Heart valve disease is a common heart disease in China, with valve damage caused by rheumatic fever being the most common. As the population ages, age-related valve disease and valve lesions caused by coronary heart disease and post-myocardial infarction are becoming more common. To understand heart valve disease, let’s start with the structure of the heart.
The human heart is divided into four chambers: the left atrium, the left ventricle, the right atrium and the right ventricle, with two atria connected to two ventricles and two ventricles connected to two large arteries. The heart valves grow between the atria and the ventricles, and between the ventricles and the aorta, and act as one-way valves to ensure unidirectional blood flow and play an important role in ensuring the normal function of the heart. The four valves in the human body are called the mitral, tricuspid, aortic and pulmonary valves.
Heart valve disease is a single or multiple valve disease in which the valves of the mitral, tricuspid, aortic, and pulmonary valves become diseased due to rheumatic fever, mucus degeneration, degenerative changes, congenital malformations, ischemic necrosis, infection, or trauma, which affects the normal flow of blood, thereby causing abnormal heart function and eventually leading to heart failure.
Common symptoms: arrhythmia, heart failure, thromboembolism.
Etiology: The major causes of heart valve disease include rheumatic fever, mucus degeneration, degenerative changes, congenital malformations, ischemic necrosis, infection, and trauma. It can cause a single valvular lesion or multiple valvular lesions. The type of valve lesion is usually stenosis or insufficiency. Once stenosis and or incomplete closure occurs, it can impede normal blood flow and increase the burden on the heart, which can cause damage to heart function and lead to heart failure.
Clinical manifestations.
Heart valve disease mostly presents a chronic development process, and there may be no clinical symptoms in the early stages of valve disease, and corresponding clinical symptoms appear when arrhythmias, heart failure, or thromboembolic events occur. Patients often present with post-activity panic, shortness of breath, fatigue and lethargy, markedly reduced activity tolerance, dyspnea with minimal exercise (i.e., exertional dyspnea), and in severe cases, paroxysmal dyspnea at night or even inability to rest. Heart valve disease can also occur acutely due to acute ischemic necrosis, acute infective endocarditis, etc., and exhibit symptoms of acute heart failure such as acute pulmonary edema.
Some patients, especially those with mitral stenosis, may present with hemoptysis, with blood in the sputum in mild cases or a large amount of fresh blood at once in severe cases, and may cough up large amounts of pink foamy sputum in acute left heart failure. In addition, prolonged pulmonary stasis can lead to frequent bronchitis, especially in winter.
Certain patients, especially those with aortic stenosis, may experience dizziness, blackouts, or even syncope after activity. Symptoms of precordial discomfort or angina pectoris may also occur.
Patients with heart valve disease can find heart murmurs characteristic of heart enlargement, valve stenosis or incomplete closure during physical examination, such as apical diastolic rumbling murmur in mitral stenosis, apical systolic blowing murmur in mitral valve incomplete closure, diastolic ha-air murmur between the 3rd and 4th ribs of the left sternal margin in aortic valve incomplete closure, systolic blowing murmur between the 2nd ribs of the right sternal margin in aortic stenosis, etc., and rhythm disturbances. In acute heart failure, there may be a wet snail woven lung examination.
1.X-ray chest film: shows enlargement of the heart, pulmonary bruising, pleural effusion and other manifestations.
2.Electrocardiogram: there can be manifestations of various arrhythmias such as atrial fibrillation, atrial and ventricular hypertrophy.
3.Color flow and Doppler spectrum echocardiography: It is an important method to diagnose and evaluate heart valve disease, and can qualify the nature of heart valve lesions, such as rheumatic mitral stenosis, senile degenerative aortic stenosis, congenital aortic valvular diastolic malformation, etc. It can quantitatively determine the degree of valve stenosis or incomplete closure, the size of each atrium, the thickness of the ventricular wall, the systolic function of the left ventricle, the pulmonary artery pressure, etc. It is valuable for guiding surgical, interventional and pharmacological treatment.
Diagnosis: The characteristics of the heart murmur found on physical examination and the heart valve lesions seen on echocardiography are the main basis for the diagnosis of heart valve disease, even at the onset of clinical symptoms. Symptoms such as shortness of breath and weakness are the main basis for grading the patient’s cardiac function. An electrocardiogram can provide a basis for the diagnosis of arrhythmias. x-ray chest films can help determine pulmonary bruits, pleural effusions, and pulmonary lesions.
Treatment: Treatment of heart valve disease includes medical treatment such as drugs, surgical treatment and interventional treatment.
1. Internal treatment.
Diuretics are used for those who show signs of heart failure such as sodium and water retention, digoxin, beta-blockers, and non-dihydropyridine calcium antagonists are used to control the ventricular rate for those who show rapid atrial fibrillation, and anticoagulant therapy such as warfarin is used for those with thrombotic risk and complications. At the same time, it is emphasized to avoid exertion and emotional excitement, appropriate restriction of sodium and water intake, prevention of infection and other factors that induce heart failure.
2. Surgical procedures.
Surgical treatment such as prosthetic heart valve replacement or valvuloplasty is the radical cure for heart valve disease. For patients with heart valve disease who already have symptoms of heart failure, the indications and contraindications for surgery should be actively evaluated for the opportunity of surgical treatment.
3. Interventional therapy.
It is mainly balloon dilatation of stenotic valves. For severe simple mitral stenosis, aortic stenosis and congenital pulmonary stenosis, if the valve calcification is not obvious, percutaneous valve balloon dilatation can be chosen, which can achieve the purpose of expanding the valve orifice area, reducing valve stenosis, and improving hemodynamics and clinical symptoms.
Prevention: Among heart valve diseases of various etiologies, rheumatic heart disease can be prevented, mainly by prevention and timely treatment of upper respiratory tract infections caused by streptococci to prevent the occurrence of rheumatic fever.