Combined valve prolapse

Introduction Combined valvular disease, acquired heart disease, when two or more valves are involved, it is called combined valvular disease. Most of the causes are rheumatic heart disease. Mostly mitral valve lesions, combined with other valves. Among them, the mitral valve coexists with the aortic valve is the most common. The valvular lesion can be either narrow or incomplete. Different types of lesions change the normal blood circulation of the heart, and the left ventricular simple volume load increases, the simple pressure load increases, or both coexist. Left ventricular muscle hypertrophy, decreased compliance. The clinical manifestations are: labor palpitations, shortness of breath, angina pectoris, and audible noise in the auscultation area of the heart. Mitral valve prolapse syndrome refers to the pathogenesis of mitral valve leaflets and/or chordae tendines caused by various causes, resulting in a leaf (mostly posterior) or two leaves. When the left ventricle contracts, Left atrial prolapse, leading to a series of clinical manifestations of mitral regurgitation. The incidence of mitral valve prolapse is as high as 1.4% to 6%, which is one of the more common non-rheumatic valvular heart diseases.

Cause

1. The cause of chronic pulmonary heart disease:

According to different parts of the primary disease, it can be divided into three categories:

1), bronchi, lung disease

Intermittent emphysema with chronic bronchitis is the most common, accounting for 80%-90%, followed by bronchial asthma, bronchiectasis, severe tuberculosis, pneumoconiosis, chronic diffuse pulmonary interstitial fibrosis, sarcoidosis, allergic alveolar Inflammation, eosinophilic granuloma, etc.

2) Thoracic dyskinesia

Less common, severe posterior spine, scoliosis, spinal tuberculosis, rheumatoid arthritis, extensive pleural adhesions, and severe thoracic or spinal deformities caused by thoracic formation, as well as neuromuscular disorders such as polio, can cause chest vestibules Limited mobility, lung compression, bronchial distortion or deformation, resulting in limited lung function, poor airway drainage, repeated lung infection, emphysema, or fibrosis, hypoxia, pulmonary vasoconstriction, stenosis, making resistance Increase, pulmonary hypertension, develop into pulmonary heart disease.

3), pulmonary vascular disease

Very rare. Allergic granulmatosis involving the pulmonary artery, extensive or recurrent multiple pulmonary embolism and pulmonary arteritis, and unexplained primary pulmonary hypertension can cause pulmonary arteriolar stenosis and obstruction It causes an increase in pulmonary vascular resistance, pulmonary hypertension and right ventricular load, and develops into pulmonary heart disease.

2. The pathogenesis of chronic pulmonary heart disease

Changes in lung function and structure, repeated airway infections and hypoxemia, leading to a series of changes in humoral factors and pulmonary vasculature, resulting in increased pulmonary vascular resistance, pulmonary hypertension, increased pulmonary circulation resistance, right heart exerts Compensatory function to overcome right pulmonary ventricular hypertrophy by overcoming the resistance to elevated pulmonary arterial pressure. In the early stage of pulmonary hypertension, the right ventricle is still compensated, and the blood pressure at the end of diastole is still normal. As the disease progresses, especially during the acute exacerbation period, the pulmonary arterial pressure continues to rise and is severe, exceeding the right ventricular load, right heart decompensation, right heart discharge, and right ventricular end-systolic residual blood volume, end-diastolic Increased pressure causes right ventricular enlargement and right ventricular failure.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) ECG

[clinical manifestations]

1. Labor palpitations, shortness of breath.

2. Angina.

3. Difficulty breathing.

4. The apical valve auscultation area can hear diastolic rumbling or contraction-like murmur, and the aortic auscultation area can smell systolic or diastolic murmur.

5. Liver, positive jugular vein return, ascites, etc.

Diagnose based on

1. Labor palpitations, shortness of breath.

2. The mitral valve auscultation area smells diastolic rumbling or systolic hairy murmur, aortic valve auscultation systolic or diastolic murmur.

3. X-ray shows more pulmonary blood, both left and right ventricles can increase. The pulmonary artery segment protrudes.

4. ECG icon: left and right ventricular hypertrophy, ST segment and T wave abnormalities.

5. Color Doppler ultrasound echocardiogram: abnormal changes in the diseased valve, stenosis and insufficiency, abnormal blood flow.

diagnosis

1. History and symptoms: Symptoms of both types of valvular lesions can occur.

2. Physical examination found that the signs of the above two valve lesions can appear, but the nature of the diastolic murmurs of the two valves during auscultation is different.

3. Auxiliary examination: The pathological changes caused by the lesions of the two flaps are dominant, so the most suitable examination is UCG, and the degree of lesion of each valve can be clearly seen.

Differential diagnosis

(A) arterial catheter is not closed and severe pulmonary hypertension patent ductus arteriosus is a left-to-right shunt congenital heart disease, the blood diverted from the descending aorta to the pulmonary artery through the pulmonary veins back to the left atrium. Mainly increased left anterior preload caused left atrium, left ventricle enlargement, severe aortic valve, mitral regurgitation, patent ductus arteriosus, developed to severe pulmonary hypertension. The blood flow through the arterial catheter becomes smaller, and the noise becomes lighter or even disappears. Especially in rural patients who have not been diagnosed before, the medical history is not detailed, and a comprehensive and careful examination may be misdiagnosed as combined valvular disease.

(B) the lower atrial septal defect caused by aortic valve mitral regurgitation with the worsening of the disease, congenital heart disease type of ventricular septal defect can progress to aortic coronary valve prolapse and aortic valve regurgitation. With the enlargement of the left ventricular cavity, mitral regurgitation, especially prolapsed aortic valve covering ventricular septal defect, is easily misdiagnosed as combined valvular disease.

(C) coronary heart disease combined with valvular disease can be combined with coronary heart disease and missed diagnosis, coronary heart disease itself can also cause valvular dysfunction and was misdiagnosed as valvular heart disease. Clinical manifestations of coronary heart disease: mainly the symptoms and signs of valvular disease. Only some patients have angina pectoris. Severe aortic stenosis has 25% of angina pectoris. There are clear coronary lesions, but no symptoms of angina pectoris. Completely rule out the existence of coronary heart disease. Patients with valvular disease and coronary heart disease have left ventricular pressure or volume overload due to valvular disease, and most patients receive oral digoxin treatment. Both can cause non-specific changes in the ECG, so the ECG diagnosis of coronary heart disease is of little significance. Coronary angiography is the only accurate method for clinically diagnosed coronary artery stenosis. Because valvular heart disease combined with coronary heart disease directly affects the mortality and surgical outcome of valve surgery. Once valvular disease complicated with coronary heart disease missed diagnosis, coronary heart disease or valvular disease caused by coronary heart disease is misdiagnosed as valvular disease, the consequences are unimaginable, the operative mortality is extremely high, so the examination should be analyzed in detail.

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