Heart valve insufficiency

Introduction to heart valve insufficiency Heart valve insufficiency is the most common cardiovascular medical disease. According to the affected part, it can be divided into mitral regurgitation, tricuspid regurgitation, aortic regurgitation, and pulmonary regurgitation. basic knowledge The proportion of sickness: 0.1% - 0.25% Susceptible people: no specific population Mode of infection: non-infectious Complications: arrhythmia heart failure infective endocarditis

Causes of heart valve regurgitation

1, congenital malformations, such as tetralogy of Fallot.

2. The root of the pulmonary artery secondary to pulmonary hypertension is dilated, causing the annulus to expand, which is seen in rheumatic mitral valve disease and Eisenmenger syndrome. Uncommon causes include idiopathic and pulmonary artery dilatation in Marfan syndrome.

3, caused by rheumatic aortic valve inflammation, can also be caused by infectious aortic valve disease, as well as aortic atherosclerosis and syphilitic aortitis involving the aortic valve. In addition, syphilitic aortitis, rheumatoid aortitis, and Marfan syndrome can cause enlargement of the annulus and cause relative aortic regurgitation.

4, other rare causes, connective tissue diseases such as systemic lupus erythematosus, rheumatoid arthritis, etc.; hypertrophic obstructive cardiomyopathy; tonic sclerosing spondylitis.

Heart valve insufficiency prevention

For certain diseases such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or funnel stenosis, right ventricular myocardial infarction, etc. or should always be alert and prevent the occurrence of functional heart valve regurgitation; and in other diseases such as congenital Ebstein malformations and common atrioventricular pathways in sexual abnormalities, and some acquired diseases such as rheumatic inflammation, coronary artery disease caused by tricuspid papillary muscle dysfunction, trauma and infective endocarditis, etc., should also pay attention to whether it occurs The performance of heart valve insufficiency.

Heart valve insufficiency complications Complications arrhythmia heart failure infective endocarditis

1, heart failure: heart failure, left heart failure can occur in the late stage of the disease, a small number of patients may also have right heart failure, and most patients with chronic aortic regurgitation may have died before right heart failure. The occurrence of left heart failure may be related to factors such as left ventricular overload, myocardial ischemia and myocardial fibrosis.

2, infective endocarditis: is the most important complication of chronic aortic regurgitation. Infective endocarditis is an important factor in the deterioration of patients with aortic regurgitation. Those who were originally only mild aortic regurgitation, once complicated by infective endocarditis, caused valve damage and caused extremely severe hemodynamic disturbances, threatening the lives of patients. For patients with severe aortic regurgitation, the consequences are even more serious.

3, arrhythmia.

Heart valve regurgitation symptoms Common symptoms Heart murmur dyspnea instability angina pectoris edema with difficulty breathing, cyanosis palpitations, dizziness, chest pain, sudden cardiac death

First, mitral regurgitation

1, acute

Mild reflux, only mild labor and difficulty breathing. Severe reflux (such as papillary muscle rupture), acute left heart failure, and even cardiogenic shock.

2, chronic

Patients with mild mitral regurgitation may have no symptoms for a long time. When the left heart function is decompensated, the patient has symptoms such as fatigue, palpitations, chest pain, and exertion of dyspnea due to decreased blood output. Subsequently, the condition worsened, there was a sitting breathing, paroxysmal nocturnal dyspnea, and even acute pulmonary edema, which eventually led to pulmonary hypertension and right heart failure.

Second, tricuspid regurgitation

1, symptoms

Fatigue, bloating and edema. Can be complicated by atrial fibrillation and pulmonary embolism.

2, signs

1 jugular vein dilatation with systolic pulsation; 2 sternal left margin and apical systolic lift-like pulsation; 3 sternal left margin full systolic murmur, increased during inhalation; 4 severe reflux, the lower left sternal border can be heard and short Diastolic rumbling murmur; 5 tricuspid prolapse has systolic click; 6 liver with systolic pulsation; 7 ascites and systemic edema.

Third, aortic valve insufficiency

1, mild to moderate patients have no obvious symptoms, severe palpitations, left lateral position is prone to left chest discomfort.

2, left heart failure can be weak, breathing difficulties, or acute pulmonary edema, the development of the disease can cause right heart failure.

3, a small number of patients have dizziness, syncope, angina or sudden death.

4, moderate and severe stenosis have diastolic blood pressure reduction and pulse pressure widening, at this time there may be obvious peripheral vascular signs.

5, apical beats are lifted, the range is more diffuse, the left sternal border can touch the diastolic tremor, and the heart expands to the left.

6, the first heart sound is often soft, the second heart sound can disappear or single heart sound, the aortic valve area can smell the early jet sound.

7, the left sternal border of the 3-4 intercostal audible diastolic murmur, conduction to the apical region, in some cases apical region can be heard diastolic murmur.

Fourth, pulmonary valve insufficiency

In most cases, the clinical manifestations of primary disease are prominent, and the performance of pulmonary valve insufficiency is concealed, only occasionally found during auscultation. The signs are as follows:

1, blood vessels and heart beats: the second intercostal ridge of the left sternal border and pulmonary systolic pulsation, may be associated with systolic or diastolic tremor. High left systolic pulsation of the left lower sternal border and right ventricle.

2. Heart sound: When the pulmonary hypertension is high, the second heart sound pulmonary valve component is enhanced. The right ventricular heart volatility increased, the ejection time was prolonged, and the second heart sound was broadly split. An increase in right stroke volume causes a sudden expansion of the enlarged pulmonary artery to produce a systolic jet sound, which is most pronounced in the second intercostal space on the left sternal border. The fourth intercostal space on the left sternal border often has third and fourth heart sounds, which are enhanced when inhaling.

3, heart murmur: secondary to pulmonary hypertension, in the left sternal border of the sternum, there is a second heart sound immediately after the second diastolic sigh early high-grade diminishing murmur, enhanced when inhaled, known as Graham Steell murmur. Due to the expansion of the pulmonary artery and the increase in the right stroke volume, there is a systolic jet murmur after the second intercostal jet of the left sternal border.

Heart valve insufficiency examination

1, imaging examination

(1) X-ray inspection.

(2) Echocardiography.

(3) CT, magnetic resonance

2, other inspections

(1) Electrocardiogram.

(2) Cardiac catheter.

Diagnostic diagnosis of heart valve insufficiency

Clinical diagnosis is based on typical diastolic murmur and left ventricular enlargement, and echocardiography can confirm the diagnosis. Etiological diagnosis can be made based on medical history and other findings.

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