Valve thickening

Introduction Valve thickening is 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.

Cause

Heart valve disease is a common heart disease in China, accounting for about 30% of heart surgery. The ratio of male to female is about 1:1.5. The causes include rheumatism, congenital, ischemic, infection and trauma. At present, valvular heart disease caused by rheumatism still accounts for the majority in China, but with the development of our society, the improvement of economic level, and the popularization of medical preventive measures. As well as aging, elderly degenerative valvular disease and ischemic valvular disease are increasing.

an examination

Related inspection

Electrocardiogram

(a) mitral stenosis:

1, left atrial compensation period: can be asymptomatic.

2, left atrial decompensation period: due to pulmonary blood stasis can cause labor and shortness of breath with cough, hemoptysis.

3, right heart involvement period: systemic blood stasis, liver large and tender, jugular vein engorgement, edema, ascites, oliguria.

4, mitral valve face (), apical area can reach diastolic tremor, can be heard and diastolic after clearer, the first heart sounds hyperthyroidism, can be heard and mitral open slap sound; pulmonary valve area The second heart sounds progressively, splits, and sometimes the area smells and whispers in the early diastolic (Graham-Steell murmur).

5. Auxiliary inspection:

(1) X-ray examination: the left atrium is enlarged (the right anterior oblique position is swallowed and fluoroscopy, the esophageal indentation is visible, the pulmonary artery segment is prominent, the heart shadow is pear-shaped, and the hilar shadow is enlarged and thickened.

(2) Electrocardiogram examination: "P wave of mitral valve" means that P wave is widened and concave; right ventricular hypertrophy with strain, common Pavl>1.0mV, RavR.0.5mV.

(B) mitral regurgitation:

1, the compensation period can be asymptomatic, when left heart failure can have heart palpitations, shortness of breath, fatigue and so on.

2, the heart to the left to expand; apical area can be heard and loud, rough systolic hairy murmur, often conduction to the underarm or back; can hear the third heart sound; the second heart sound of the pulmonary valve area.

3. Auxiliary inspection:

(1) X-ray examination: the left atrium, the left ventricle are enlarged, and the pulmonary artery is prominent.

(2) Electrocardiogram examination: left atrial enlargement and left ventricular hypertrophy and strain.

(3) Echocardiography: When the left atrium of the left atrium is enlarged, the M-shaped map can be measured.

(3) Aortic valve regurgitation:

1, early asymptomatic, or have anterior discomfort or head artery pulsation; late symptoms of left heart failure, acute severe patients have chest pain.

2, the face is pale, the apex capture shifts to the left, is lifted, the heart sounds the voice boundary to increase the boot shape, the aortic valve area and the left sternal border 3 to 4 intercostal can have diastolic, high pitch, diminishing Type-like gas murmur, conduction to the tip of the heart; apical area can be heard and low-pitched soft mid-diastolic murmur (Austin-Flint murmur); diastolic blood pressure decreased, pulse pressure increased, peripheral vascular signs, such as water pulse, gunshot sound, Capillary capture and Durozicr sign.

Differential diagnosis

Differential diagnosis of valve thickening:

(a) hypertrophic obstructive cardiomyopathy

Also known as idiopathic hypertrophic aortic subvalvular stenosis (IHSS), the fourth intercostal space of the left sternal border can be heard and systolic murmurs, systolic snoring is rare, and the second heart sound in the aortic area is normal. Echocardiography showed asymmetry of left ventricular wall hypertrophy, thickening of ventricular septum, ratio of left ventricular posterior wall 1.3, systolic ventricular septal forward, narrowing left ventricular outflow tract, may be associated with mitral anterior flap The leaves are displaced to cause mitral regurgitation.

(two) aortic dilation

Seen by various causes such as high blood pressure, aortic dilatation caused by syphilis. A short systolic murmur can be heard in the second intercostal space on the right side of the sternum. The second heart sound in the aortic area is normal or hyperthyroidism, and there is no second heart sound splitting. Echocardiography can confirm the diagnosis.

(three) pulmonary stenosis

The second rib space on the left sternal border and the rough systolic murmur, often accompanied by systolic click, the second heart sound in the pulmonary valve area is weakened and split, the second heart sound in the aortic valve area is normal, and the right ventricular hypertrophy is enlarged. The trunk of the pulmonary artery expands after stenosis.

(four) tricuspid regurgitation

The lower end of the left sternal border smells and high-profile full-systolic murmur. When the inhalation increases, the amount of blood returning can increase the noise and weaken when exhaling. The jugular vein beats and the liver enlarges. The right atrium and right ventricle are significantly enlarged. Echocardiography confirms the diagnosis.

(5) mitral regurgitation

In the apical region, the systolic murmur of the systolic period is transmitted to the left iliac crest; after the inhalation of isoamyl nitrite, the murmur is weakened. The first heart sound is weakened, the second heart sound of the aortic valve is normal, and the aortic valve is not calcified.

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