Structural abnormalities of the heart

Introduction Heart - basic structure The surface of the heart is close to the bottom of the heart, and the transverse coronal groove is almost a week around the heart, interrupted only by the beginning of the aorta and pulmonary artery. Above the ditch is the left and right atrium, and below the ditch is the left and right ventricles. There are longitudinal sulcus in the front and back (lower) sides of the ventricle, extending from the coronal sulcus to the right side of the apex, respectively called the anterior and posterior interventricular sulcus, which is the surface boundary of the left and right ventricles. The normal positional relationship between the left atrium, the left ventricle, the right atrium, and the right ventricle showed a slight right-to-left torsion phenomenon, that is, the right heart was biased to the right front upper and the left heart was biased to the left rear lower. The heart is a hollow muscular organ with four chambers inside: the posterior upper part is the left atrium and the right atrium, and there is a septal separation between the two; the anterior lower part is the left ventricle and the right ventricle, and the two are separated by a septum. Under normal circumstances, due to the separation of the room and the compartment, the left half of the heart and the right half of the heart do not directly communicate, but each atrium can pass through the chamber to the ipsilateral ventricle. The right atrium wall is thin. According to the direction of blood flow, the right atrium has three entrances and one exit. The entrance is the superior and inferior vena cava and the coronary sinus. The coronary sinus is the main entrance to the heart wall venous blood. The exit is the right atrioventricular opening, with which the right atrium leads to the right ventricle. The ovoid depression in the lower part of the room is called the fossa ovalis, which is the remains of the oval pores that connect the left and right atrium during the embryonic period. The part of the right atrium that protrudes to the left front is called the right atrial appendage. There are two entrances and exits in the right ventricle. The entrance is the right atrium. The periphery is attached with three leaf-shaped valves called the right atrioventricular valve (ie, the tricuspid valve). The front flap, the back flap, and the septum are respectively called by position. The valve is perpendicular to the luminal cavity and is connected to the papillary muscles on the ventricular wall by a number of linear chordae. The outlet is called the pulmonary artery, and there are three semilunar valves on the periphery, called the pulmonary valve. The left atrium forms the majority of the heart, with four entrances and one exit. On both sides of the posterior wall of the left atrium, there is a pair of pulmonary veins, which are the entrances of the left and right pulmonary veins; the left atrium has a left atrial port in front of the left atrium, leading to the left ventricle. The part of the left atrium that protrudes to the front of the right side is called the left atrial appendage. There are two in and out of the left ventricle. The entrance is the left atrioventricular septum, and the left atrioventricular valve (mitral valve) is attached to the periphery. The anterior and posterior lobes are called by position. They are also connected with the anterior and posterior papillary muscles. The exit is the aortic orifice, located at the right anterior superior of the left atrioventricular ostium, with a semilunar aortic valve attached to the periphery. Abnormal heart structure, common in hypertension, uremia, electrolyte metabolism disorders and acidosis, renal anemia, arteriovenous fistula, atherosclerosis and so on.

Cause

Hypertension: Long-term high blood pressure overloads the heart, causing hypertrophy of the ventricular wall, enlargement of the heart, and long-term heart failure. Plasma catecholamine levels increase during uremia, and the degree of elevation is closely related to the occurrence of heart failure. In addition, because hypertension also accelerates the progression of atherosclerosis, causing heart failure.

The role of uremic toxins: harmful metabolic products accumulate in the body during CRF, toxins inhibit myocardial damage caused by myocardium, leading to myocardial hypofunction and heart failure.

Electrolyte metabolism disorder and acidosis: In CRF, myocardial electrical and myocardial excitability changes due to electrolyte imbalance, leading to heart rhythm disorder and heart failure.

Renal anemia: long-term anemia in patients with CRF causes myocardial hypoxia and myocardial dysfunction. As the body compensates for the heart rate, the cardiac output increases, and the heart is overloaded and the myocardial hypoxia can cause heart failure.

Arteriovenous fistula for dialysis: due to the large flow of arteriovenous blood, which aggravates the heart load, it can lead to heart failure for a long time.

Atherosclerosis: Hypertension associated with CRF and hyperlipidemia after dialysis can accelerate the progression of atherosclerosis, increase the mortality of CRF, and often die from myocardial infarction during dialysis.

Immunity is low: Immunity is low when uremia is easy to cause infection, and cause post-infection myocarditis or pericarditis leading to heart failure.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

With the development of perinatal medicine and ultrasound technology, fetal heart ultrasound examination has been paid more and more attention by scholars at home and abroad, especially in recent years, the improvement of two-dimensional ultrasound resolution and color Doppler technology, harmonic imaging, tissue multi-spectrum Le imaging and real-time three-dimensional appearance provide a basis for diagnosis of cardiac abnormalities.

Differential diagnosis

Perforation of heart valve: common in mitral regurgitation, refers to mitral valve thickening, hardening, weakening or disappearing of elasticity, valve curling, shortening, thickening and shortening of chordae, sometimes valve perforation, rupture or calcification The mitral annulus dilatation causes mitral valve regurgitation.

Left heart outflow tract malformation: common in children with Digolger syndrome, most patients with left heart outflow tract malformation, facial features of children with Digolger syndrome include long face, spherical tip and narrow nose, cleft palate The humerus is flat, the eye distance is widened, the squint is low, the lower lop ear is accompanied by the ear canal depression and the insufficiency of the ear wheel and the mandible is too small.

Heart enlargement: refers to the enlargement of the heart chamber and the change of heart shape. X-ray examination, heart enlargement is an important sign of heart disease, including heart wall hypertrophy and heart cavity enlargement, both of which coexist.

Ventricular hypertrophy: caused by excessive load on the ventricle (diastolic or systolic) and is a common consequence of organic heart disease. It can also be said that due to cardiovascular blockage, the heart can not withstand long-term overload work and has been deformed.

Valve thickening: mainly caused by heart valve disease. Heart valve disease is a heart disease in which the heart valve loses its one-way valve due to thickening, deformation, adhesion, calcification, and rupture. Heart valve disease can cause stenosis or insufficiency of the heart valve, so that the blood can not flow smoothly or flow backwards, the blood can not flow smoothly called the valve stenosis, the blood flow after the backflow is called valve insufficiency. The most common is mitral valve disease, followed by aortic valve disease.

Cardiac malformation: more common in congenital heart malformations, congenital heart malformations are congenital heart disease, one of the common malformations of the fetus, the incidence rate is about 0.4-0.8%. Most chromosomal abnormalities of the fetus, combined with many fetuses with severe deformities, have a cardiac malformation. The easiest and safest method for prenatal diagnosis of congenital heart malformation is fetal echocardiography.

The left ventricular cavity volume increases: the posterior anterior position, the left ventricle segment is extended, and the apex extends downward to the left. The apex of the apex is displayed in the stomach cavity, and becomes dull and left shifting, and the midline of the clavicle. The normal apex is at the level of the iliac crest and within the midline of the clavicle. The left ventricle segment is round and the heart is depressed. As the left ventricular segment is extended, the opposite beat point is moved up. When the increase is significant, the right ventricle can be pushed to move the lower right part of the right edge of the heart to the right and bulge, or the left atrium can be pushed to shift backwards and upwards. At the same time, the heart can be rotated to the right, making the depression of the heart more obvious.

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