Rheumatic heart disease (“rheumatic heart disease”), we may have heard of it, and for some rheumatic heart disease patients, they are concerned about the question: How did I get rheumatic heart disease? Do I really need surgery? What happens after surgery? What kind of valve should I choose? How should I take warfarin? …… and so on. These questions once troubled them, both before and after surgery, making them very hesitant and worried.
After years of clinical follow-up, we have collected many such questions from patients with wind heart disease, and have summarized and summarized them, and made appropriate explanations based on our clinical experience. In order to facilitate the understanding of the majority of patients and families, we use as much language as possible to introduce to you, hope that the majority of patients and families will help.
1.What is rheumatic heart disease?
To know what “rheumatic heart disease” is all about, we have to start with “rheumatic fever”. What is rheumatic fever? It is an inflammatory disease caused by repeated infections with bacteria, which causes the body’s immune system to attack its own tissues and organs, damaging the function of organs, most commonly “rheumatoid arthritis”.
The reaction in the heart is known as rheumatic heart disease. This inflammatory reaction causes the heart valves to thicken, adhere, calcify, thicken and fuse the tendons, which restricts the opening and closing of the valve leaflets, thus affecting the pumping function of the heart and causing the patient to have symptoms such as chest tightness and breathlessness. This is rheumatic heart disease, referred to as “rheumatic heart disease”.
2.Why do you get rheumatic fever?
Rheumatic fever often occurs in adolescence, mostly in the season of cold and changeable climate. Rheumatic fever mostly occurs in poor accommodation, living in a dark and humid environment for a long time, and people with poor nutrition. Patients mostly have a history of tonsillitis, pharyngitis, sore throat, and joint pain. In other words, people with poor environment, weak resistance, and susceptible parts of the body are prone to rheumatic fever.
Therefore, we commonly see patients with rheumatic heart disease who usually became ill at a young age and just never developed the disease (symptoms are not obvious). So, as people’s living and housing conditions improve, does rheumatic fever cease to exist? The answer is: no! Many data show that the onset of some mild and atypical manifestations of rheumatic fever has not decreased.
3.What are the changes in heart valves caused by rheumatic heart disease?
Recurrent attacks of rheumatic fever lead to chronic inflammation of the heart, causing heart valve congestion, swelling, scar formation, calcification, contracture of papillary muscles and tendons, adhesions, and fusion, resulting in valve stenosis and/or incomplete closure. The lesions mainly involve the mitral and aortic valves and, rarely, the tricuspid valve. In the figure below, we can see a normal mitral valve and a stenotic mitral valve with lesions.
Normal mitral valve (above)
A diseased stenotic mitral valve (calcified ulcer)
Let’s talk about the role of heart valves: There are four valves in the human heart, namely the mitral valve, tricuspid valve, aortic valve and pulmonary valve. The role of the heart valves is to ensure that the blood in the flow of the process can flow smoothly in one direction, playing a “one-way valve” role, just like the bellows of the “dampers”, pull the bellows lever, in the “dampers “the one-way valve, the airbox can be a constant source of wind to the furnace, and will not suck the wind back.
Under normal circumstances, the human valve thin and flexible, with the contraction and diastole of the heart, constantly doing the closing and opening action, thus ensuring the smooth one-way flow of blood. If the valve is thickened or even calcified, then the valve cannot be opened and closed easily and freely, which is like a broken “damper” of the bellows, how hard to pull the bellows lever, the wind will be very little.
Rheumatic valve disease makes the heart valve narrow or
4.What are the effects of rheumatic valve disease on the human body?
Incomplete closure, commonly known as the heart “door” can not be opened or closed, then naturally will affect the normal flow of blood. For example, if the valve is narrowed, blood flow through the valve will be very difficult, making the upstream blood stagnation; on the contrary, if the valve is not closed tightly, it will lead to the original flow of the past blood and a part of the backward flow, can not completely one-way flow, these lesions will increase the burden on the heart.
It is like a broken bellows, a lot of effort, the result of sending out the wind only a little, then to burn the fire, you have to spend more effort than others, over time will be tired of pulling the bellows of people. The heart is also the same, because of the valve lesions, the heart has to spend more effort than other hearts to work, over time the heart will be exhausted, causing heart enlargement, cardiac insufficiency, arrhythmia and other functional abnormalities, and then show leg swelling, abdominal distension, chest tightness and breathlessness and other symptoms of cardiac insufficiency.
5.What are the symptoms of rheumatic heart disease?
Generally speaking, in the early stage of the disease, the degree of valve lesion is mild, and most patients have no discomfort. As the lesion progresses, patients may experience chest tightness, shortness of breath and panic during activities or physical labor, and some patients may experience dizziness and even chest pain. Some patients usually have no symptoms, but only after they catch a cold do they develop symptoms of cardiac insufficiency such as breath-holding, and the cold symptoms are severe and not easily treated, often developing into pneumonia.
Therefore, many patients mistakenly believe that they have pneumonia or coronary artery disease or angina pectoris. When the lesion continues to progress, the patient’s mobility begins to decline significantly, and the above-mentioned symptoms may occur at rest, and even at night when sleeping, they cannot lie down, and when they lie down, they hold their breath and can only sleep sitting up, which we call “heart failure”. Of course, there are exceptions, some patients have very heavy valve lesions but no symptoms, the amount of activity is also close to normal, only during the examination of the doctor’s auscultation found a heart murmur, echocardiography diagnosed as valve disease, whether such patients need treatment, to consult a professional doctor comprehensive judgment.
6.What are the treatment methods for wind heart disease?
The treatment of wind heart disease mainly includes medication, interventional treatment and surgical treatment. Drug treatment is the basic treatment, can relieve the patient’s symptoms to a certain extent, but can not get rid of the “root of the disease”. Interventional treatment is for certain patients with early rheumatic heart disease who are eligible for certain surgery. Surgical treatment is the most direct and effective means for rheumatic heart disease.
The two main types of treatment are valve replacement (surgical removal of a broken valve and installation of a new artificial valve) and valvuloplasty (surgical repair of a broken valve). The need for surgical treatment is based on the patient’s degree of valve disease, the functional status of the heart and the patient’s actual situation.
7.What is valve surgery?
Valve replacement surgery, commonly known as “valve replacement”, is an operation that removes the original diseased valve and implants an artificial valve to replace the function of the valve with an artificial valve, thus avoiding further damage to the heart function. If the heart is compared to a house, the valve is compared to the door, then the valve replacement surgery is like a house door is broken, can not close or open, we will remove the hinges on the door, so the old door is removed, the artificial valve is like a new door, the door is with the door frame as one, the old door frame and the new door frame fixed together the new door is installed, that is, the valve replacement surgery is completed. Valve replacement surgery is currently the most important surgical procedure for the treatment of rheumatic heart disease.
Valve plication surgery is a procedure that preserves your own valves and repairs the bad ones to restore their original function. It is like a room with a broken door that does not close tightly, so we fix the old door so that it can close tightly. Since the damage of rheumatic heart disease is generally more serious, fewer valves are in a position to be repaired.