Internal illnesses. Aortic stenosis (lecture notes)

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Internal illnesses. Aortic stenosis (lecture notes)

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LECTURE No. 12. Aortic stenosis

Aortic stenosis is a heart defect caused by narrowing of the aortic orifice, in which blood flows with difficulty from the left ventricle to the aorta. It is rare in isolated form, more often in combination with aortic valve insufficiency. Most often men are ill.

Etiology. In the development of the disease, valvular narrowing of the aorta is important in rheumatism, atherosclerosis, infective endocarditis, gummous syphilis, congenital narrowing of the aortic orifice, or subvalvular (subaortic) narrowing in hypertrophy of the interventricular septum.

Pathogenesis. As a result of the narrowing of the aortic orifice, the systole time of the left ventricle is prolonged. There is an increase in the pressure gradient between the left ventricle and the aorta (more than 40 mm Hg) and left ventricular hypertrophy.

Compensation is long due to the flow of blood into the aorta.

Clinic. There are no clinical manifestations in the compensation stage. With physical exertion, emotional stress, pain in the region of the heart (like angina pectoris), shortness of breath, dizziness, a tendency to faint, headache may appear, which refers to manifestations of the ischemic type.

The skin is pale, the apical impulse is reinforced diffuse, shifted to the left and down, on the handle of the sternum on the right in the II intercostal space and in the jugular fossa, systolic trembling ("cat's purr") is noted.

With a decrease in the contractile function of the left ventricle, attacks of cardiac asthma may occur, which is characteristic of the congestive type.

Additional diagnostic study. An ECG study shows a levogram, signs of overstrain of the left ventricle, there may be a negative T wave, blockade of the left branches of the His bundle.

An x-ray examination determines the aortic configuration of the heart, a rounded apex, narrowing of the retrocardial space due to a hypertrophied and moderately dilated left ventricle.

Echocardiography revealed fibrosis of the valvular leaflets, a decrease in their amplitude of systolic origin.

FCG-study over the aorta is determined diamond-shaped systolic murmur, which is not adjacent to the I tone.

Doppler echocardiography reveals changes in blood flow velocity.

Complications. It is possible to develop left ventricular heart failure, pulmonary edema, as well as conduction disorders (blockade of the left leg of the His bundle, complete AV blockade), coronary insufficiency with angina attacks, myocardial infarction, total heart failure is possible.

Treatment. Conservative treatment consists in the treatment of the underlying disease, angina pectoris (nitrates, calcium channel blockers), heart failure. Surgical treatment consists of aortic commissurotomy, aortic valve replacement.

Forecast. With compensated conditions, the prognosis is favorable, the average life expectancy is 40 years. In decompensated states, the prognosis is serious.

Author: Myshkina A.A.

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