biological prostheses. In some cases, bovine pericardial prostheses may be indicated.

With the help of surgery, you can improve the health of a person who has been diagnosed with aortic stenosis. The operation can last several hours, after which the patient must adhere to the recommendations of the doctor. Patients must be under the strict supervision of a cardio-rheumatologist. At the same time, any physical activity is excluded, and bed rest is prescribed. If there are certain complications, then appropriate treatment of the patient is carried out.

Features of aortic stenosis

Aortic stenosis is a common valvular disease. This disease is most common in older people. This disease is characterized by hardening of the valves and is characterized by narrowing above or below the aortic valve itself. The valve is stenosed by the fusion of its three leaves or by a significant tension of calcification.

Aortic malformation with a predominance of stenosis is a disease of old age, where a large number of patients are people in their fifties and sixties. The whole process slowly progresses in such a way that a large amount of time is lost in the manifestation of the disease. Usually, all symptoms occur when the stage of the disease is in a serious condition. The normal state of the aortic opening during systole is measured at five centimeters. When the value deviates from the norm, then the patient has a heart murmur.

Treatment of critical aortic stenosis

Critical aortic stenosis is diagnosed by examination, which involves the use of Doppler echocardiography. It is in this way that the need for aortic valve replacement can be determined. Coronary angiography is performed for men who have reached the age of over forty years. This method of determining stenosis can be used for women over fifty years old.

If a patient has angina associated with mitral regurgitation, doctors may prescribe left ventriculography.

Critical aortic stenosis has a total opening area of less than 0.8 square centimeters. In this case, the disease must necessarily be treated with an emergency aortic valve replacement, if the patient's condition allows the presented method of treatment. It is almost impossible to meet cases when critical aortic stenosis occurs without special symptoms. Doctors cannot determine the total duration of the surgical intervention in this case.

An absolute contraindication for surgery is the presence of a violation of the contractile function of the left ventricle. A large number of patients who have a pronounced decrease in the contractile function of the left ventricle noted an improvement in their own condition after surgery. That is, an operation was performed to replace the valve. Patients who have problems with hemodynamic coronary artery disease should be evaluated by a physician. He will prescribe coronary artery bypass surgery, because the rates of a possible outcome of intraoperative mortality are increasing. Such a threat concerns isolated aortic valve replacement.

What is mitral aortic stenosis

Mitral aortic stenosis is a combination of stenosis involving the left atrioventricular orifice and stenosis extending to the aortic orifice. Such a disease occurs in the modern world quite often. The combination of these defects can affect significant hemodynamic disturbances. It is worth noting that mitral stenosis is located a few millimeters above the aortic one.

Any violations in the field of hemodynamics, which are most often caused by the occurrence of mitral stenosis, persist with a slight flow of blood into the left ventricle. During such an illness, patients may resemble people who have experienced isolated mitral stenosis. There have been cases when people have had a small mitral and severe disease in the area of aortic stenosis. In such a situation, hemodynamics will be disturbed similarly to aortic stenosis. It must be remembered that various signs of circulatory disorders in the small circle can occur a little earlier. That is, a pronounced degree of left ventricular hypertrophy practically does not occur, so pain in the region of the heart, regular fainting and dizziness are not observed in patients.

What is congenital aortic stenosis

Congenital aortic stenosis occurs in almost 10% of patients who have experienced heart defects. Men suffer from this disease more often than women. Congenital valvular and subvalvular aortic stenoses have a large number of similarities. Congenital stenoses in most cases are valvular.

The presented form of defect by adult patients is tolerated several times worse, unlike children or adolescents. Doctors state the fact that there are a large number of cases when there is a gradual increase in the degree of obstruction of the outflow tract. During the development and progression of the valve defect, the commissures are in a soldered state. The valves in this case are significantly thickened, the valves are in a domed state with a small hole. During a severe form of stenosis, the patient has concentric hypertrophy of the left ventricle. In this case, there are no significant changes in the volume of the cavity. Also, a person does not develop post-stenotic expansion of the ascending aorta. During the progression of subvalvular stenosis, a significant narrowing of the outflow tract is observed. It is due to the presence of a discrete membrane under the valve.

This may indicate that the patient has an annulus, which is located slightly below the valve. All of the listed forms of stenosis have properties to be combined with each other, as well as to talk about the presence of coarctation of the aorta, an open arterial duct.

Features of the manifestation of the defect, as well as its study

Hemodynamic manifestations of the defect are able to manifest themselves with the help of a systolic pressure gradient. It is localized between the left ventricle and the aorta itself. The magnitude of the pressure directly depends on the stroke volume, the total amount of ejection time, and the severity of the stenosis. At a late stage, during the onset of heart failure, dilatation of the left ventricle often appears. Patients experience an increase in end-diastolic pressure. If a patient has a severe case of the disease, then we can talk about pulmonary hypertension and right ventricular failure.

It should be noted that the laboratory and clinical manifestations of congenital aortic stenosis do not have certain differences during the disease of rheumatic aortic stenosis. To make a differential diagnosis, it is important to take a patient history. Also, do not forget about the definition of various concomitant heart defects. They occur with acquired defect, rheumatic lesions, as well as with mitral manifestations. If a patient has supravalvular stenosis, then this may indicate a family nature of the disease. Some stages of the disease in a patient can be determined during his general examination, without a clinical examination. In any case, to correctly determine the existing disease, it is necessary to seek the advice of a specialist. The longer the date of visiting the doctor is postponed, the more difficult it will be for the specialist to cure the existing disease.