Heart defects are heart diseases associated with a violation of its functions as a result of lesions (deformation) of the heart valves or narrowings (stenosis) of the holes covered by the valves. Often in the same patient, deformation of the valves and narrowing of the holes exist simultaneously. In addition, combined heart defects are often found when not one valve or hole is affected, but 2 or 3 valves.
Etiology.
Types of heart defects.
Heart defects are distinguished: Acquired and Congenital, They arise as a result of abnormal formation of the heart during fetal development (the main image on the right side of the heart). Congenital heart defects include:
- valve ,
- Defects in the partitions between the individual chambers of the heart (eg., A defect of the interventricular septum or cleft oval hole in the septum between the atria )
- Defects larger vessels , such as cleft arteriosus duct, narrowing of the pulmonary artery or aorta constriction isthmus.
Acquired heart defects most often develop after rheumatism (rheumatic heart disease) , less often after syphilis and atherosclerosis, and very rarely after an injury (wound) of the heart. For rheumatic heart diseases is characteristic:
- Defeat clamshell valve and left predserdno- ventricular openings
- Aortic valves are less commonly affected . With heart defects of syphilitic origin, only aortic valves are affected.
Pathogenesis.
If the valves are insufficient , due to the fact that they cannot completely cover the hole, the blood, when the heart contracts (systole), partially returns to the chamber of the heart where it just came from, which leads to its overflow. Thus, stagnation of blood occurs in the heart chamber above the diseased valve. When the heart relaxes (diastole), this increased amount of blood in the overlying chamber of the heart goes to the chamber, which lies below the diseased valve, and overflows it.
With the narrowing (stenosis) of one or another opening of the heart, the same thing happens, since the heart chamber lying above the narrowed opening, due to the existing narrowing, cannot overtake all the blood in it.
With such a change in the work of the heart, a circulatory disorder would quickly turn out if the heart did not adapt to new working conditions: the cavities of that part of the heart in which more than normal accumulates, the amount of blood increases in size, the muscle walls of the heart thicken ( hypertrophy ), accordingly, muscle strength increases, and it can thus cope with increased stress.
Thus, Compensation of the heart develops . Under favorable conditions, heart defects remain compensated for a long time, and the heart retains the ability to perform work, like a healthy heart.
However, a hypertrophied heart muscle requires delivery of a larger amount of blood compared to the norm for its nutrition. In the absence of such an increase in blood supply to the heart muscle, its strength weakens, and it is no longer able to perform the increased work that is necessary to overcome the existing defect and normal supply of blood to the body. Other factors act in the same direction on the heart muscle ( e.g. , a new outbreak of rheumatism that repeatedly affects the heart muscle). In the chambers of the heart located above the affected valve or narrowed opening, stagnation of blood occurs. Then heart decompensation develops . Clinical symptoms. Blood stasis begins to spread throughout the body – in the tissues, organs and cavities of the body. This is manifested in the following:
- Cyanotic coloration of the skin (especially on the face and limbs),
- Swelling (more on the legs),
- Shortness of breath
- Cough with sputum,
- Enlarged liver
- Accumulation of fluid in the pleural cavities and in the abdominal cavity ( ascites ).
The prognosis for heart defects.
The prognosis for heart defects depends on many factors, primarily on the nature of the valve defect, the degree of valve defect, as well as on the combination of a violation of the valve apparatus (defect of two or three valves). Combined valvular defects always have a more adverse effect on the functioning of the heart than each of them individually. Among other factors, it is necessary to take into account the nature of the disease process that led to the formation of heart defects, its activity, as well as the presence of heart compensation.
Of great importance is the condition of other organs – the lungs, kidneys, intracecretory and nervous systems, blood, since their activity is closely related to the work of the heart.
For example, the presence of pulmonary emphysema, anemia, kidney damage, and thyroid dysfunction in heart diseases cause the need for increased heart function, and therefore worsen the prognosis of heart defects. For the prognosis, prevention and treatment, it is also necessary to take into account the working conditions and life of the patient.
Prevention
Prevention of the development of heart defects coincides with the prevention of those diseases that may be its cause.
With an existing heart defect, preventive measures should be aimed at preventing decompensation. The patient needs to establish such a regimen and provide such work that correspond to his condition. Improving heart function is achieved by prescribing appropriate exercises. The limits of the load that can be resolved by the patient are determined by the doctor, but control by the patient himself is especially important. The patient should know that every tension that causes some unpleasant sensations , such as shortness of breath, palpitations, pain in the heart or liver, etc. harmful to him. He should know that any overwork (physical or mental), sleepless nights, hot baths, baths, sunbaths, drinking alcohol, smoking tobacco, excessive sexual intercourse and so on, which for a healthy person to a certain extent go unpunished, can happen to a patient cause decompensation of the heart and contribute to poor health.
The patient’s nutrition should be regular and moderate, the last meal should be 3-4 hours before bedtime. Patients with heart disease need to monitor the regular action of the intestines, fight excess weight, since the accumulation of excess fat in the body significantly complicates blood circulation and creates an increased burden for the heart.
TREATMENT
Treatment for compensated defects is limited to moderate training of patients with physiotherapy and hydrotherapy (carbon dioxide baths in Kislovodsk, Darasun, hydrogen sulfide baths in Sochi-Matsesta, etc.). Drug treatment for compensated heart defects, as a rule, is not required. When signs of decompensation appear, the patient should limit the work, sometimes change it, change the mode, be under the supervision of a doctor. With significant decompensation, bed rest, a raised headboard is necessary. A milk and vegetable diet rich in vitamins, with a restriction of salt and liquid, is recommended. If the patient has edema and developed exhaustion, protein-rich foods (eggs, meat, liver, vitamins, especially from group B) should be included in the patient’s nutrition. Medication is prescribed by a doctor. Surgical treatment of both acquired and congenital heart defects is possible . The success of treatment is further fixed by training the heart through physiotherapy exercises.