What is aortic valve insufficiency

The typical performance of the heart is made sure by the smooth performance of the room and also ventricle. An important problem is the flow of blood in one instructions.

Blood enriched with oxygen from the left room is pressed right into the left ventricle. Valve brochures in between these components of the heart are therefore firmly shut. When the ventricle is pressed, the shutoffs of the lunar valve open, and also the blood is pressed right into the aorta, and also from there it relocates along the splitting arteries.

  • Aortic valve insufficiency is shared in disturbance of the valve brochure: after compression of the belly, when blood relocates right into the aorta, the brochures do not close entirely and also component of the blood recedes. At the following compression, the ventricle attempts to press the blood that has actually returned back in addition to a brand-new part. However, component of the blood returns once again.
  • As an outcome, the left ventricle is regularly dealing with added lots and also is regularly experiencing the stress of the blood continuing to be in it. To make up for the added lots, this location is hypertrophied, its muscle mass are pressed, the ventricle boosts in quantity.

But this is just one side of the infraction. Since component of the blood regularly returns, an absence of blood is created in the big circle of blood flow from the very start. Accordingly, the body does not have oxygen and also nutrients with a totally typical, enough job of the breathing system.

At the exact same time, diastolic stress lowers, which works as a signal for the heart to change to extensive setting.

Since the primary lots for making up for reduced stress pushes the left ventricle, for a long period of time, blood circulation disruption is unimportant. Symptoms are virtually missing.

  • However, when the reverse blood circulation gets to a considerable quantity – greater than 50%, all heart muscle mass go through hypertrophy. The heart increases, while the opening in between the left ventricle and also the room is extended and also mitral valve insufficiency is created.
  • At this phase, decompensation takes place. Violation of the left ventricular kind creates the growth of bronchial asthma, lung edema can be caused. Right ventricular decompensation takes place later on and also, generally, establishes much quicker.

If at the phase of settlement the signs and symptoms might not have actually materialized whatsoever – the individuals did not also have lack of breath throughout sporting activities, after that with the beginning of decompensation, aortic insufficiency obtains extremely powerful indicators.

In serious phases of the illness, the diagnosis of life relies on surgical treatment.

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Aortic insufficiency is split right into 3 levels. They vary in the aberration of the valve flaps. At initially look, it looks easy. It:

  • Valsalva sinuses – they lie behind the aortic sinuses, instantly behind the shutoffs, which are typically called lunar. Coronary arteries start from this location.
  • Fibrous ring – it has high stamina and also plainly divides the start of the aorta and also the left room.
  • Lunar cusps – there are 3 of them, they proceed the endocardial layer of the heart.

Sashes lie in a round line. When the valve is enclosed a healthy and balanced individual, the space in between the shutoffs is entirely missing. The level and also intensity of aortic valve insufficiency relies on the dimension of the space when assembling.

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First level

The first degree is characterized by mild symptoms. The divergence of the valves is not more than 5 mm. Feels like a normal state is no different.

Grade 1 aortic insufficiency is manifested by mild symptoms. With regurgitation, the blood volume is not more than 15%. Compensation occurs due to increased tremors of the left ventricle.

Patients may not even notice pathological manifestations. When the disease is in the stage of compensation, then the therapy can not be carried out, they are limited to preventive actions. Patients are prescribed an appointment with a cardiologist, as well as regular ultrasound checks.

Second degree

Aortic valve insufficiency, which belongs to the 2nd degree, has symptoms with a more pronounced manifestation, while the divergence of the valves is 5-10 mm. If this process occurs in a child, then the signs are hardly noticeable.

If, when aortic insufficiency occurs, the volume of blood that has returned back is 15-30%, then the pathology refers to a disease of the second degree. Symptoms are not very pronounced, but shortness of breath and also a frequent heartbeat may appear.

To compensate for the defect, the muscles and valve of the left atrium are involved. In most cases, patients complain of shortness of breath with light exertion, increased fatigue, severe heartbeat, and pain.

During examinations using modern equipment, an increase in heartbeat is detected, the apical impulse is slightly shifted down, the boundaries of dullness of the heart expand (to the left by 10-20 mm). When using X-ray examination, an increase in the left atrium is seen down.

With the help of auscultation, you can clearly hear the noise along the sternum on the left side – these are signs of aortic diastolic murmur. Also, in the second degree of insufficiency, systolic murmur is manifested. As for the pulse, it is enlarged and pronounced.

Third degree

The third degree of insufficiency, it is also called pronounced, has a discrepancy of more than 10 mm. Patients require serious treatment. More often prescribed surgery with subsequent drug therapy.

When the pathology is at the 3rd degree, the aorta loses more than 50% of the blood. To compensate for the loss, the heart organ speeds up the rhythm.

Mostly patients often complain of:

  • shortness of breath at rest or at minimal exertion;
  • pain in the heart area;
  • fatigue;
  • persistent weakness;
  • tachycardia.

In studies, a strong increase in the size of the borders of dullness of the heart is determined down and to the left. Displacement also occurs in the right direction. As for the apical impulse, it is reinforced (spilled character).

In patients with a third degree of insufficiency, the epigastric region pulsates. This indicates that the pathology involved the right chambers of the heart in the process.

During research, a pronounced systolic, diastolic murmur and Flint murmur appear. They can be heard in the second intercostal space on the right side. They have a pronounced character.

Chronic and acute forms

Aortic valve insufficiency may be chronic in nature, but may take an acute form. As a rule, the course of the disease determines the cause. The traumatic impact of a blunt instrument, of course, will cause an acute form, while lupus erythematosus, transferred in childhood, will “leave” a chronic one.

Symptoms may not be observed at all, especially with good physical preparation of the patient. The heart compensates for some lack of blood, so the signs of the disease do not cause proper concern.

Chronic aortic insufficiency has the following symptoms:

  • frequent headaches, concentrated mainly in the frontal lobe, are accompanied by noise and a sensation of pulsation;
  • fatigue, fainting and loss of consciousness with a sharp change of position;
  • pain in the heart at rest;
  • arterial pulsation – “arterial dance”, as well as a sensation of pulsation – the most characteristic symptoms of the defect. The pulsation is noticeable during visual examination and is caused by high pressure with which the left ventricle ejects blood into the aorta. But if aortic insufficiency is accompanied by other ailments of the heart, this characteristic picture may not be observed.

Shortness of breath, in contrast to mitral valve insufficiency, for example, manifests itself only at the stage of decompensation, when blood circulation in the lungs is disturbed and asthma symptoms appear.

Acute aortic valve insufficiency is characterized by pulmonary edema and arterial hypotension. Treatment with the surgical method in most cases is carried out only with pronounced symptoms and a severe stage of the disease.

Symptoms, Signs, and Causes

When aortic valve insufficiency begins to develop, then the symptoms do not appear immediately. This period is characterized by the absence of serious complaints. The load is compensated by the left ventricular valve – it is able to withstand the reverse current for a long time, but then it is stretched and slightly deformed. Already at this time there are pains, dizziness and a frequent heartbeat.

The first symptoms of failure:

  • there is a certain sensation of pulsation of the cervical veins;
  • strong tremors in the heart;
  • increased frequency of contraction of the heart muscle (minimizing reverse blood flow);
  • pressing and compressing pain in the chest area (with strong reverse blood flow);
  • the occurrence of dizziness, frequent loss of consciousness (occurs with poor supply of oxygen to the brain);
  • the appearance of general weakness and a decrease in physical activity.

During a chronic disease, the following symptoms appear:

  • pain in the heart region, even when calm, without stress;
  • during exertion fatigue quickly enough appears;
  • constant tinnitus and a feeling of intense pulsation in the veins;
  • the occurrence of fainting during a sharp change in body position;
  • headache in the front area;
  • pulsation of arteries visible to the naked eye.

When the pathology is in a decompensatory degree, the metabolism in the lungs is disturbed (often the appearance of asthma).

Causes of the disease:

  • congenital malformation of the aortic valve.
  • complications after rheumatic fever.
  • endocarditis (the presence of bacterial infection of the inside of the heart).
  • changes with age – this is due to wear of the aortic valve.
  • an increase in the size of the aorta – a pathological process occurs with hypertension in the aortic region.
  • hardening of the arteries (as a complication of atherosclerosis).
  • aortic dissection, when the inner layers of the main artery are separated from the middle layers.
  • violation of the functionality of the aortic valve after its replacement (prosthetics).

Less common are the reasons in the form of:

  • aortic valve injuries;
  • autoimmune diseases;
  • the effects of syphilis;
  • ankylosing spondylitis;
  • manifestations of diffuse diseases associated with connective tissues;
  • complications after applying radiation therapy.

It is important to consult a doctor at the first manifestations.

Classification of the disease

Two classification methods are considered: according to the length of the blood regurgitation stream, that is, the return from the aorta to the left ventricle, and by the amount of blood returned. The second classification is used more often during examination and conversations with patients, as it is more understandable.

  • An ailment of the first degree of intensity is characterized by a regurgitation blood volume of not more than 15%. If the disease is at the stage of compensation, then treatment is not prescribed. The patient is prescribed constant monitoring by a cardiologist and regular ultrasound.
  • Aortic insufficiency with a volume of returned blood from 15 to 30% is called grade 2 and, as a rule, is not accompanied by severe symptoms. At the compensation stage, treatment is not carried out.
  • At grade 3, the amount of blood that aorta lacks reaches 50%. It is characterized by all of the above symptoms, which excludes physical activity and significantly affects the lifestyle. The treatment is therapeutic. Constant monitoring is necessary, since such an increase in the volume of regurgitation blood violates hemodynamics.
  • With 4 degrees of severity, aortic valve insufficiency exceeds 50%, that is, half of the blood returns to the ventricle. The disease is characterized by severe shortness of breath, tachycardia, pulmonary edema. Both drug and surgical treatment are being undertaken.

Third level

Features of the disease in children

Many children do not notice problems for a long time and do not complain about the disease. In most cases, they feel good, but it does not last long. Many are still able to engage in sports training. But the very first thing that torments them is shortness of breath and an increased frequency of heartbeats. With these signs and symptoms, it is important to consult a specialist immediately.

At first, discomfort is noticed with moderate loads. In the future, aortic valve insufficiency occurs even in a resting state. Disturbing shortness of breath, severe pulsation of arteries located on the neck. Treatment should be of high quality and timely.

Symptoms of the disease can manifest as noise in the area of ​​the largest artery. As for physical development, in children it does not change with insufficiency, but there is a noticeable blanching of the skin of the face.

When considering an echocardiogram, aortic valve insufficiency is expressed as a moderate increase in lumen at the mouth of the artery. There are also noises in the region of the left part of the chest, which indicates the progress of the discrepancy between the lobes of the lunate flaps (more than 10 mm). Strong shocks are explained by the increased work of the left ventricle and atrium in the compensation mode.

Causes of appearance

Aortic insufficiency is congenital: if instead of a 3-leaf valve, a 1-, 2- or 4-leaf valve is formed.

However, the more common causes of the disease are as follows:

  • rheumatism – or rather, rheumatoid arthritis, is the cause of the defect in 60–80 cases. Since the onset of the disease is rheumatic fever, which was transferred during adolescence, it is not easy to diagnose aortic insufficiency;
  • infectious myocarditis – an inflammatory lesion of the heart muscle;
  • syphilitic damage to the aortic valve – there is a likelihood of the process transitioning from the aorta to the valve, treatment is difficult;
  • atherosclerosis – can also pass from the aorta, although less frequently;
  • chest trauma;
  • systemic diseases of the connective tissue, such as lupus erythematosus.

Treatment of a disease of grade 3, 4 requires first to establish the real cause of the disease and, if surgery is not indicated, proceed to its treatment, since the defect is secondary in nature.

Methods of diagnosis

To correctly assess changes in the functionality of the heart and its systems, you need to undergo a quality diagnosis:

  1. dopplerography;
  2. radiography (effectively determines pathological changes in the shutoffs and tissues of the heart);
  3. echocardiography;
  4. phonocardiography (determines the noise in the heart and aorta);
  5. ECG.

Upon examination, experts pay attention to:

  • complexion (if it is pale, then this means insufficient blood supply to small peripheral vessels);
  • rhythmic expansion of the pupils or their narrowing;
  • condition of the tongue. Ripples, change its shape (noticeable upon examination);
  • shaking of the head (involuntary), which takes place in the rhythm of the heart (this is because of strong shocks in the carot >

The pulse is unstable, there are recessions and growths. With the use of auscultation of the heart organ and its vessels, it is possible to more quickly and accurately identify noise and other indicators.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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