Aortic stenosis is a narrowing of the aortic opening in the valve area, which significantly complicates the outflow of blood from the left ventricle. Of course, this pathology entails consequences. And when ignored, a fatal outcome is inevitable.
But for what reasons does it arise? What could be a predisposing factor? What symptoms indicate the presence of this pathology? And how is the treatment carried out? This and much more will now be discussed.
Characteristics and types of disease
Aortic valve stenosis is a very common heart disease in adults. Pathology is congenital (about 3-5.5% of cases) and acquired.
There are stenoses of the following types:
- Valve. It occurs in 60% of cases. The most common heart disease. In total, it occurs in 0.4-2% of the world's population. It is characterized by deformation of the valve, often combined with coarctation of the aorta and open ductus arteriosus.
- Subvalvular. It occurs in 30% of cases. It is characterized by polymorphic subvalvular narrowing of the excretory tract of the left ventricle. This heart disease is congenital, but rarely detected in infants. Pathology makes itself felt throughout life.
- Supravalvular. It 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 large systemic arteries - abdominal, pulmonary, brachiocephalic and aorta.
The severity of the narrowing depends on the gradient of systolic pressure between the left ventricle and the aorta, and also on the area of the valve opening. Normally, it should be 2.5-3.5 cm². But in people with aortic stenosis, the opening area is much smaller. In severe cases - about 0.74 cm².
Stages of the disease
In its development, aortic stenosis goes through five stages:
The first (full compensation). Pathology can only be detected auscultatively, by listening to sound phenomena. The aorta in this case is slightly narrowed. In order to avoid the development of pathology, the patient should be observed by a cardiologist and follow his recommendations.
The second (latent heart failure). Symptoms are manifested: fatigue, dizziness, shortness of breath, even with small physical exertion. The second stage allows you to determine the conduct of radiography and ECG. A pressure gradient is observed in the range from 36 to 65 mm Hg. Art. This becomes an indication for the operation to correct the defect.
Third (relative coronary insufficiency). Shortness of breath intensifies, angina pectoris occurs, bouts of fainting are frequent. The pressure gradient is more than 65 mm RT. Art. In the third stage, surgical treatment is necessary.
Fourth (severe heart failure). Shortness of breath worries 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). Characterized by the steady progression of heart failure, edematous syndrome appears. The operation at this stage is contraindicated, and taking medications can only improve the condition of a person for a short while.
Causes
Acquired aortic stenosis occurs due to rheumatic lesions of the valve cusps. This leads to deformation of their barriers, because of which they coalesce among themselves, becoming rigid and dense. As a result, the valve ring narrows.
Also, the following pathologies and conditions are the reasons for the development of acquired aortic stenosis:
- Accumulation of calcium in the aortic valve (calcification, calcification).
- Infectious endocarditis.
- Atherosclerosis of the aorta.
- Paget's disease, manifested 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 with a narrowing of the mouth of the aorta, which a person has from birth.
The disease of this form makes itself felt at the age of 30 years. Acquired stenosis appears after 60 years.
It should be noted that at risk are people suffering from arterial hypertension and hypercholesterolemia, as well as smokers.
Manifestations of the disease
Symptoms of aortic stenosis (in ICD-10, the disease appears under the code I35 "Non-rheumatic lesions of the aortic valve"), as mentioned earlier, has not been shown so clearly for a long time. But you should be wary if you have noted such signs:
- Fast fatiguability.
- Severe shortness of breath during physical exertion.
- Muscle weakness.
- Palpitations.
- Dizziness.
In the future, as the disease progresses, fainting due to a rapid change in body position, attacks of angina pectoris, nocturnal dyspnea join these symptoms.
Very often, cardiac asthma occurs. This is a clinical syndrome that manifests itself in sharp bouts of inspiratory dyspnea, which develops into suffocation. It occurs due to congestion in the pulmonary circulation and pulmonary edema of an interstitial nature. Often, due to cardiac asthma, alveolar pulmonary edema begins to develop , which usually ends in death.
With aortic valve stenosis, right ventricular failure also often develops. If it is present, edema appears, a feeling of heaviness in the right hypochondrium.
If a person has noticed signs of aortic stenosis, he immediately needs to 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.
Diagnostics
The presence of aortic stenosis can often be determined even by the appearance of the patient. The person looks pale, he has a narrowing of blood vessels, and in the later stages there is cyanosis of the skin and peripheral edema.
When conducting percussion, it is possible to determine the expansion of the borders of the heart down and to the left, and palpation reveals a shift in the apical impulse and trembling in the jugular fossa of a systolic character.
Also, with this pathology, the doctor reveals a systolic gross murmur over the mitral valve and aorta.
All of these manifestations can be identified through phonocardiography - this method is specially designed to record heart sounds and cardiac sounds using a phonocardiograph.
Another patient will need to undergo an ECG, since the data obtained during this procedure will help determine the signs of arrhythmia, left ventricular hypertrophy and blockade.
In addition, it is necessary to take an x-ray. The image shows signs of pulmonary hypertension, an expansion of the shadow of the left ventricle, post-stenotic aortic dilatation, and a characteristic aortic configuration of the heart.
It will also be necessary to undergo an echocardiography to establish a diagnosis. It will help to identify whether there is hypertrophy of the walls of the left ventricle and thickening of the valve flaps, as well as to find out how limited the amplitude of movement of the valve cusps into the systole.
To measure the pressure gradient, the patient is sent to the sounding of the heart cavities. Based on the results of this procedure, conclusions can be drawn regarding the degree of development of pathology.
By means of ventriculography, mitral concomitant insufficiency can be detected, and coronography and aortography allow differential diagnosis of aortic stenosis of the heart with IHD and aneurysm of the ascending aorta.
Operation
If the degree of aortic stenosis allows surgery, then the cardiologist will most likely recommend valve replacement. This operation can significantly improve the patient’s quality of life and extend it.
In this case, resort to the method of minimally invasive surgery. During the operation, the damaged valve is removed and replaced with an artificial - biological or mechanical.
In some cases, as a prosthesis, a pulmonary valve is used, which is located between the opening of the pulmonary artery and the lower right chamber. And it, in turn, is replaced with artificial. This operation is effective, but only suitable for people under 25 years old.
By the way, it was previously said that with a severe degree of pathology, the operation is contraindicated. But many experts argue that postponing an operation in such cases is a more risky decision than carrying it out. If the valve is not replaced, death is guaranteed in the next 2.5 years.
An operation is strictly contraindicated only if the patient has a low local ejection fraction and impaired functioning of the left ventricle. But even in this case, many people took a risk, and he was justified.
Often, before the operation, the cardiologist prescribes the passage of a coronarogram or coronary catheterization. The results of these studies make it possible to determine whether a person has obstruction of the coronary arteries or not. If yes, and the case is serious, then the patient will be offered coronary bypass surgery, which is performed 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 drugs. Also often carried out the correction of respiratory failure and violations of the thyroid gland.
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 drugs can lead to serious complications:
- Peripheral vasodilators. They expand veins and small arteries, affecting their muscle tone. May cause dyspeptic symptoms and a decrease in blood pressure.
- Nitrates. Their administration can provoke tachycardia, orthostatic collapse, increased intraocular pressure, as well as the development of the dependence of the coronary vessels on the action of nitrates.
- Calcium channel blockers. They cause headaches, palpitations and have a paradoxical pro-ischemic effect (provoke angina attacks).
- Beta blockers. They reduce heart rate, 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 strengthen heart contractions, reduce conductivity, increase excitability and increase pressure.
However, again, everything is purely individual. If a person reveals atrial fibrillation with aortic valve stenosis, treatment will have to be supplemented with 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 need to consult a cardiologist. There are many recipes, and here are the most popular:
- In equal proportions mix tincture of peony, motherwort, hawthorn, valerian and Corvalol. Drink 1 tsp. day and evening, diluting in 1/3 glass of water.
- May honey (200 ml) mixed with chopped onions (1 cup) and send for a week to infuse in a dark place. In the closet, for example. Then for 14 days, remove the mixture in the refrigerator. After the time can be consumed - 3 tbsp. l per day for half an hour before meals for two months.
- Shredded coltsfoot (1 tsp) pour boiling water (200 ml) and let it brew for 20 minutes. Then filter out. Drink 0.5 cups of infusion per day.
- Pour berries of hawthorn (1 kg) with water (300 ml) and leave overnight. In the morning, drain the liquid. Berries must be drained. Then they should be abundantly sprinkled with sugar and sent to the fire for 5 minutes to boil. Then the mixture must be allowed to cool and put in 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 consequences usually happen 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 - he has to push a huge amount of blood into the aorta.
At first, these changes are adaptive in nature. 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 aortic stenosis, the doctor's recommendations must be observed. And one of them is the transition to a special diet. Have to abandon these products:
- Alcohol.
- Coffee, cocoa, strong tea.
- Energy drinks.
- Blue cheese (and indeed all stale foods).
- Spicy, fatty, salty, smoked food.
- Products containing E codes, carcinogens and supplements.
- Carbonated drinks.
- Fast food.
All of the above provokes the appearance of blood clots, cancer cells, diseases of the bones, stomach and heart. It is recommended to eat low-fat fish and meat, dairy products, vegetables and fruits, cereals and natural juices.
A healthy diet will not only facilitate the work of the body and all its systems, but also significantly increase immunity.