Internal illnesses. Aortic valve insufficiency (lecture notes)

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Internal illnesses. Aortic valve insufficiency (lecture notes)

Lecture notes, cheat sheets

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LECTURE No. 11. Aortic valve insufficiency

Aortic valve insufficiency is the incomplete closure of the semilunar cusps of the aortic valve, which leads to a backflow of blood from the aorta into the left ventricle during its diastole (aortic regurgitation). Men are more often ill.

Etiology. In the development of the disease, rheumatism, atherosclerosis, infective endocarditis, syphilitic mesaortitis, congenital anomalies, diffuse connective tissue diseases, and injuries are important.

Pathogenesis. As a result of incomplete closure of the aortic valve cusps in diastole, blood flows back from the aorta into the cavity of the left ventricle. There comes a volumetric diastolic overload of the left ventricle, its hypertrophy.

The ejection of blood into the aorta increases. An increase in systolic blood pressure leads to a decrease in diastolic blood pressure. The contractility of the myocardium gradually weakens, myogenic dilatation, decompensation of the left ventricular type occurs.

Valvular (due to the destruction or wrinkling of the valves) and relative (with significant dilatation of the left ventricle with the expansion of the aortic opening) insufficiency of the aortic valve are formed.

Long-term compensation due to the left ventricle.

Clinic. There are no clinical manifestations in the compensation stage. In the stage of circulatory insufficiency, pulsation of large arteries, "carotid dance", Musset's symptom, positive capillary pulse, pulsation of pupils, dizziness, fainting, pain in the heart area are noted.

There is a pronounced cyanosis, an increase in the boundaries of the heart to the left. In the II intercostal space on the left, a diastolic murmur is heard, an enlarged, painful liver is palpated.

Shortness of breath and suffocation occur in the stage of decompensation.

Additional diagnostic study. An ECG examination reveals a shift in the ST interval, the appearance of biphasic or negative T waves (dystrophic changes in the myocardium).

X-ray examination establishes the aortic configuration of the heart, bulging of the IV arch, aortic expansion throughout, its pulsation, "dancing heart", with a free retrocardial space in the I oblique projection, the contrasted esophagus does not deviate.

FCG study at the Botkin point and in the II intercostal space on the right reveals a high-frequency, low-amplitude decreasing noise immediately after the II tone, a decrease in the amplitude of the I tone above the apex and the II tone above the aorta.

Doppler echocardiography determines the change in blood flow velocity.

An echocardiographic study establishes the presence of dilatation, increased mobility of the walls of the left ventricle (volume load), premature closure of the mitral leaflets, diastolic flutter of the mitral leaflets, flutter of the aortic valves, and the absence of their closure in diastole.

Complications. Possible development of heart failure.

Treatment. Conservative treatment involves the treatment of the underlying disease. Cardiac glycosides are used, which are prescribed with caution due to a slowing of the heart rate and an increase in cardiac output (may increase regurgitation), vasodilators for depositing blood in the vascular system and reducing regurgitation (apressin in combination with nitrosorbide).

During surgical treatment, aortic valve replacement is performed.

Flow. In the stage of compensation, the course is long, in the stage of decompensation it is rapidly progressing.

Forecast. The average life expectancy is 20-30 years. With timely treatment, the prognosis is relatively favorable.

Author: Myshkina A.A.

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