Rheumatic heart disease is part of the manifestations of pathological reactions caused by group A beta hemolytic streptococcal infections and is an autoimmune disease. Its pathological changes in the heart area occur mainly in the heart valve area. Common clinical heart valve lesions are.
1, mitral stenosis or incomplete closure.
2, Aortic stenosis or insufficiency.
3, tricuspid stenosis or insufficiency.
4, joint valve lesions (multiple valve damage), etc.
Mitral valve insufficiency symptoms
Mainly from pulmonary hypertension and low cardiac output. Patients with mild mitral valve insufficiency are often asymptomatic; more severe cases often feel fatigue and weakness (due to reduced cardiac output) or palpitations during physical activity and dyspnea (pulmonary stasis). Patients with rheumatic mitral valve insufficiency often have only mild symptoms, which worsen when there is rheumatic activity, infective endocarditis, or tendon rupture. 75% of patients with mitral valve insufficiency develop atrial fibrillation, which can increase the pressure in the left atrium. Left ventricular volume overload is another important cause of mitral valve insufficiency and palpitations and shortness of breath in patients with mitral valve insufficiency. Later in the course of the disease, pulmonary edema, hemoptysis, and right heart failure may be present. Mitral valve insufficiency often presents later and less severely than mitral stenosis; however, in the presence of mitral stenosis, symptoms often appear earlier and more severely.
Symptoms of Aortic Stenosis
Patients with compensated aortic stenosis may be asymptomatic, while most patients with severe stenosis have fatigue, dyspnea (exertional or paroxysmal), angina, vertigo, or syncope. Even sudden death.
Angina: Angina can occur in 20% to 60% of patients, and the pain increases with age and severity of the stenosis. The presence of angina indicates significant aortic stenosis, with an orifice area often less than 0.8 cm2. Angina can occur after exertion or at rest, suggesting that it is not necessarily related to exertion or physical activity. The mechanism may be related to myocardial hypoxia, increased oxygen consumption, and high ventricular wall tension during left ventricular systole.
② Vertigo or syncope: About 30% of patients have vertigo or syncope, which can last as short as 1 minute and as long as half an hour or more. Some patients have As syndrome or cardiac arrhythmia. Vertigo or syncope often occurs after labor or when the body is bent forward, and is sometimes induced at rest, during a sudden change in position or when sublingual nitroglycerin is administered for angina pectoris.
(iii) Dyspnea: Exertional dyspnea is often a sign of cardiac insufficiency, often accompanied by fatigue and weakness. with paroxysmal increases in venous pressure. As heart failure worsens, paroxysmal nocturnal dyspnea may occur. End-stage breathing. Coughing of pink foamy sputum.
Sudden death: Sudden death may occur in about 20% to 50% of cases. Most cases may be preceded by recurrent angina or syncope episodes, but it may also be the first symptom. The cause may be related to a serious, fatal arrhythmia. For example, ventricular fibrillation (ventricular fibrillation) is related.
⑤ Excessive sweating and palpitations: Patients in this category sweat particularly profusely due to increased myocardial contraction and arrhythmias. Patients often feel palpitations, and excessive sweating often follows palpitations and may be associated with autonomic dysfunction and increased sympathetic tone.
Tricuspid stenosis symptoms
The clinical manifestations of tricuspid stenosis may be less pronounced or confused with symptoms of mitral stenosis due to the presence of coexisting mitral stenosis. Patients are more likely to be fatigued (low cardiac output). There are frequent complaints of right upper abdominal discomfort or distension (hepatic stasis) and peripheral edema. The marked pulsation of the carotid pulse often gives the patient a fluttering discomfort in the neck.
In addition, due to the stasis of blood in the gastrointestinal tract. Patients often complain of loss of appetite. Nausea, vomiting, or belching. A small number of patients with tricuspid stenosis may also experience syncope, periodic cyanosis (right-to-left shunts also occur via unclosed hatching circles) or retrosternal discomfort. Patients may have dyspnea. This may be due to respiratory muscle fatigue. However, paroxysmal dyspnea never occurs. Acute pulmonary edema or hemoptysis (with the exception of those complicated by pulmonary infection or pulmonary infarction), as in patients with significant mitral stenosis without signs of pulmonary stasis, suggests the possibility of tricuspid stenosis.
Symptoms of tricuspid valve insufficiency
The symptoms of tricuspid insufficiency in the absence of pulmonary hypertension are relatively mild. In the coexistence of pulmonary hypertension and tricuspid valve incompetence and insufficiency, cardiac output is reduced and symptoms of right heart failure are evident. It may manifest as weakness, generalized edema, ascites, and distension and pain in the right quarter rib area and right upper abdomen caused by hepatic stasis. Loss of appetite due to stasis of blood in the gastrointestinal tract. Indigestion, and jugular vein anger due to jugular vein stasis. A sensation of pulsating neck or abdominal veins because the pulsating blood returning to the right atrium during systole can be transmitted to the head and neck veins. This is especially noticeable during physical work or emotional stress. Sometimes there may be eye fluttering, and some patients may have mild jaundice. In many patients with tricuspid insufficiency, the pulmonary stasis caused by the coexisting mitral valve lesion may decrease as the disease progresses, but weakness, malaise, and other symptoms of decreased cardiac output become apparent.
Treatment Principles
Valve lesions, whether stenosis, insufficiency, or both, require surgical treatment at the onset of significant clinical symptoms. Repair or replacement of the diseased valve is performed. This type of surgery began in the 1950s and 1960s and is technically very mature and effective.
Surgical treatment of rheumatic heart disease
For chronic rheumatic heart valve disease without symptoms, surgery is generally not required; for those with symptoms and indications for surgery, prosthetic valve replacement can be performed, and prosthetic valve replacement is the main treatment for aortic stenosis in adults.