Aortic stenosis is a narrowing of the aortic opening in the valve area, which significantly impedes the outflow of blood from the left ventricle. Of course, this pathology entails consequences. And if it is ignored, death is inevitable.
But for what reasons does it arise? What can be a predisposing factor? What symptoms indicate the presence of this pathology? And how is the treatment carried out? This and many other things will be discussed now.
Characteristics and types of disease
Aortic valve stenosis is a very common heart disease among adults. Pathology is congenital (about 3-5.5% of cases) and acquired.
The following types of stenosis are distinguished:
- Valved. Occurs in 60% of cases. The most common heart defect. In total, it occurs in 0.4-2% of the world's population. It is characterized by valve deformity, often combined with coarctation of the aorta and patent ductus arteriosus.
- Subvalve. Occurs in 30% of cases. It is characterized by polymorphic subvalvular narrowing of the outflow tract of the left ventricle. This heart disease is congenital,but is rare in infants. Pathology makes itself felt throughout life.
- Supravalvular. Occurs in 10% of cases. With this pathology, diffuse or local narrowing of the lumen of the ascending aorta is observed. It can occur either above the sinotubular zone, or at its level. This pathology is dangerous because it affects all major systemic arteries - abdominal, pulmonary, brachiocephalic and aorta.
The severity of the narrowing also depends on the systolic pressure gradient between the left ventricle and the aorta, and also on the area of the valvular orifice. Normally, it should be 2.5-3.5 cm². But in people with aortic stenosis, the area of the opening is much smaller. In especially severe cases - about 0.74 cm².
Stages of disease
Aortic stenosis progresses through five stages:
First (full compensation). Pathology can be detected only auscultatively, by listening to sound phenomena. The aorta in this case is narrowed slightly. To avoid the development of pathology, the patient should be observed by a cardiologist and follow his recommendations.
Second (hidden heart failure). The following symptoms appear: fatigue, dizziness, shortness of breath even with slight physical exertion. The second stage allows you to determine the conduct of radiography and ECG. There is a pressure gradient in the range from 36 to 65 mm Hg. Art. This becomes an indication for an operation to correct the defect.
Third (relative coronary insufficiency). Dyspneaintensifies, angina pectoris occurs, frequent attacks of fainting. The pressure gradient is over 65 mm Hg. Art. In the third stage, surgical treatment is necessary.
Fourth (severe heart failure). Shortness of breath bothers even at rest, attacks of cardiac asthma often occur at night. At this stage, the operation is excluded. In some cases, surgical correction is possible, but with less effect.
Fifth (terminal). It is characterized by a steady progression of heart failure, edematous syndrome appears. The operation is contraindicated at this stage, and taking medication can only improve a person's condition for a short time.
Reasons
Acquired aortic stenosis occurs due to rheumatic damage to the valve leaflets. This leads to deformation of their barriers, because of which they grow together, becoming rigid and dense. As a result, the valve ring narrows.
Also, the causes of the development of acquired aortic stenosis are the following pathologies and conditions:
- Accumulation of calcium in the aortic valve (calcification, calcification).
- Infective endocarditis.
- Atherosclerosis of the aorta.
- Paget's disease, which manifests itself in a violation of the process of destruction and restoration of bone tissue.
- Terminal renal failure.
- Systemic lupus erythematosus.
- Rheumatoid arthritis.
Congenital pathology is observed with a bicuspid aortic valve (this is an anomaly) or withnarrowing of the mouth of the aorta, which a person has from birth.
The disease of this form makes itself felt before the age of 30 years. Acquired stenosis appears after age 60.
It should be noted that at risk are people suffering from arterial hypertension and hypercholesterolemia, as well as smokers.
Manifestations of disease
Symptoms of aortic stenosis (in ICD-10 the disease is listed under the code I35 "Non-rheumatic lesions of the aortic valve"), as mentioned earlier, for a long time do not appear so clearly. But you should be wary if you have noted the following signs:
- Fatigue.
- Severe shortness of breath on exertion.
- Muscle weakness.
- Feeling heartbeats.
- Dizziness.
Further, as the disease progresses, these symptoms are joined by fainting due to a rapid change in body position, angina attacks, nocturnal shortness of breath.
Very common is cardiac asthma. This is a clinical syndrome that manifests itself in sharp attacks of inspiratory dyspnea, which develops into suffocation. It occurs due to congestion in the pulmonary circulation and interstitial pulmonary edema. Often, due to cardiac asthma, alveolar pulmonary edema begins to develop, which, as a rule, ends in death.
Aortic valve stenosis also often develops right ventricular failure. If it is present, edema appears, a feeling of heaviness in the right hypochondrium.
If a person has noticed signs of aortic stenosis, he should immediately make an appointment with a cardiologist. Ignoring the disease is fraught with consequences. And in 5-10% of cases with this pathology, sudden cardiac death occurs.
Diagnosis
The presence of aortic stenosis can often be determined even by the appearance of the patient. The person looks pale, he has vasoconstriction, and in the later stages there is cyanosis of the skin and peripheral edema.
During percussion, it is possible to determine the expansion of the borders of the heart down and to the left, and palpation reveals the displacement of the apex beat and trembling in the jugular fossa of a systolic nature.
Also with this pathology, the doctor detects a rough systolic murmur over the mitral valve and aorta.
All of the above manifestations can be detected through phonocardiography - this method is specially designed to record murmurs and heart sounds using a phonocardiograph.
The patient will also need to undergo an ECG, as the data obtained during this procedure will help to identify signs of arrhythmia, left ventricular hypertrophy and blockade.
Besides this, it is necessary to make an x-ray. The resulting image shows signs of pulmonary hypertension, widening of the left ventricular shadow, post-stenotic dilatation of the aorta, and a characteristic aortic configuration of the heart.
You will need to undergo echocardiography to establish the diagnosis. It will help to identify whether there is hypertrophy of the walls of the left ventricleand thickening of the valve flaps, as well as to find out how limited the amplitude of movement of the valve flaps in systole.
To measure the pressure gradient, the patient is directed to probing the heart cavities. Based on the results of this procedure, conclusions can be drawn regarding the degree of development of the pathology.
Through ventriculography, mitral concomitant insufficiency can be detected, and coronography and aortography allow differential diagnosis of aortic stenosis with coronary artery disease and aneurysm of the ascending aorta.
Operation
If the degree of aortic stenosis allows for surgery, the cardiologist will most likely recommend a valve replacement. This operation can significantly improve the patient's quality of life and prolong it.
In this case, they resort to the method of minimally invasive surgery. During the operation, the damaged valve is removed and replaced with an artificial one - biological or mechanical.
In some cases, a pulmonary valve is used as a prosthesis, which is located between the opening of the pulmonary artery and the lower right chamber. And it, in turn, is replaced by an artificial one. This operation is effective, but only suitable for people under 25.
By the way, it was said earlier that surgery is contraindicated in severe pathology. But many experts argue that postponing the operation in such cases is a riskier decision than performing it. If the valve is not replaced, death is guaranteed within the next 2.5 years.
Surgery is strictly contraindicated only if the patient has a low local ejection fraction and dysfunction of the left ventricle. But even so, many people took the risk, and it turned out to be worth it.
Often before the operation, the cardiologist prescribes the passage of a coronary angiogram or coronary catheterization. The results of these studies allow you to determine whether a person has blockages in the coronary arteries or not. If yes, and the case is serious, then the patient will be offered coronary bypass surgery, which is carried out in parallel with valve replacement.
Drug therapy
Treatment of aortic stenosis, of course, is prescribed only by a cardiologist. Drug therapy is aimed at stabilizing hemodynamics, and for this purpose, patients are prescribed diuretic and inotropic agents. Also, correction of respiratory insufficiency and violations of the ASC is often carried out.
Despite the fact that the treatment of aortic stenosis is not specific, it is strictly forbidden to prescribe drugs on your own. And you also need to know that taking such funds can lead to serious complications:
- Peripheral vasodilators. They dilate veins and small arteries, affecting their muscle tone. May cause dyspepsia and lower blood pressure.
- Nitrates. Their intake can provoke tachycardia, orthostatic collapse, increased intraocular pressure, as well as the development of coronary vessels dependence onaction of nitrates.
- Calcium channel blockers. They cause headaches, increased heart rate and paradoxical pro-ischemic effects (provoke angina attacks).
- Beta-blockers. They lower the heart rate and cause metabolic and pulmonary complications.
- Alpha-beta blockers. The main contraindication to their use is heart problems and insufficiency, so they should not be taken in any case.
- Cardiac glycosides. They increase heart rate, reduce conduction, increase excitability and increase blood pressure.
However, again, everything is purely individual. If a person develops atrial fibrillation with aortic valve stenosis, the treatment will have to be supplemented with the intake of the notorious glycosides (Digoxin, for example), since only they can cope with this disease.
But in general, with conservative therapy, special attention is paid to restoring normal blood flow and neutralizing the effects of arrhythmia.
Folk remedies
Before using them, you should consult a cardiologist. There are many recipes, and here are the most popular ones:
- In equal proportions, mix the tincture of peony, motherwort, hawthorn, valerian and Corvalol. Drink 1 tsp. afternoon and evening, diluted in 1/3 glass of water.
- May honey (200 ml) mixed with chopped onions (1 cup) and sent to infuse for a week in a dark place. Into the cupboard,For example. Then put the mixture in the refrigerator for 14 days. After the time has passed, you can use - 3 tbsp. l. per day for half an hour before meals for two months.
- Crushed coltsfoot (1 tsp) pour boiling water (200 ml) and let it brew for 20 minutes. Then filter. Drink 0.5 cups of infusion per day.
- Hawthorn berries (1 kg) pour water (300 ml) and leave overnight. Drain the liquid in the morning. The berries must be crushed. Then they should be sprinkled abundantly with sugar and sent to the fire for 5 minutes to boil. Then the mixture must be allowed to cool and transferred to a container. There are 1 tsp daily. on an empty stomach for a week.
In addition to the above, you can do herbal baths, massage and exercise therapy. But all this will be effective only at the initial stage of the disease.
Complications
Much has been said above about the causes, symptoms and classification of aortic stenosis. Now it’s worth talking about what are usually the consequences if a person ignores the manifestations of this ailment.
As the disease progresses, the left ventricle thickens and grows in size, because with a narrowed valve, its task is complicated - it has to push a huge amount of blood into the aorta.
At first, these changes are adaptive. They help the left ventricle to pump blood with greater force. But in the end, the left ventricle weakens, and behind it the whole heart as a whole.
Proper nutrition
With aorticstenosis, the doctor's recommendations must be followed. And one of them is the transition to a special diet. You will have to refuse such products:
- Alcohol.
- Coffee, cocoa, strong tea.
- Energy drinks.
- Cheese with mold (and indeed all stale products).
- Spicy, fatty, s alty, smoked food.
- Products containing E codes, carcinogens and additives.
- Soda drinks.
- Fast food.
All of the above provokes the occurrence of blood clots, cancer cells, diseases of the bones, stomach and heart. It is recommended to consume low-fat fish and meat, dairy products, vegetables and fruits, cereals and natural juices.
He althy eating will not only facilitate the work of the body and all its systems, but also significantly increase immunity.
