1.What is rheumatic heart disease?
Abbreviated as rheumatic heart disease, it is a lesion caused by rheumatic fever activity involving the heart valves, myocardium and pericardium. Common is rheumatic heart valve disease, the history of the disease can be several years to decades, rheumatic myocarditis, pericarditis in the acute rheumatic fever activity period is common. Surgical treatment of rheumatic heart disease is mainly chronic rheumatic valve lesions, mostly mitral valve lesions, aortic lesions, or a combination of both, and some patients also have secondary tricuspid valve closure insufficiency. Ye Liang, Department of Cardiac Surgery, Shanghai Oriental Hospital
2.What is the manifestation of wind heart disease?
Patients with wind heart disease have increased cardiac work due to disturbance of intracardiac blood flow, reduced blood supply to the body, pulmonary stasis and visceral stasis. The patient’s symptoms are heavy in winter and light in summer, and can be aggravated by cold or pneumonia, and improve after drug treatment.
3.How to prevent wind heart disease?
Rheumatic fever is the direct cause of rheumatic heart disease, which is generally considered to be a secondary immune reaction caused by the infection of human body by group A type B hemolytic streptococci. Its main preventive measures are to improve the standard of living, improve the living environment, avoid cold, humidity, exertion and hunger; improve the work and production environment; reduce labor intensity; strengthen physical exercise to enhance the body’s resistance; eat on time, strengthen nutrition, enhance the body’s nutrition and strengthen the strength of resistance to disease; actively treat colds, tonsillitis, pharyngitis, otitis media, scarlet fever, upper respiratory tract infections, etc. and avoid strong physical work, so as not to aggravate the disease. There are still many patients with rheumatic heart disease in China, and the incidence rate is higher in northeast and north China than in south China. Rheumatic heart disease is mostly seen in young people aged 20-40, and there are more women than men.
4.What are the complications of rheumatic heart disease?
Complications of rheumatic heart disease commonly include the following categories: heart failure, acute pulmonary edema, arrhythmia, arterial embolism, subacute infective endocarditis, lung infection, etc.
5.What are the symptoms of wind heart disease complicating heart failure?
Exertional palpitations and shortness of breath, fatigue, loss of energy, loss of appetite, in severe cases, inability to lie down, sitting and breathing, coughing up sputum, coughing up pink frothy sputum, suddenly waking up when sleeping at night, difficulty in breathing, chest and abdominal fluid, edema of both lower limbs or the lower part of the body, and even sudden death. Patients with mitral valve lesions are mostly in right heart failure, patients with aortic valve lesions are mostly in left heart failure, and patients with aortic stenosis are prone to sudden death, i.e., sudden death.
6.What are the symptoms of acute pulmonary edema complicated by wind heart disease?
Acute pulmonary edema is a serious and urgent complication of severe mitral stenosis, with a high mortality rate, occurring mostly during strenuous physical activity, emotional excitement or various types of tachycardia episodes; it is more likely to be induced during pregnancy due to increased blood volume. It is characterized by inability to lie down, sitting breathing, cyanosis, coughing up sputum, coughing up pink foamy sputum, sudden awakening at night when sleeping, difficulty in breathing, both lungs covered with wet rales, sometimes accompanied by the sound of asthma caused by fine bronchospasm.
7.What are the symptoms of arrhythmia complicated by wind heart disease?
Atrial fibrillation is the most common complication. About 60%-70% of patients in the late stage of wind heart disease can develop atrial fibrillation, which is manifested by absolute irregularity of heart rate, varying heart rate, up to 160-180 beats/minute when fast, about 50-60 beats/minute when slow, and patients have panic and uncertainty of heart; varying strength of heart sounds; varying strength of pulse rate. Atrial fibrillation can aggravate the deterioration of cardiac function, early atrial fibrillation patients more paroxysmal episodes, can be combined with atrial premature beats, atrial tachycardia and atrial flutter, drug treatment effect is better, after a long time atrial fibrillation more persistent, if the heart rate is not higher than 100-120 beats/min, the patient can be no obvious discomfort, but the effect of drugs or electrical diversion atrial fibrillation is poor, if not heart valve replacement, can not maintain sinus rhythm for a long time.
8.What are the symptoms of arterial embolism complicated by wind heart disease?
The left atrium of patients with wind heart disease is large, especially after the occurrence of atrial fibrillation, the left atrium is prone to thrombosis. In some patients, the thrombus is easily dislodged into the left ventricle, ascending aorta and body circulation, which can cause embolism in brain, liver, kidney and limbs, causing a series of complications, including cerebral embolism, acute myocardial infarction and even sudden death. In the late stage of wind heart disease, patients who are bedridden for a long time may suffer from acute pulmonary embolism, manifested as sudden onset of severe chest pain, dyspnea, sweating, increased blood pressure, followed by a drop, and in severe cases, sudden death.
9.What are the symptoms of endocarditis complicated by wind heart disease?
It is less common. Endocardial damage in patients with wind heart disease can easily cause bacterial and mycobacterial infections, which manifest as fever of different degrees, muscle and joint pain, weakness, splenomegaly, skin and mucous membrane bleeding, embolism of brain, spleen, kidney and other organs, congestive heart failure, and high mortality.
10.What are the symptoms of combined pulmonary infection?
Patients with stenosis of the mitral valve, aortic valve or incomplete closure of the left atrium caused by stasis of blood, pulmonary stasis of blood, local resistance to decline, prone to lung infection. Pulmonary infection can induce congestive heart failure and subacute infective endocarditis.
11.What are the treatment methods of rheumatic heart disease?
There are three surgical methods: balloon dilatation, valvuloplasty, and valve replacement. Mitral valve balloon dilation is indicated for mild to moderate valve lesions, good valve elasticity, and valve junction adhesions, and is a less invasive intervention; valvuloplasty is the repair of diseased valves under direct vision in extracorporeal circulation to achieve a normal working state, preserving the valve itself without anticoagulation, but rheumatic fever cannot be eliminated, and some patients need to undergo valve replacement again if the valve lesions are aggravated and the disease deteriorates again after surgery. valve replacement surgery; valve replacement surgery to remove the diseased valve, replaced with artificial valves, most of the postoperative cardiac function to recover well, but need lifelong anticoagulation therapy.
12.Can wind heart disease be treated with medication?
It is true that patients with wind heart disease can take drugs to reduce symptoms, but once wind heart disease occurs, its valve lesions cause changes in blood flow, and the abnormal blood flow in turn continues to aggravate the valve lesions. Therefore, taking medication alone cannot cure wind heart disease. Moreover, the longer the duration of the disease, the worse the patient’s heart function, and the risk of surgery and the difficulty of postoperative rehabilitation are greatly increased, so patients with wind heart disease should undergo regular treatment as early as possible.
13.What kind of patients need valve replacement surgery?
Patients with moderate or above degree valve lesions; patients with severe valve lesions, such as leaflet coiling, calcification, tendon contracture, fusion, shortening resulting in moderate to severe valve stenosis or incomplete closure; patients with combined atrial fibrillation, i.e. heartbeat disorder; patients with left atrial thrombosis or combined brain or limb embolism 1-3 months after healing; patients with prosthetic valves causing thrombosis, or endocarditis, or patients with damaged biological valves.
14.What is the effect of valve replacement?
Most patients recover well after valve replacement and can participate in normal work and study; a few patients do not recover well and still need medication to improve their heart function. There is a possibility of secondary valve replacement for those with biological valves and a chance of valve failure and valve seizure for those with mechanical valves, about 1%. Lifelong anticoagulation therapy is also required to prevent prosthetic valve-induced thrombosis. Anticoagulation accidents occur in about 1% of patients each year, resulting in embolism or bleeding, which can lead to serious complications or death.
15.What are the types of prosthetic heart valves?
There are three types of prosthetic heart valves.
Mechanical valve: the advantage is durable, life expectancy of up to 40-50 years, the disadvantage is the possibility of valve failure, stuck valve, the chance of about 1%; need lifelong anticoagulation, about 1% of patients each year, anticoagulation accidents, body embolism or bleeding, can cause serious complications or death.
Biological flap: made from processed materials such as pericardium of pigs and cattle. The advantage is that it is not easy to induce thrombosis, and three months of postoperative anticoagulation is sufficient, suitable for the elderly, and the disadvantage is that the life span is short, about 15 years. However, the quality of patient survival is good, and the clinical use is now significantly increasing.
Homogeneous valve: less source, less clinical application.
16.How to choose a prosthetic heart valve?
Biologic valves do not require long-term anticoagulation and have a life expectancy of only 15 years. Women who have not had children and elderly people with a life expectancy of about 20 years can have their biologic valves replaced. Mechanical valves have a long life span, but require lifelong anticoagulation and regular review and monitoring. Generally, young and middle-aged patients who do not want to replace their valves again in the future due to damage to the biologic valve can choose mechanical valves.
17.Can female patients get pregnant and have children after flap replacement?
If the valve is a biologic valve, you only need to take anticoagulants for three months to six months, and you can have a baby as long as your heart function allows. In order to avoid bleeding or teratogenic problems caused by taking warfarin, subcutaneous injection of low molecular heparin can be used instead.
18.Why should I take warfarin? How to take the medication to be scientific?
Warfarin is an anticoagulant to prevent thrombosis on the valve, which can lead to embolic complications. Patients who have a biological valve replacement take three months of warfarin, and patients who have a mechanical valve replacement need to take the drug for life. It is important to take the medication in the dose prescribed by the doctor and to monitor PT and INR with regular blood tests to keep the anticoagulant strength within a certain range to avoid thrombosis with too little medication and bleeding with too much medication. Patients should pay close attention to this point, as there are many lessons learned from serious complications and even death without taking medication or regular monitoring.
19.How to deal with heart valve replacement after surgery?
In general, patients can be discharged from the hospital in 1-2 weeks after surgery with a few days of antibiotics, cardiotonic and diuretic drugs, and anticoagulants. Severe patients may need intensive treatment to control heart failure, arrhythmia and stabilize water-electrolyte balance.
20.What are the precautions for daily life in wind heart disease?
Patients with wind heart disease can generally have symptoms of panic, chest tightness and shortness of breath, and some patients are accompanied by systemic symptoms, such as enlarged heart, swollen lower limbs, weakness and loss of appetite, etc. Therefore, in addition to active treatment, the following points should be noted in daily life care
( 1 ) Hot and cold appropriate, prevent cold and flu.
( 2 ) moderate exercise, optimism, wind heart disease patients in a stable period can be moderate exercise, in order to patients can easily bear the principle.
( 3 ) varied diet, pay attention to nutrition, to ensure rich protein and microbiotics, eat less and more meals, pay attention to keep the bowel movement smooth.