Internal illnesses. Tricuspid valve insufficiency (most important)

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Internal illnesses. Tricuspid valve insufficiency (most important)

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14. INSUFFICIENCY OF THE THREE-LEAVEL VALVE

Leaflet valve insufficiency is incomplete closure of the valve leaflets, as a result of which part of the blood flows from the right ventricle into the right atrium during systole. Valve insufficiency can be absolute or relative. In the first case, the cause of the disorder is damage to the tricuspid valve and its leaflets. The cause of relative insufficiency is damage to the muscle of the right ventricle, as a result of which the valve ring is stretched. Relative tricuspid valve insufficiency occurs 3 times more often than organic insufficiency.

Etiology. In the development of the disease, the following are important: organic failure (rheumatism, infective endocarditis) and relative failure with severe dilatation of the right ventricle (mitral stenosis, pulmonary hypertension, cardiosclerosis, pneumosclerosis).

Pathogenesis. During contraction of the right ventricle, part of the blood returns to the right atrium, which simultaneously receives the usual amount of blood from the vena cava. Dilatation of the right atrium occurs with excess blood flow in diastole into the right ventricle, dilatation and hypertrophy of the right ventricle).

Decompensation of venous congestion in the systemic circulation develops early.

Clinic. Clinical manifestations of signs of insufficiency of the right side of the heart are characterized by moderate shortness of breath during physical exertion, which does not sharply limit activity (as with mitral stenosis), there is no difficulty in breathing in the supine position. There are: weakness, palpitations, vague pain in the heart, heaviness in the right hypochondrium, dyspeptic disorders, drowsiness, edema.

Expressed cyanosis of the skin and visible mucous membranes (sometimes with an icteric tinge), swelling and pulsation of the jugular veins (positive venous pulse), right ventricular heart beat, epigastric pulsation, pulsation of the liver, anasarca, ascites.

The borders of the heart are enlarged only to the right. Systolic murmur, better auscultated by the right border of the heart, increases with inspiration, there is no emphasis on the pulmonary artery, arterial pressure is reduced, venous pressure is increased.

Additional diagnostic study. An ECG study shows a rightogram, a negative T wave in II, III standard leads, right chest leads, signs of right atrial hypertrophy, atrial fibrillation, incomplete blockade of the right bundle branch block.

X-ray examination establishes a significant increase in the right ventricle and right atrium, there are no changes in the pulmonary pattern.

In the FCG study in the 5th intercostal space on the right and left of the sternum, immediately after the first tone, a systolic murmur is determined, occupying the entire systole; at the height of forced inspiration with breath holding, its severity increases.

EchoCG study reveals an increase in the amplitude of the opening of the anterior leaflet, dilatation of the cavity of the right ventricle, hyperkinesia of its walls.

Treatment. Used conservative treatment and preventive treatment of congestive circulatory failure.

Forecast. With congestive circulatory failure, the prognosis is poor.

Author: Myshkina A.K.

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