Regurgitation – this term is often found in the professional life of doctors of various specialties, for example, therapists, cardiologists, functional diagnosticians.
And many patients have come across it, but they don’t have a clue what it is about.
It’s time to understand this issue, so that when the doctor says that “regurgitation on the pulmonary valve” is present, you should clearly know what it is and what dangers are associated with it.
Regurgitation refers to reverse blood flow from one cardiac chamber to another.
This means that when the heart muscle contracts, some blood volume for some reason returns to the heart cavity from which it was moving.
This is not to say that regurgitation is an independent disease, therefore this term cannot be used as a diagnosis. However, it characterizes other pathological changes and conditions, an example is heart disease.
It is important to understand that blood without interruption moves from one heart to another. It comes from the pulmonary vessels, goes into the main circle of blood circulation.
But the term “regurgitation” applies to all four valves on which reverse current can occur. Different blood flow returns, which allows you to highlight the degree of regurgitation.
Such degrees include determining the clinical signs of the condition. For a better understanding of pulmonary regurgitation, it is necessary to understand the anatomy.
As you know, the heart is a hollow muscle organ that has 4 chambers, namely: in a pair of ventricles and atria. Between the heart chambers and the vascular bed are valves that act as gates.
They let blood through in only one direction. Thanks to this system, a normal blood flow from one circle to another is ensured, since the heart muscle contracts rhythmically.
It pushes blood into the vessels and inside the heart.
When the valvular apparatus and myocardium are functioning normally during the period of contraction of a cavity, the valve flaps close tightly. With different heart lesions, the mechanism can be disturbed. The following valves are available:
- pulmonary artery and aortic valves.
Depending on the problem location, a precise definition of the condition is given: mitral, tricuspid or aortic regurgitation. This means that if the mechanism associated with the valve of the pulmonary artery is disrupted, then pulmonary regurgitation of a certain degree has occurred. Insufficiency of this valve causes blood flow from the pulmonary artery to the pancreas during diastole.
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- Causes of acquired tricuspid regurgitation
- Stage of the disease
- Treatment and prognosis
- Short description
- Features of regurgitation in children
- Briefly about anatomy .
- Symptoms of the disease in adults
- Causes of acquired tricuspid regurgitation
- Aortic regurgitation
The most common cause is pulmonary arterial hypertension. What it is? This is called an increase in pressure in the pulmonary artery system. This disease is not common.
It occurs against a background of high pressure in the arteries that lead from the heart to the lungs. They are called pulmonary arteries. High blood pressure is a strong heart strain.
Over time, it causes a stop on its right half.
The most common cause of pulmonary regurgitation is secondary pulmonary arterial hypertension.
Primary pulmonary hypertension is an independent disease, and secondary is a complication of various diseases of the respiratory organs and circulatory systems, it is not an independent disease. Four degrees of pulmonary hypertension are distinguished.
There is an opinion that secondary pulmonary hypertension can develop in people taking drugs or having HIV infection.
It is clear that in some cases, diseases that cause secondary pulmonary hypertension and appropriate regurgitation can occur not accidentally, but because of a person’s improper lifestyle.
It includes a sedentary lifestyle, and alcohol abuse, and smoking, and frequent stress, and some other reasons. In addition, if the underlying diseases are not treated on time, they will progress, which can easily lead to the development of regurgitation.
Unfortunately, not every person understands that, leading an unhealthy lifestyle or not treating his illness on time, he only exacerbates his condition. Therefore, the first thing to do if regurgitation is detected is to tidy up your life and also start treating the underlying diseases.
There are other causes of pulmonary regurgitation:
- infective endocarditis;
- congenital valve disease;
- idiopathic dilatation of the pulmonary artery;
- surgical treatment of tetralogy of Fallot;
- rheumatic fever;
- probe trauma;
- carcinoid syndrome.
The last three reasons are the rarest. Some of these diseases are directly related to the condition of the heart and valves. For example, infectious endocarditis is an inflammation of the inner heart membrane, namely, valves, endocardium and the main adjacent vessels.
Idiopathic dilatation of the pulmonary artery refers to a malformation of the main trunk, which is manifested by aneurysmal dilatation, but the function of the pulmonary valve is not impaired.
Tetralogy of Fallot is a group of four defects, namely: stenosis of the pulmonary artery, a large defect in the interventricular septum, an “upper sitting aorta” and obstruction of blood flow. Typically, radical surgery is performed before the age of three years. If such an intervention occurs in an older age, especially after twenty years, the long-term results are worse.
Acute rheumatic fever is an inflammatory disease of the connective tissue that is caused by beta-hemolytic group A streptococcus in individuals genetically predisposed to this. These and other diseases, one way or another, may be involved in the fact that pulmonary regurgitation is detected during the examination.
Pulmonary regurgitation can contribute to the development of pancreatic hypertrophy, and, ultimately, heart failure induced by pancreatic dysfunction.
But most often, the significance of pulmonary arterial hypertension is more significant in the appearance of such a complication.
In rare cases, acute heart failure, which is caused by pancreatic dysfunction, begins to develop with endocarditis, leading to acute pulmonary regurgitation.
Sometimes doctors use a term such as physiological regurgitation. In this case, we mean a slight change in the blood flow in the valve cusps.
That is, at the valvular opening, a kind of turbulence of blood occurs, while the myocardium and sashes remain healthy. In general, this condition does not affect blood circulation, so there are no symptoms. Physiological is considered regurgitation 0-1 degree.
But it is important to understand that it does not apply to the pulmonary valve, but only to the tricuspid valve.
Basically, pulmonary regurgitation occurs without symptoms. Some patients show signs of heart failure, which is caused by pancreatic dysfunction.
Initial degree regurgitation on the valve of the pulmonary artery does not cause significant hemodynamic disorders. However, a significant return of blood to the pancreas and atrium leads to the development of hypertrophy and expansion of the cavities of the right cardiac half.
These changes are associated with severe heart failure in the main circle and venous congestion.
Pulmonary regurgitation is manifested by the following symptoms:
- shortness of breath;
- severe swelling and so on.
With congenital valvular pathology, signs that blood circulation is impaired begin to manifest at an early age. Often they are irreversible and are severe. Severe regurgitation of a certain degree in the case of an irregular heart structure manifests itself almost immediately after the birth of the baby.
Unfortunately, there are many cases where significant violations result in death. Therefore, every expectant mother should take care not only of herself before she becomes pregnant, but of her baby while wearing it, so it is important for her to conduct an ultrasound diagnosis on time.
Today, diagnostics are seriously developing. Thanks to ultrasound, various diseases can be accurately detected. Using Echo KG, dopplerography can assess the nature of blood flow through the vessels, heart cavities, the movement of valve flaps during myocardial contractions, determine the degree of regurgitation, and so on.
We can say that echocardiography is the most reliable and most informative way to study cardiac pathology in real time. At the same time, this diagnostic method is inexpensive and affordable.
ECG diagnostics – the ability to determine regurgitation on the pulmonary valve
Some signs of regurgitation can be detected by ECG during a thorough cardiac auscultation.
It is very important to identify violations of the valvular apparatus of the heart with regurgitation in both adults and children.
Thanks to ultrasound of pregnant women, at various times, it is possible to detect the presence of defects that are not in doubt even during the initial examination, as well as to identify regurgitation, which is an indirect symptom of possible chromosomal abnormalities and the resulting valve defects.
The treatment of regurgitation to a certain extent depends on the cause that caused this condition. The specific degree of severity also matters. When determining the treatment, the doctor takes into account whether there is heart failure and concomitant pathology.
A decision can be made on the operative correction of valve structure disorders, which includes valve prosthetics and various types of plastics, or conservative drug therapy. Such therapy is aimed at normalizing blood flow in organs, treating arrhythmias and circulatory failure.
Most patients whose regurgitation is pronounced and both circles of blood circulation are affected, need constant monitoring by cardiologists. They also need diuretics and other drugs that the specialist selects.
It is very important not to resort to self-treatment. If you rely on yourself instead of consulting a doctor, you can only make it worse. When prescribing, the doctor takes into account not only the patient’s condition, but also his medical history, the results of all studies, contraindications and other factors.
Causes of acquired tricuspid regurgitation
Pulmonary regurgitation is a pathology of the heart muscle that occurs due to increased pressure in the arteries of the lungs.
This disease is rarely diagnosed, in many cases it appears in people who have had heart disease before.
When signs of regurgitation appear, diagnosis is required, and it is often possible to determine the presence of concomitant diseases and provoking factors for the development of pathology.
Heart valve regurgitation is a pathological process in the body, during which, during contraction of the heart muscle, the blood flow partially returns to the department from which the movement began. Due to this, a malfunction in the circulatory system occurs, caused by damage to the heart muscle.
Regurgitation can affect any of the 4 heart valves:
Depending on the location of the damage to the heart muscle, as well as on the causes of the pathology, regurgitation can be a complication of a cardiovascular disease or a separate pathology that does not pose a threat to life.
REFERENCE! The most common cause of pathology in the heart valves is a rapid and significant increase in pressure in their arteries.
Mitral valve regurgitation occurs due to one of the following reasons:
- disruption and damage to the papillary muscles;
- left ventricular hypertrophy;
- rheumatic diseases;
- lesions of the mitral valve.
The return of blood flow to the diastolic state due to damage to the tricuspid heart valve may occur due to causes that cause regurgitation of the pulmonary artery and mitral valve. Their list also includes:
- tricuspid valve prolapse;
- Marfan syndrome;
- malformations of valve flaps and other valvular departments;
- severe chest injuries;
- long-term use of active drugs;
- congenital heart defects;
- obstruction of the artery of the lungs.
Most often, tricuspid regurgitation develops as a complication of other types of this pathology.
Stage of the disease
Depending on the affected area of the heart, regurgitation of the heart valves is divided into 4 main types (according to the names and number of valves), each of which goes through 4 stages:
- Stage 1 does not have symptoms, because of which it is possible to identify it only during the diagnosis.
- The 2nd stage, at which the first signs of pathology occur, the volumes of the reverse blood flow are moderate, the rate of development of the disease increases.
- Stage 3, which is characterized by a significant increase in symptoms, the volume of reverse blood flow becomes large and lead to the development of hypertrophy of the right ventricle.
- The 4th stage, turning into a chronic form of pathology, in which the symptoms become pronounced and severe, heart muscle diseases develop, the consequences are irreversible.
Pulmonary regurgitation can be either congenital or acquired pathology, and therefore the duration of each stage may differ: the earlier the disease arose, the sooner it will develop. It is especially important to take this into account during pregnancy and to parents of newborns and infants. It is recommended in the first months after the birth of the baby to undergo a diagnosis to prevent the development of pathology.
It is possible to diagnose pulmonary regurgitation before the baby is born, while pathology is not a contraindication to childbirth and in most cases does not complicate the course of pregnancy.
In a newborn baby, congenital regurgitation appears externally in the first days after birth with the following symptoms:
- cyanosis of the skin;
- the appearance of shortness of breath, difficulty breathing;
- development of insufficiency in the right ventricle.
ATTENTION! Children suffering from pathology in acute and severe forms sometimes fail to avoid death. It is important for a pregnant woman to undergo a timely diagnosis and start treatment as soon as possible in order to maintain the health of the child.
It is recommended to resort to diagnostic measures regularly to prevent the development of complications and pathologies associated with pulmonary regurgitation. The first signs of pathology require immediate contact with specialists and mandatory examination.
Diagnostic measures include the following:
- Ultrasound examination (ultrasound) of the heart, which allows to determine the state of the heart valves, as well as the performance of the heart, its size and structure.
- Echocardiography (Echocardiography), the results of which allow you to find out about the nature of blood flow in the vessels and heart cavities, which helps determine the degree of regurgitation.
- An electrocardiogram (ECG), which makes it possible to establish the presence of regurgitation of the artery of the lungs and other developing and existing abnormalities of the heart valves.
- Examination and questioning by a doctor, which will help clarify the stage of the pathological process, establish the accompanying symptoms and possible causes of the disease.
- The doctor’s study of the patient’s history, which will help determine the cause of the pathology, information on the history of cardiovascular diseases and heart surgery.
- Dopplerography (as a separate study or as part of an ultrasound scan), by the results of which you can find out about possible blood pressure disorders.
- Cardiography, which allows to determine heart rhythm disorders, to control attacks of arrhythmia.
- Blood test, the results of which allow you to determine the content of glucose, cholesterol and antibodies in the blood, to establish the presence of infections and inflammatory processes of the myocardium.
- Chest x-ray, according to which it is possible to establish lung diseases, their swelling, as well as the development of right ventricular hypertrophy resulting from regurgitation.
- Cardiac catheterization, which allows to detect the presence of coronary heart disease, provoking the development of pathology.
IMPORTANT! For pregnant women, only ultrasound diagnostics is permissible, this is enough to confirm congenital regurgitation in the child.
Treatment and prognosis
It is only necessary to begin treatment of regurgitation of the pulmonary artery after eliminating its root cause.
Its scheme should take into account the presence of other chronic diseases and pathologies of the cardiovascular system, in particular, heart failure and congenital heart defects.
The first thing that is necessary for patients with any degree of the course of the disease is the constant monitoring of a cardiologist.
The physiological stages of the pathology require medical treatment, the action of which is aimed at normalizing blood flow and curing arrhythmias and circulatory failure. The list of necessary drugs to prevent the development and treatment of severe and acute forms of the disease include:
- Diuretics and diuretics — to remove excess fluid and prevent the development of complications by reducing the burden on the body (“Furosemide”, “Lasix”, “Trifas”).
- ACE inhibitors — to normalize blood pressure (Captopril, Monopril, Lisinopril).
- Angiotensin-2 antagonists are used only if there are contraindications for taking ACE inhibitors (Candesartan, Irbesartan, Diovan).
- Nitrates, vasodilators and cardiac glycosides — to reduce the load on the right ventricle of the heart (“Cardix”, “Olikard”, “Nitromint”).
- Antiarrhythmic drugs — to reduce or increase heart rate (Lidocaine, Quinidine, Rhythmorm).
- Metabolic agents — to initiate reparative and energy-exchange processes in the myocardial fibers (Apilak, Glycine, Milife).
- Beta-blockers are used for hypertension (Carvedilol, Nadolol, Labetalol).
REFERENCE! The course and duration of medication is prescribed by the doctor. In the presence of concomitant infections and diseases, the administration of drugs for symptomatic treatment is included in the therapeutic course. For the 1st degree of the disease, conservative treatment is enough.
An effective and necessary method of therapy in the presence of rapidly developing regurgitation of stages 2–4 is surgical intervention. Operations are divided into 2 types:
- Recovery of the heart valve.
- Plastic and heart valve replacement when it is impossible to restore its functionality.
In the case of an extreme stage of regurgitation of the pulmonary artery with concomitant hemodynamic disturbances, doctors may resort to a heart and lung transplant.
The prognosis of life in pathology is in most cases favorable for timely diagnosis and treatment. It is also recommended to lead a healthy lifestyle.
Congenital cases of regurgitation without surgery often have an unfavorable prognosis, leading to death.
Pulmonary regurgitation can occur after previously transferred heart diseases, as well as with the development of cardiovascular pathologies. Due to the absence of symptoms at the onset of the disease, it is important to regularly undergo a diagnosis in which it is possible to detect and prevent the development of symptoms and complications.
The timely establishment of a diagnosis, as well as the maintenance of a therapeutic regimen in most cases allows not only to save the patient’s life, but also to extend it.
The most common causes of this congenital pathology are:
- underdevelopment of valve leaflets;
- abnormal development (number) of valve leaflets;
- connective tissue dysplasia;
- Ehlers-Danlos syndrome;
- Marfan syndrome;
- Ebstein anomaly.
Tricuspid regurgitation in the fetus in isolation is very rare, usually it is combined with other heart defects. This valve insufficiency may be part of the mitral-aortic-tricuspid defect.
Regurgitation of the tricuspid valve acquired is much more common than congenital. It is primary and secondary. The primary causes of this pathology include rheumatism, drug addiction, carcinoid syndrome.
- Rheumatism is the most common cause of this pathology. In 20% of cases, it is recurrent rheumatic endocarditis that leads to deformation (thickening and shortening) of the valve cusps, and tendon filaments change in the same way. Very often, stenosis of the right atrioventricular opening joins this pathology. This combination is called a combined tricuspid defect.
- Rupture of the papillary muscles can also lead to tricuspid regurgitation. Such breaks occur with myocardial infarction or may be traumatic.
- Carcinoid syndrome can also lead to this pathology. It occurs in certain types of oncology, for example, cancer of the small intestine, ovaries or lungs.
- Taking heavy drugs very often leads to infectious endocarditis, and it, in turn, can cause tricuspid regurgitation.
Since the blood continuously moves from one part of the heart to another, coming from the blood vessels of the lungs and leaving into a large circle of blood circulation, the term “regurgitation” is applicable to all four valves on which the reverse current may occur. Depending on the volume of blood that comes back, it is customary to distinguish the degrees of regurgitation, which determine the clinical manifestations of this phenomenon.
A detailed description of regurgitation, isolation of its degrees and detection in a large number of people became possible with the use of ultrasound of the heart (echocardiography), although the concept itself has been known for a long time. Listening to the heart gives subjective information, and therefore does not allow judging the severity of blood return, while the presence of regurgitation is not in doubt unless in severe cases.
mitral regurgitation on echocardiography
In addition to ultrasound, indirect signs of regurgitation can be detected on the ECG, with careful auscultation of the heart and assessment of symptoms.
It is extremely important to identify violations of the valvular apparatus of the heart with regurgitation not only in adults, but also during fetal development. The practice of ultrasound examination of pregnant women at different periods allows us to detect the presence of defects that are not in doubt even during the initial examination, as well as to diagnose regurgitation, which is an indirect sign of possible chromosomal abnormalities or emerging valve defects.
In the case of circulatory disorders, palpitations, interruptions in the heart, shortness of breath during physical exertion and as the process progresses at rest, leg swelling more pronounced in the evening, abdominal pain due to an increase in the liver.
The history reveals the presence of chronic diseases, previous manipulations that could lead to infectious endocarditis, heart trauma, and intravenous drug use.
Physically, it is possible to detect signs of circulatory disorders in a large circle – swelling of the extremities, hepatomegaly, increased respiratory rate and heart rate, arrhythmia of the pulse, cyanosis of the skin.
With percussion, an increase in the boundaries of the heart is noted, and auscultation with regurgitation determines the noise at the site of the projection of the valve of the pulmonary artery (Graham Still’s noise). In patients with physiological reverse blood reflux, only characteristic noise can be detected.
Of the instrumental methods, electrocardiography and ultrasound with dopplerography are informative. On the cardiogram, you can detect signs of overload or an increase in the right heart, heart rhythm disorder.
When conducting ultrasound diagnostics, the sizes of the heart, the existing structural changes, and the ejection fraction are estimated.
Using dopplerography, the presence of regurgitation and its degree is established.
Laboratory abnormalities are revealed that indicate pathologies that are accompanied by pulmonary regurgitation: impaired lipid metabolism, increased D-dimer, positive rheumatic tests, positive Wasserman reaction, and toxicological examination proves the fact of drug use.
Dopplerography is designed to determine the nature of the movement of blood in the heart chambers of a particular person. After receiving the results, the attending physician compares them with the norms. Echocardiography is the best way to identify a disease. It shows the work of the heart muscle in real time.
An ECG is another aid in the diagnosis. She is able to identify some signs of the disease that are not symptomatic. Ultrasound will determine this pathology in an unborn child. In most cases, the cause is chromosomal abnormalities.
Treatment can only be prescribed by a doctor who has compared the patient’s symptoms and well-being with the degree of pathology. Also, the appointment of a certain list of medicines and procedures should take into account the chronic diseases that a person has and the presence of heart failure.
The highest results are given by surgery. With the help of surgical intervention, a defective valve is replaced with a healthy one. The 1st degree of the disease most often does not involve complex therapeutic regimens, and the latter is due only to the use of drugs.
With the help of medications, the patient will be able to normalize blood flow, eliminate arrhythmia and improve blood circulation of tissues. Usually, a cardiologist is involved in such diseases. It is he who will be able to prescribe the appropriate treatment, taking into account all the characteristics of the patient.
Self-treatment with pulmonary regurgitation is unacceptable. Lack of qualified help or improperly selected drugs will only worsen the patient’s situation and well-being, can lead to complications. Before starting treatment, a cardiologist conducts a number of tests, compares their results and contraindications that a person has. Only after this, the patient is prescribed a suitable list of drugs for him.
Regurgitation is one of the symptoms of other complex diseases of the cardiovascular system (for example, a symptom of heart failure).
As you know, the main work of the heart muscle is to continuously transport blood through the human body and to saturate it with oxygen.
In the heart itself, blood in a certain order moves from one department to another, after which it continues its movement through the veins in a large circle of blood circulation.
With regurgitation, there is a reverse movement of blood in various volumes, and the severity of symptoms depends on the latter.
Regurgitation is a pathological process that indicates the malfunction of the heart muscle in connection with a serious illness. This condition has 5 stages of development. It is necessary to consider each of them:
- Regurgitation of 1 degree. This stage is called easy and at this moment is of great interest. The pathological process that occurs in the heart during the first stage can be described as follows: blood entering the heart ventricle flows from it into the atrium through the valve cusps.
- Grade 2 regurgitation cannot be ignored, it must be treated. The flow of blood from the valves exceeds 25 mm.
- Grade 3 regurgitation is diagnosed if the blood stream exceeds 2 cm. Such a phenomenon can in no case be ignored, the patient is registered.
- Grade 4 disease – the flow of blood stream exceeds 2,5 cm.
- 5 degree is considered a physiological feature of a person. That is, if pathology does not develop, it does not pose a threat to human life.
- physical examination method, i.e. listening with a stethoscope tones and heart sounds;
- Echocardiography (echocardiography) is an ultrasound of the heart that reveals the functional and morphological state of the heart muscle and valves;
- ECG, in which you can see signs of an enlarged right atrium and ventricle of the heart;
- chest x-ray – this study also shows increased sizes of the right ventricle, you can see signs of pulmonary hypertension and deformation of the mitral and aortic valves;
- produce biochemical blood tests;
- general blood analysis;
- cardiac catheterization – this latest invasive procedure is used both for the diagnosis of cardiac pathologies and for treatment.
Features of regurgitation in children
In childhood, the correct development and functioning of the heart and circulatory system is very important, but unfortunately, violations are not uncommon. Most often, valve defects with insufficiency and return of blood in children are caused by congenital malformations (Fallot tetrad, pulmonary valve hypoplasia, defects of the walls between the atria and ventricles, etc.).
Severe regurgitation with an incorrect heart structure manifests itself almost immediately after the birth of a child with symptoms of respiratory disorders, cyanosis, right ventricular failure. Often, significant violations end fatally, so each expectant mother needs not only to take care of her health before the alleged pregnancy, but also to visit a specialist in ultrasound diagnostics in a timely manner during gestation.
Congenital tricuspid regurgitation in infants in 25% of cases is manifested as supraventricular tachycardia or atrial fibrillation, and later severe heart failure may occur.
In older children, even with minimal exertion, shortness of breath and a strong heartbeat appear. A child may complain of heart pain. Dyspeptic disorders (nausea, vomiting, flatulence) and pain or a feeling of heaviness in the right hypochondrium may occur. If there is stagnation in the great circulation, peripheral edema, ascites, hydrothorax, or hepatomegaly appear. All these are very serious conditions.
Briefly about anatomy .
In order to better understand the essence of regurgitation, it is necessary to recall some moments of the structure of the heart, which most of us have safely forgotten, having once studied at school in biology classes.
The heart is a hollow muscle organ that has four chambers (two atria and two ventricles). Between the chambers of the heart and the vascular bed are valves that perform the function of the “gate”, passing blood in only one direction. This mechanism provides adequate blood flow from one circle to another due to the rhythmic contraction of the heart muscle, pushing blood inside the heart and into the vessels.
The mitral valve is located between the left atrium and ventricle and consists of two cusps. Since the left half of the heart is the most functionally weighed, it works under heavy load and under high pressure, it is often here that various malfunctions and pathological changes occur, and the mitral valve is often involved in this process.
The tricuspid, or tricuspid, valve lies on the way from the right atrium to the right ventricle. It is already clear from its name that anatomically it represents three interlocking leaflets. Most often, its defeat is secondary in nature with the existing pathology of the left heart.
Valves of the pulmonary artery and aorta carry three leaflets and are located at the junction of these vessels with the cavities of the heart. The aortic valve is located on the path of blood flow from the left ventricle to the aorta, the pulmonary artery – from the right ventricle to the pulmonary trunk.
In the normal state of the valvular apparatus and myocardium at the time of contraction of a particular cavity, the valve flaps are tightly closed, preventing the reverse flow of blood. With a variety of heart lesions, this mechanism may be impaired.
Sometimes in the literature and in the conclusions of doctors you can find a mention of the so-called physiological regurgitation, which means a slight change in blood flow in the valve cusps. In fact, this causes a “turbulence” of blood at the valvular foramen, while the cusps and myocardium are quite healthy. This change does not affect blood circulation in general and does not cause clinical manifestations.
Regurgitation of 0-1 degree on the tricuspid valve, in the mitral cusps, which is often diagnosed in thin tall people, and according to some reports, is found in 70% of healthy people, is physiological. This feature of blood flow in the heart in no way affects the well-being and can be detected by chance during examination for other diseases.
As a rule, a pathological reverse flow of blood through the valves occurs when their valves do not close tightly at the time of myocardial contraction. The reasons may be not only damage to the valves themselves, but also to the papillary muscles, tendon chords involved in the mechanism of movement of the valve, the extension of the valve ring, the pathology of the myocardium itself.
Symptoms of the disease in adults
Typically, tetralogy of Fallot is diagnosed in early childhood due to severe symptoms in a child who is immediately operated on. The disease in question often becomes a cause of thickening of the walls of the right heart ventricle. This, in turn, can lead to heart failure. In another case, an existing pathology can provoke the occurrence of this ailment.
In medicine, there is the concept of physiological regurgitation. Physiological this condition is called only if the changes that have arisen due to pathology are insignificant. That is, the blood flow at the valve slows down, however, while the heart muscle does not undergo any negative changes and remains healthy. Usually regurgitation of the 1st degree is considered a physiological phenomenon.
In the event that the sick person does not have this ailment, such symptoms may occur due to a malfunction of the right heart ventricle. Level 1 regurgitation as an independent pathology does not cause significant disturbances in the human circulatory system.
If a person has stage 2 or 3 of the disease, then a large amount of blood entering the right heart ventricle can lead to organ failure.
This is due to the expansion of the chambers and thickening of the walls of the heart muscle.
In cases where this defect in the pulmonary artery is congenital, the disease manifests itself in the first few months of the child’s life. Most sick children have severe symptoms due to a severe form of the disease.
If the newborn suffers from the 4th degree of regurgitation, then the disease can not be corrected, in this case a fatal outcome is possible.
For this reason, both adults and children should undergo appropriate procedures annually and take tests that will help identify the disease at an early stage.
With more severe valve insufficiency, significant swelling of the jugular veins is observed. In this case, if you put a palm to the right jugular vein, you can feel its trembling. In severe cases, this pathology leads to dysfunction of the right ventricle, atrial fibrillation, or may cause heart failure.
Tricuspid regurgitation of the 1st degree – what is it? In this case, the return of blood is negligible and barely determined. In this case, the patient does not complain about anything. The clinical picture is absent.
With a diagnosis of “tricuspid regurgitation of 2 degrees”, the reverse jet of blood reflux is carried out within 2 cm from the walls of the valve. The clinic at this stage of the disease is almost absent; pulsation of the jugular veins may be weakly expressed.
The regurgitation of the tricuspid valve 3 degree is determined by the reflux of the reverse blood flow more than 2 cm from the tricuspid valve. Patients in addition to the pulsation of the neck veins may feel palpitations, weakness, and rapid fatigability; even with slight physical exertion, slight shortness of breath may occur.
swelling of the lower extremities, a feeling of pulsation on the left in the sternum, which is intensified by inhalation, impaired heart tones, cold extremities, enlarged liver, ascites (accumulation of fluid in the abdominal cavity), abdominal pain, and with the rheumatic nature of this disease, aortic or mitral vice.
Causes of acquired tricuspid regurgitation
- dilatation of the fibrous ring that occurs with dilated cardiomyopathy;
- high degree of pulmonary hypertension;
- weakness of the myocardium of the right ventricle, which occurs in the so-called pulmonary heart;
- chronic heart failure;
- myocardial dystrophy.
If the mitral valve is insolvent, when its valves do not close tightly enough, there is a reverse flow of blood from the left ventricle to the cavity of the left atrium during systole. This condition is called mitral regurgitation or mitral valve prolapse. This pathology, like tricuspid regurgitation, can be either congenital or acquired.
- 1 degree – mitral regurgitation is negligible;
- 2 degree – mitral regurgitation is moderate;
- 3 degree – mitral regurgitation is pronounced;
- Grade 4 – severe mitral regurgitation, often there is a complicated course.
Minor mitral, tricuspid regurgitation 1 degree, which does not cause objective complaints in the patient, does not require any treatment. Therapeutic treatment is carried out with a complicated course of the disease, for example, cardiac arrhythmias or pulmonary hypertension. Surgical intervention is indicated for severe or severe mitral insufficiency, in these cases plastic or valve prostheses are made.
If the cause of valve insufficiency is established, then therapeutic treatment will be prescribed to eliminate the provocative disease. In the absence of positive dynamics, surgical treatment of regurgitation is indicated. This usually happens with severe and severe disease.
Patients who have undergone surgical treatment for valve insufficiency are usually prescribed indirect anticoagulants.
Mitral regurgitation is clearly observed with valve insufficiency or prolapse. At the time of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MK). At the same time, the left atrium is filled with blood flowing from the lungs through the pulmonary veins.
Such an overflow of the atrium with excess blood leads to overstretching and an increase in pressure (volume overload). Excess blood while contracting the atria penetrates the left ventricle, which is forced to push more blood into the aorta with greater force, as a result of which it thickens and then expands (dilatation).
For some time, intracardiac hemodynamic disturbances may remain invisible to the patient, since the heart, as it can, compensates for blood flow due to the expansion and hypertrophy of its cavities.
With mitral regurgitation of the 1st degree, its clinical signs are absent for many years, and with a significant amount of blood return to the atrium, it expands, the pulmonary veins overflow with excess blood and signs of pulmonary hypertension appear.
Among the causes of mitral regurgitation, which is the second acquired heart disease in frequency after changes in the aortic valve, are the following:
- Atherosclerosis, deposition of calcium salts on the valves of MK;
- Some connective tissue diseases, autoimmune processes, metabolic disorders (Marfan syndrome, rheumatoid arthritis, amyloidosis);
- Coronary heart disease (especially heart attack with damage to the papillary muscles and tendon chords).
With mitral regurgitation of the 1st degree, the only sign may be the presence of noise in the region of the apex of the heart, detected auscultatory, while the patient does not complain, and there are no manifestations of circulatory disorders. Echocardiography (ultrasound) allows you to detect a slight divergence of the valves with minimal impairment of blood flow.
Regurgitation of the mitral valve of the 2nd degree accompanies a more pronounced degree of insufficiency, and a stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of its total amount located in the cavity of the left ventricle, then signs of stagnation in a small circle and characteristic symptoms are detected.
They say about the degree of regurgitation when, in the case of significant defects of the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.
When the myocardium cannot cope with the excess volume of the contents in the cavities, pulmonary hypertension develops, leading, in turn, to overload the right half of the heart, resulting in a lack of blood circulation and in a big circle.
With 4 degrees of regurgitation, the characteristic symptoms of severe disturbances in blood flow within the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, cardiac asthma and even pulmonary edema may occur. In advanced cases of heart failure, puffiness, blueness of the skin, weakness, fatigue, a tendency to arrhythmias (atrial fibrillation), heart pain join the signs of damage to the pulmonary blood flow. In many ways, manifestations of mitral regurgitation of a pronounced degree are determined by the disease that led to damage to the valve or myocardium.
Separately, it is worth mentioning mitral valve prolapse (MVP), which is often accompanied by varying degrees of regurgitation. In recent years, prolapse began to appear in diagnoses, although such a concept was rarely encountered before. In many respects, this state of affairs is associated with the advent of visualization methods – ultrasound examination of the heart, which allows you to track the movement of the MK valves during heart contractions. With the use of Doppler, it became possible to establish the exact degree of blood return to the left atrium.
MVP is characteristic of people who are tall, thin, and are often found in adolescents by chance when examined before being drafted into the army or undergoing other medical commissions. Most often, this phenomenon is not accompanied by any violations and does not affect the lifestyle and well-being, so you should not be afraid right away.
Mitral valve prolapse with regurgitation is not always detected, its degree in most cases is limited to the first or even zero, but at the same time, such a feature of the functioning of the heart can be accompanied by extrasystole and impaired conduction of nerve impulses along the myocardium.
In the case of detection of MVP of small degrees, you can limit yourself to the supervision of a cardiologist, and treatment is not required at all.
Tricuspid regurgitation leads to a violation of the complete emptying of the right half of the heart, adequate venous return through the vena cava and, accordingly, stagnation appears in the venous part of the pulmonary circulation.
For tricuspid valve insufficiency with regurgitation, the occurrence of atrial fibrillation, cyanosis of the skin, swelling syndrome, swelling of the cervical veins, enlargement of the liver, and other signs of chronic circulatory failure are quite characteristic.
The reverse flow of blood on the aortic valve occurs when it is insufficient or if the initial part of the aorta is damaged, when in the presence of the inflammatory process its lumen and the diameter of the valve ring expand. The most common causes of such changes are:
- Rheumatic fever;
- Infectious endocarditis with inflammation of the valves, perforation;
- Congenital malformations;
- Inflammatory processes of the ascending aorta (syphilis, aortitis with rheumatoid arthritis, ankylosing spondylitis, etc.).
Such common and well-known diseases as arterial hypertension and atherosclerosis can also lead to changes in valvular valves, aorta, and the left ventricle of the heart.
Aortic regurgitation is accompanied by the return of blood to the left ventricle, which is overflowing with excessive volume, while the amount of blood entering the aorta and further into the pulmonary circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume.
As the mass of the left ventricle increases, so does its need for oxygen and nutrients, which the coronary arteries are unable to provide. In addition, the amount of arterial blood pushed into the aorta is becoming smaller and, therefore, it will not be enough to enter the vessels of the heart. All this creates the prerequisites for hypoxia and ischemia, resulting in cardiosclerosis (proliferation of connective tissue).
With the progression of aortic regurgitation, the load on the left half of the heart reaches its maximum extent, the myocardial wall cannot hypertrophy to infinity and it stretches. Subsequently, events develop in a similar manner as in the case of a mitral valve lesion (pulmonary hypertension, stagnation in the small and large circles, heart failure).
Patients may complain of palpitations, shortness of breath, weakness, pallor. A characteristic feature of this defect is the appearance of angina attacks associated with inadequate coronary circulation.
We found that the tricuspid valve regurgitation may be congenital and acquired, primary (organic) or secondary (functional) according to etiology. Organic failure is expressed by the deformation of the valve apparatus: thickening and wrinkling of the valve leaflets or their calcification. Functional deficiency manifests itself in valve dysfunction caused by other diseases, and is manifested by rupture of papillary muscles or tendon chords, as well as violation of the annulus.
Secondary regurgitation is considered prognostically the most unfavorable. The death of patients in this case usually occurs from myocardial infarction, increasing heart failure, pneumonia or pulmonary embolism.
According to statistics after surgical treatment of heart valve insufficiency, the survival of patients up to 5 years and more is 65% after prosthetics and 70% after annuloplasty.
The prognosis is favorable with a diagnosis of tricuspid regurgitation of 1 degree. What is it, patients usually learn only with preventive examinations. With minor insufficiency of heart valves, there is no direct threat to life.
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