Aortic stenosis symptoms. Aortic stenosis

Pathology of the cardiac system, expressed in a significant narrowing of the aorta passing in the valve area, requires rapid diagnosis and initiation of appropriate treatment, which applies equally to both the aortic and aortic.

Aortic stenosis manifests itself in deterioration of breathing even with small physical activity, emotional stress, as well as in the form of shortness of breath, dizziness and nausea.

Features of the disease

Impaired blood flow, manifested in the left ventricle, increases the load on it and manifests itself as difficulty in systolic emptying of the left half of the heart. This disease accounts for 25% of the total number of cases of heart defects. In men, this pathology is more common.

Aortic valve stenosis can be diagnosed in adults, as well as in children, as well as in newborns. However, the manifestations for all age categories are largely similar, which makes it possible, even by subjective manifestations, to pre-diagnose disturbances in the functioning of the cardiac system. But since aortic stenosis requires a different treatment method compared to other pathologies of the cardiac system, it is necessary to conduct a more detailed study after preliminary diagnosis.

In the following video, a famous doctor will talk about the features of aortic stenosis in children and adults:

In adults

The appearance of shortness of breath and rapid fatigue during physical exertion, dizziness, which can occur even to the point of fainting, are all manifestations of the condition in question. Even a short-term loss of consciousness against the background of decreased activity and a high degree of physical fatigue should be considered a sufficient reason to consult a doctor for an examination for abnormalities in the functioning of the cardiac system.

Critical aortic stenosis

In children

Children with cardiac dysfunction may also feel short of breath, have pale skin, avoid physical activity, and exhibit a high degree of fatigue. Their lethargy is explained by excessive stress on the heart, which leads to the inability to accept overwork.

This pathology tends to occur in childhood with a hereditary predisposition, since this is the cause that is most often the key to aortic stenosis. Also, this pathology can manifest itself in increased heartbeat and chest pain.

Shortness of breath is possible even in childhood, and this should be considered a serious manifestation of this type of heart failure - aortic valve stenosis.

In newborns

The pathology in question is rarely diagnosed in newborns, since its manifestations at this age are practically invisible. These include the following:

• pale or blue discoloration skin;
• arrhythmia;
• loss of consciousness;
• Irregular heartbeat.

In newborns, due to this heart defect Sudden asymptomatic death most often occurs.

The hereditary factor also plays a key role here, therefore, if there is a family with this disease, you should be especially careful and conduct the earliest possible examination of the newborn child to identify cardiac pathologies.

Degrees of aortic valve stenosis

The classification of aortic stenosis is based on the type of pathology: congenital stenosis is more common than acquired stenosis - about 85% and 15%, respectively. According to the type of localization of the narrowing of the aorta, the disease can also be classified as follows:

• subvalvular form, accounting for about 30% of cases of this condition;
• supravalvular type - about 6-11% of cases;
• valve - 60%.

There is also a division of the pathological condition under consideration into five degrees, which are divided in accordance with the hemodynamics of the process.

Diagram of aortic valve stenosis

First stage

It is also called full compensation. At the first stage, the disease is not very pronounced, the narrowing of the aortic mouth is insignificant.

This degree of pathology affects the condition to a small extent. A cardiologist may recommend regular monitoring and appropriate examinations; surgery is not prescribed.

Second stage

The second stage is also called hidden heart failure. At this stage of development, the pathology already has some external manifestations in the form of slight shortness of breath and rapid fatigue and with little physical activity. Rare fainting and dizziness are possible.

The examination is carried out to identify defects in the functioning of the cardiac system. Using ECG and x-ray examination it becomes possible to identify developing pathologies. Treatment is in the form of surgical correction.

Third stage

With relative coronary insufficiency, external manifestations are already more pronounced: shortness of breath, fatigue, heart rate appear often, dizziness and loss of consciousness are also possible.

Fourth stage

With severe heart failure, shortness of breath occurs even at rest, physical activity is no longer possible. Arrhythmia and angina pectoris are almost constant, loss of consciousness is frequent.

Treatment with surgery is no longer recommended; therapeutic treatment of this defect of the cardiac system does not bring significant results.

Fifth stage

On terminal stage shortness of breath, interruptions in heart function and dizziness are almost constant. Surgical treatment in the form of intervention and correction is no longer possible.

What are the objective reasons for the development of aortic stenosis?

Causes

Congenital aortic stenosis is inherited, and genetic predisposition should be considered the main reason for the development of this heart defect. The disease is usually diagnosed before the age of 30.

Acquired aortic stenosis can occur for the following reasons:

• rheumatic damage to the heart valve and its leaflets;
• aorta;
• systemic lupus;
• end-stage renal failure.

Factors that stimulate the appearance of this pathology are excess cholesterol in the blood.

Read on to learn more about the symptoms of aortic valve stenosis.

Symptoms

Since the disease can progress, and therefore is classified according to stages of development, its manifestations can vary significantly in intensity. However, they are approximately similar in physical manifestations, and can occur in children, newborns, and adults.

The symptoms that characterize this pathological condition of the cardiac aorta include the following:

• shortness of breath, which manifests itself depending on the stage of the disease: at the initial stage it manifests itself exclusively with significant physical or moral overload, and at the final stage even with calmness;
• angina pectoris and heart rhythm disturbances;
• dizziness;
• loss of consciousness and fainting;
• rapid physical fatigue;
• muscle weakness even at rest;
• feeling of an excessively loud heartbeat;
• pulmonary edema.

A gradual increase in the listed manifestations indicates the development of pathology and requires immediate medical attention.

Diagnostics

Thanks to timely diagnostic measures, it becomes possible to identify the pathological process of narrowing of the aorta of the heart and carry out the necessary treatment.

To the most effective and frequently used diagnostic measures the following should be included:

• palpation - this is the measure that allows you to diagnose preliminary diagnosis when detecting cardiac tremors;
• measurement of pulse and blood pressure;
• auscultation - with its help it becomes possible to identify systolic murmurs in the heart;
• ECG provides detection of changes in the size of the left ventricle;
• X-rays provide diagnosis of changes in the size of the heart and disturbances in the size of the lumen of the cardiac aorta;
• Using echocardiography, it is possible to see compaction and thickening of the walls of the valves of the left and right ventricles.

Thanks to early diagnosis, effective treatment and a positive diagnosis on the patient’s survival become possible. Now let's learn about the basics of treatment for aortic valve stenosis and the possibility of treating it without surgery.

Treatment

This pathology of the cardiac system is treated mainly by surgical intervention; therapeutic treatment is prescribed by a doctor only at the first stage of the pathological process. Regular visits A visit to a cardiologist will allow you to see the dynamics of the development of the disease.

Therapeutic

Conservative treatment of aortic stenosis consists of the following therapeutic measures:

• stabilization of blood pressure;
• slowing down the pathological process;
• elimination of heart rhythm disturbances and arrhythmias.

With this type of therapeutic effect Special attention is focused on restoring normal blood flow in the heart area and neutralizing negative consequences arrhythmias.

Medication

If aortic stenosis is detected, the doctor prescribes medications such as diuretics, which accelerate the removal of fluid from the body and thereby lower blood pressure, and if cardiac arrhythmia develops, cardiac glycosides (for example, the drug Digoxin) are prescribed.

Potassium supplements are also aimed at removing excess fluid from the body.

Carrying out the operation

Surgical intervention eliminates this pathology by widening the narrowing of the cardiac aorta. However this method Treatment of pathology is acceptable only in the early stages of the disease.

The operation may involve two options for making adjustments to the cardiac sections:

1. Balloon plastic.
2. Valve replacement.

The operation is prescribed in cases where the patient has no contraindications to its implementation and there are no strong negative manifestations of the pathology.

Indications for carrying out surgical intervention in the presence of aortic stenosis the following conditions are present:

• myocardial function at a satisfactory level;
• increase in the size of the left ventricle;
• slight excess of normal systolic pressure.

Correction of the heart valve leaflet causes minor damage: artificial separation of the fused valve leaflets is performed.

The video below will tell you about the features of treating aortic stenosis using the endovascular method:

Disease prevention

Since in congenital lesions of the cardiac aorta preventive measures does not exist, to eliminate this heart defect only surgery. However, the acquired disease can be avoided, and for this it is necessary to prevent the development the following diseases, leading to the occurrence of this cardiac pathology:

• atherosclerosis;
• infectious endocarditis;
• rheumatism.

The correct advice would be to thoroughly treat a sore throat, and proper nutrition, not allowing education cholesterol plaques on the walls of blood vessels.

Complications

If aortic stenosis is not detected in a timely manner, further progression occurs. terrible disease, and in the absence of treatment is likely death.

Increasing shortness of breath and complete inability to even perform minor physical exertion, as well as gradual narrowing of the passage of the cardiac aorta, is possible consequences insufficient treatment of pathology.

Forecast

Timely detection of pathology in the early stages has a very high 5-year survival rate - about 85%, and the prognosis for the next 10 years in this case is 70%.

With frequent fainting, severe angina and increased fatigue, the prognosis can be only 5-8 years.

Even more useful information on the issue of aortic stenosis contains the following video with a well-known presenter:

Moderate aortic stenosis is a condition in which the opening in the aortic valve narrows, causing an obstruction of blood flow from the left ventricle. This pathology is considered a heart defect and occurs in both adults and children. According to statistics, it most often develops in older people, predominantly males. Aortic stenosis has an extensive classification: according to the nature of its occurrence, according to the severity of the course, according to the degree and location of the narrowing.

Types of disease and symptoms

Depending on where the narrowing occurs, there are 3 forms of the disease: subvalvular, supravalvular and valvular.

Subvalvular aortic stenosis, like valvular stenosis, can be congenital or acquired. The supravalvular type of narrowing is only of congenital origin.

Based on how narrowed the opening in the valve is, 3 degrees of pathology are distinguished: minor, moderate and severe. Stenosis is considered minor if the orifice area reaches sizes from 1.2 to 1.6 cm. With a moderate degree - 0.75 -1.2 cm. Severe (severe) aortic stenosis is characterized by narrowing of the valve to such a state that the orifice area does not exceed 0.7 cm.

Normal condition and 3 degrees of aortic stenosis: minor, moderate and severe

How separate forms There are two more types of this disease: aortic stenosis and subaortic stenosis.

The characteristics of the latter are as follows:

1. It is of hereditary origin. It is detected exclusively in newborns.
2. Symptoms appear as the child grows.
3. The valve replacement operation is performed in adolescence.
4. It is possible to maintain health in a satisfactory condition with medication before surgical treatment.

Aortic stenosis is characterized by a more difficult diagnosis, since it is detected when the hole in the valve is narrowed by 30%. This defect develops against the background of other heart diseases and is observed more often in men.

Course of the disease and its symptoms

Aortic stenosis is one of those diseases that long time may proceed without appearing in any way. The disease progresses through 5 stages:

With timely initiation of treatment after the onset initial signs pathology, the prognosis will be relatively good. The following can aggravate the course of the disease: concomitant diseases, such as severe hypotension or, as well as endocarditis.

In people suffering from aortic stenosis, the symptoms of the disease are as follows:

• chest pain and tightness;
• impaired hemodynamics;
• fast fatiguability;
• fainting;
• headaches and shortness of breath;
• arterial hypertension;
• heart rhythm disturbance.

With aortic stenosis, the properties of the pulse also change.

Reasons for the development of pathology

Before finding out the reasons for the development of aortic stenosis, it should be noted that the pathology can be congenital or acquired.

The congenital form accounts for about 10% of all cases of the disease and is the result of an abnormal development of the aortic valve and its various defects. It is considered normal when the valve has 3 leaflets. They regulate the flow of blood from the left ventricle to the aorta. In case of congenital pathology, this element will consist of two or one valve.

A bicuspid or single-leaf valve differs from a normal valve in having a narrower lumen, which prevents the optimal outflow of blood. This causes overload of the left ventricle.

Normal tricuspid and abnormal bicuspid aortic valves

In the vast majority of cases, aortic stenosis is an acquired heart defect. This pathology begins to occur in adults after they reach 60 years of age. Experts identify a number of factors that increase the risk of developing aortic stenosis. These include smoking, high blood cholesterol, and hypertension.

Acquired aortic valve stenosis develops as a result of the following reasons:

• disease with rheumatism;
• heredity;
• degenerative processes in the structure of the valve;
• systemic lupus erythematosus;
• severe renal failure;
• infectious endocarditis.

In patients with rheumatism, the valve leaflets are affected, which causes them to contract. As a result of this process, they become dense and lose flexibility, which causes the hole in the valve to narrow. Salt deposits on the aortic valve often lead to decreased mobility of the valves. As a result of this, narrowing also occurs.

This kind of pathological transformation also occurs with infective endocarditis. In some cases, degenerative processes observed in the valve itself lead to aortic stenosis. They begin to appear in people after 60 years of age. Since this cause is associated with age-related changes and wear of the valve, the disease is called idiopathic aortic stenosis.

Degenerative processes that cause stenosis also occur with atherosclerosis of the aorta itself. In this case, sclerosis occurs and the mobility of the valves is impaired. With aortic stenosis, an obstructive process in the heart is observed - difficulty in the movement of blood flow into the aorta from the left ventricle.

How does pathology develop in children?

In newborns and preschool children, this pathology may occur without symptoms, but as they grow, stenosis will begin to appear. There is an increase in the size of the heart and, accordingly, the volume of circulating blood, and the narrow lumen in the aortic valve remains unchanged.

Narrowing of the aortic valve in newborns occurs due to abnormal development valves during the period intrauterine development. They grow together or do not separate into 3 separate valves. You can see such a pathology in the fetus as early as 6 months of pregnancy using echocardiography.

Such a diagnosis is mandatory and very important, since immediately after birth the child develops critical stenosis. The danger of the condition is that the left ventricle with aortic stenosis works with an excessively increased load. But it will not be able to function in this mode for a long time. Therefore, if such a pathology is detected in time, it is possible to perform surgery after the birth of the child and prevent an unfavorable outcome.

Critical stenosis occurs when the lumen in the aortic valve is less than 0.5 cm. Non-critical stenosis causes a deterioration in the child’s condition during the first year of his life, but for several months after birth the baby may feel quite satisfactory. In this case, poor weight gain and tachycardia with shortness of breath will be noted. In any case, if parents suspect signs of illness in their child, they should consult a pediatrician.

You can guess about aortic stenosis in a newborn by the following signs:

• a sharp deterioration in the child’s condition in the first 3 days after birth;
• the baby becomes lethargic;
• lack of appetite, poor breastfeeding;
• the skin becomes bluish.

For older children, the situation is not as bad as for newborns. Signs of vice for a long time may not appear, and it is possible to track the development of pathology over time, selecting an appropriate correction method. The obvious signs of the disease cannot be ignored; it must be treated, as it can be fatal. There are 3 options for the development of pathology, as a result of which the methods for eliminating it are different:

• the valve flaps are stuck together and need to be separated;
• the valve flaps are so altered that they require complete replacement;
• the diameter of the valve opening is so small that it is not able to pass through a device for replacing a part of the organ.

Diagnosis and conservative treatment

The main method by which aortic valve stenosis is detected is ultrasound examination of the heart. If ultrasound is performed in combination with Doppler, it is also possible to evaluate the speed of blood flow. A traditional ECG allows us to identify only some of the accompanying signs of this pathology, characteristic of its later stages. Auscultation is also used; it will allow you to determine a rough murmur in the heart due to aortic stenosis. However, listening alone cannot be the basis for making a final diagnosis. It only indicates a possible pathology.

ECG of a patient with aortic stenosis. Left atrial hypertrophy. Hypertrophy and systolic overload of the left ventricle

A minor illness in the absence of complaints from the patient does not require therapeutic measures. Treatment of aortic stenosis becomes necessary when threatening symptoms increase, which indicate the progression of the disease, which is life-threatening. To slow down this process in the absence of the possibility of surgical intervention, the patient is prescribed drug treatment.

Your doctor will recommend taking diuretics to reduce your risk of heart failure. In addition, as part of drug therapy, antiarrhythmic drugs and medications are prescribed to normalize blood pressure. One of the directions of conservative therapy is the elimination or prevention of atherosclerosis.

Drug therapy is prescribed to those patients who, for objective reasons, are not subject to surgical treatment or it is not yet indicated for them due to the slow progression of the disease without severe symptoms. Medications to eliminate aortic stenosis are selected individually, taking into account the reasons that caused this disease.

Conservative treatment of stenosis is also indicated for those patients who have already undergone valve replacement surgery. This does not apply to all operated patients, but only to those in whom this manipulation was caused by rheumatism. For them, the main therapeutic goal is the prevention of endocarditis.

This is an inflammatory disease of the lining of the heart and valves. Since it has an infectious nature of development, antibacterial drugs are used to treat it. medications. The appropriate medications and duration of their use are determined by the attending physician. You need to be prepared for the fact that therapy can be either long-term or lifelong.

Surgery

The main treatment methods for severe aortic stenosis consist of surgically replacing the damaged valve. The following surgical techniques are used for this:

• open surgery;
• balloon valvuloplasty;
• percutaneous valve replacement.

Aortic valve replacement

Open surgery involves opening chest and artificial. Despite the complexity and trauma, such an intervention is a highly effective method of aortic valve replacement. As a replacement, artificial valves made of metal and donor valves borrowed from animals are used. If a metal prosthesis is installed, the patient must take anticoagulants—blood thinning drugs—for the rest of his life. This is due to the fact that surgery increases the risk of blood clots. The donor prosthesis is sewn in temporarily, its service life is no more than 5 years. After this period has expired, it needs to be replaced.

Balloon valvuloplasty is used to treat children. This technique is not suitable for adult patients, since the valve leaflets become more fragile with age and can be destroyed as a result of the intervention. For this reason, it is carried out in exceptional cases for men and women. One of them is the impossibility of using general anesthesia.

Aortic balloon valvuloplasty

The operation is performed as follows: through femoral artery A special balloon is inserted, which expands the narrowed lumen of the aorta. All manipulations are carried out under radiographic control. Observation of patients who have undergone a similar procedure shows that re-narrowing of the valve occurs. In addition, in rare exceptions, such treatment can cause complications - these are:

• valve insufficiency;
• cerebral embolism;
• stroke.

Percutaneous valve replacement is performed on the same principle as balloon valvuloplasty. The only difference is that in this case an artificial valve is installed, which opens after it is inserted through the artery. It presses tightly against the walls of the vessel and begins to perform its functions. Although this method of replacing the aortic valve is minimally traumatic, it has many contraindications. Therefore, it is not suitable for all patients with such pathology as aortic stenosis.

Aortic stenosis is also called aortic stenosis or aortic stenosis. Simply put, this is a narrowing of the aortic opening along various reasons. The pathology is unpleasant because it significantly reduces life expectancy (if left untreated!) - from 15 to 20 percent may suffer sudden death.

Disease statistics show that congenital stenosis is most often diagnosed before the age of 30, and rheumatic stenosis after that. In some cases, aortic stenosis is accompanied by other pathologies.

Failure to see a doctor in a timely manner can lead to radical treatment in the form of an aortic valve transplant. The operation is far from cheap, so it is better to get by with drug therapy and prevention.

Stenosis in medical practice means a narrowing of the organic nature of a vessel, hollow organ, canal, or duct. In this case, there is a complete or partial obstruction of the patency of the stenotic area.

Stenosis occurs:

• False (compression) - in such cases, the narrowing is caused by external factors.
• True - such a narrowing develops as a result of changes in the walls of blood vessels, organs, etc. True stenoses, in turn, are congenital and acquired; compensated and decompensated.

All stenoses, regardless of their nature, can be single or multiple.

Aortic stenosis - what is it?

Aortic stenosis is a pathology of the semilunar valve of the aorta, which consists of narrowing of its outflow tract. This defect is a heart defect and is characterized by obstructed blood flow from the left ventricle during systole.

In this case, a pronounced pressure difference arises between the aorta and the left ventricular chamber, and the load on the heart muscle increases in all parts of the heart. Over time, a pronounced hemodynamic disturbance occurs.

For reference! Aortic stenosis (stenosis of the aortic mouth) is up to 4 times more common in men.

In cardiological practice, the most common lesion of the aortic valve is combined with other heart defects.

An isolated lesion is recorded very rarely - in only 1.5% of cases.

For reference! Of all valve defects, aortic stenosis accounts for approximately 25% of all cardiac malformations.

Basic pathogenetic links Such a disease consists of the development of successive reactions:

• The stenotic area does not allow proper blood flow.
• When trying to push the required volume of blood into such a section, the heart begins to work under constant load.
• Constant activity of the heart in this mode leads to the development of left ventricular hypertrophy.
• Lack of blood, which the vessels do not receive, and, accordingly, internal organs, leads to total hypoxia.
• The hypertrophied myocardium of the left ventricle loses its ability to maintain stroke volume and ejection fraction at the proper level, with subsequent development systolic dysfunction. In this case, the heart is no longer able to cope with the load.
• Such changes increase pressure in the left atrium and pulmonary circulation with the development of pulmonary hypertension. In this case, hypertrophy of the right ventricle appears due to pulmonary hypertension. This is how total heart failure occurs.

For reference! With the development of hypoxia, all vital organs are affected, especially the brain, which has small reserves of glucose and, in conditions of lack of oxygen, is susceptible to the development of vascular accidents.

Aortic stenosis. Gradient classification

First of all, aortic valve stenosis is divided into types according to origin:

• Congenital.
• Acquired.

According to the location of aortic stenosis, it can be:

• Subvalvular - occurs in 25-30% of cases.
• Supravalvular – recorded in 6-10% of patients.
• Valvular – occurs most often, in 60% of cases.

Cardiologists use pressure gradient data to assess the degree of aortic stenosis.

For reference! The pressure gradient is the difference in blood pressure in the left ventricle before and after the aortic valve. In the absence of narrowing, the pressure is minimal, and the more pronounced the narrowing, the higher the pressure becomes.

Under physiological conditions, the aortic valve opening ranges from 2.5 to 3.5 cm2. In such cases, blood flows without obstruction, delivering the required amount of oxygen from the heart to the tissues.

In the case of development of stenosis, depending on the severity of the narrowing of the aortic mouth, several degrees of severity are distinguished, which is determined by the area of ​​opening of the valve leaflets and the pressure difference. Aortic stenosis and its gradient classification are as follows:

• I degree, slight stenosis - valve opening is at least 1.2 cm2, pressure gradient is from 10 to 35 mm Hg. Art.
• II degree, moderate - orifice area 1.2 - 0.75 cm2 with a gradient of 36-65 mm Hg. Art.
• III degree, severe - the valve opening is no more than 0.74 cm2, and the gradient becomes more than 65 mm Hg. Art.
• IV degree, critical stenosis - the lumen is narrowed to 0.5 - 0.7 cm2 with a pressure gradient of more than 80 mm Hg. Art.

Aortic stenosis is characterized by hemodynamic disturbances, which depend on the degree of narrowing of the aortic orifice. In this case, clinicians divide the disease into several stages:

• Stage 1, compensated - in such cases, the defect can be detected only by auscultation of the heart, the degree of valve narrowing is insignificant. The heart functions almost normally.
• Stage 2, latent heart failure - pathology is determined on an ECG and chest x-ray. At this stage, patients begin to complain about changes in their health status. Pressure gradient from 36 to 65 mmHg. Art.
• Stage 3, relative coronary insufficiency – complaints intensify, the patient’s condition worsens. Pressure gradient more than 65 mm Hg. Art.
• Stage 4, severe heart failure – a significant deterioration in the condition of patients. gradient more than 80 mm Hg. Art.
• Stage 5, terminal – severe heart failure leading to death.

For reference! Aortic stenosis can be compensated, when it is still possible to help patients, and decompensated, when only short-term symptomatic help is possible. This phenomenon is called critical aortic stenosis.

Causes of aortic stenosis

Often acquired aortic stenosis is caused by damage to the valves of rheumatic origin. The basis of this defeat is deformation of the valve leaflets, their fusion, compaction, weakness, which leads to a narrowing of the aortic mouth.

(arising intravitally, as a result of a previous disease).

Aortic stenosis is one of the types of changes in the valve apparatus. In the presence of this defect, the valve leaflets grow together, preventing normal blood flow.

As a result of aortic adhesions, during systole (contraction), blood from the left ventricle of the heart has difficulty entering the aorta, because of this the muscle (myocardium) significantly hypertrophies, and the left ventricle is stretched.

Stages and degrees of aortic stenosis

There are several degrees of severity of aortic stenosis. They are determined by the area of ​​opening of the valve leaflets at the time of systole and the pressure difference.

Note:pressure gradient - an indicator indicating the difference in pressure before and after the valve. Determined by cardiac catheterization.

Severity of aortic stenosis:

• I degree(minor stenosis) - the valve opening is at least 1.2 cm 2, and the gradient is from 10 to 35 mm Hg.
• II degree(moderate stenosis) - valve opening area 1.2 - 0.75 cm 2 with a pressure gradient from 36 to 65 mm Hg.
• IIIdegree(severe stenosis) - the size of the valve opening does not exceed 0.74 cm 2, and the gradient is more than 65 mm Hg.
• IVdegree(critical stenosis) - narrowing is 0.5 - 0.7 cm 2, pressure gradient is more than 80 mm Hg.

It is also worth paying attention to the stages of development of stenosis; each of them has certain symptoms that help establish the most accurate diagnosis.

4 stages of aortic stenosis:

• Compensation- asymptomatic period. The heart can fully cope with the increased load, and symptoms may not appear for several decades.
• Subcompensations - The first symptoms appear, mainly during heavy physical exertion, especially those that are unusual for the patient.
• Decompensation - severe and severe heart failure. Symptoms appear not only after minor exertion, but also at rest.
• Terminal - due to complications and catastrophic changes in the heart and organs, death occurs.

Causes of aortic stenosis, risk factors

This acquired defect most often occurs in older people (every 10 patients). More than 80% of stenosis occurs due to age-related changes valve leaflets of the artery (sclerosation), and 10% of cases are caused by. A risk factor is also the presence of a congenital malformation such as a bicuspid aortic valve, which causes stenosis in a third of patients with this feature.

Heredity, bad habits, high blood cholesterol and arterial hypertension play a special role.

Symptoms of the disease

The symptoms of the disease directly depend on how narrowed the aortic opening is, that is, on the degree of the disease.

I degree of aortic stenosis

This stage of the disease is characterized by a rather long asymptomatic course (more than 10 years). Most often, pathology is discovered during examinations aimed at searching for other diseases or during medical examinations. After detection of stenosis, the patient is registered with a cardiologist, who, with the help of regular heart examinations (), will be able to monitor the development of the disease and prescribe treatment in a timely manner, preventing the occurrence of complications.

Over time, fatigue occurs during physical activity. The first signs appear.

Symptoms of stage II aortic stenosis

When the disease moves to the second level, when physical work short-term stress may occur (pressing pain behind the sternum, “angina pectoris”). Night shortness of breath is also possible, and in severe cases, attacks of cardiac asthma and.

III degree

Symptoms increase and are disturbing not only under severe stress, but also at rest. Significantly obstructed outflow of left ventricular blood provokes an increase not only in intracardiac pressure, but also in pressure in the pulmonary vessels. Choking occurs, and subsequently attacks of cardiac asthma are permanent.

IV degree of aortic stenosis

As the heart chambers hypertrophy, blood stagnation in other vessels increases: liver, lungs, kidneys, muscles. Increasingly, pulmonary edema occurs, which is life-threatening for patients, cardiac edema ( lower limbs), ascites (swelling of the abdomen), .

Important: If you notice the above symptoms, consult a cardiologist.

Complications

Aortic stenosis, if not properly treated, leads to. It increases gradually, due to the fact that it becomes increasingly difficult for the left ventricle to “push” blood into the aorta. In the future, the myocardium becomes increasingly difficult to cope with the increasing load, which can first cause atrophy of the left ventricle, and then similar processes will be observed in the muscle of the entire heart.

Aortic valve stenosis increases the susceptibility of the endocardium to various viruses and bacteria, which can cause endocarditis.

Important:in front of some medical interventions, after consulting with your doctor, you should take antibiotics for prevention. For example, this must be done before tooth extraction.

Diagnosis of aortic stenosis

Usually, the first suspicions of a cardiologist arise after listening to characteristic pathological heart murmurs during auscultation. Further, additional research methods are prescribed to confirm or exclude the diagnosis.

In diagnostics of this disease The following methods are used:

Treatment of aortic valve stenosis

If your medical record contains a diagnosis of “aortic stenosis,” you should exclude sports and heavy physical activity, even if the symptoms do not interfere with your life. It is necessary to visit a cardiologist at least once a year to prevent progression of the disease and endocarditis.

Conservative treatment

These drugs will not widen the narrowed aorta, but will help improve blood circulation and general state hearts:

1. Dopaminergic drugs - Dopamine
2. Diuretics (diuretics) - Trifas
3. Vasodilators - Nitroglycerin
4. Antibiotics - Cephalexin

Note:All medications are taken STRICTLY as prescribed by the doctor and after prescribing the dosage you need, which correlates with the degree and stage of the disease!

Surgery for aortic stenosis

Method surgical intervention most effective for stenosis. The operation must be performed before the development of left ventricular failure, otherwise there is a high probability of complications.

The operation is indicated for moderate and severe stenosis or in the presence of clinical symptoms. Valvuloplasty (cutting adhesions and adhesions in the valves) is performed for moderate stenosis. If the stenosis is severe, especially if it is combined with insufficiency, a more appropriate treatment method would be to replace the damaged valve.

Prevention

Aortic stenosis is prevented by preventing diseases such as endocarditis and eliminating risk factors as much as possible.

Special diet

Productive treatment of aortic stenosis is impossible without following an appropriate diet.

The following foods should be excluded from the diet:

• excessively spicy, salty, smoked, fatty;
• “fast” food - hamburgers, shawarma;
• carbonated drinks and desserts containing dyes;
• alcohol, smoking.

Must be present:

• low-fat meats and fish
• dairy products
• fruits, vegetables, their juices

Note:Despite the diet, the body needs a complex of vitamins and minerals. In this situation, synthetic vitamin complexes will be the best solution.

Features of the course of aortic stenosis in children and pregnant women

At the initial stage of the disease, the child behaves the same as usual, and parents often do not consult a doctor. And minor symptoms: slight pallor, poor sucking reflex, even in infants, do not give rise to the idea of ​​contacting a cardiologist.

In adolescence, the course of stenosis is similar to that in adults.

The course of pregnancy with aortic stenosis

Due to the fact that pregnancy forces the heart to work harder, in case of severe stenosis, termination of pregnancy is indicated due to the high probability of death of the mother and child, and the risk of the baby developing a congenital heart defect is more than 20%.

Both in the case of termination and in the case of continued pregnancy, endocarditis is prevented.

Tavaluk Natalya, medical columnist

Aortic stenosis

Aortic stenosis or stenosis of the aortic ostium is characterized by a narrowing of the outflow tract in the area of ​​the semilunar valve of the aorta, which makes systolic emptying of the left ventricle difficult and the pressure gradient between its chamber and the aorta sharply increases.

The share of aortic stenosis in the structure of other heart defects is 20–25%. Aortic stenosis is 3–4 times more common in men than in women.

Isolated aortic stenosis is rare in cardiology - in 1.5-2% of cases; in most cases, this defect is combined with other valve defects - mitral stenosis, aortic insufficiency, etc.

Classification of aortic stenosis

By origin, congenital (3-5.5%) and acquired stenosis of the aortic mouth are distinguished. Taking into account the localization of the pathological narrowing, aortic stenosis can be subvalvular (25-30%), supravalvular (6-10%) and valvular (about 60%).

The severity of aortic stenosis is determined by the systolic pressure gradient between the aorta and the left ventricle, as well as the area of ​​the valve opening.

With minor aortic stenosis of the first degree, the opening area is from 1.6 to 1.2 cm² (with the norm being 2.5-3.5 cm²); The systolic pressure gradient is in the range of 10–35 mmHg. Art. Moderate aortic stenosis of degree II is indicated when the valve opening area is from 1.2 to 0.75 cm² and the pressure gradient is 36–65 mm Hg.

Art. Severe aortic stenosis III degree noted when the area of ​​the valve opening is narrowed to less than 0.74 cm² and the pressure gradient increases above 65 mm Hg. Art.

Depending on the degree of hemodynamic disturbances, aortic stenosis can occur in a compensated or decompensated (critical) clinical variant, and therefore there are 5 stages.

Stage I(full compensation). Aortic stenosis can only be detected by auscultation; the degree of narrowing of the aortic orifice is insignificant. Patients require dynamic monitoring by a cardiologist; surgical treatment is not indicated.

Stage II(latent heart failure). There are complaints of fatigue, shortness of breath with moderate physical activity, and dizziness. Signs of aortic stenosis are determined by ECG data and radiography, pressure gradient in the range of 36–65 mm Hg. Art., which serves as an indication for surgical correction of the defect.

Stage III(relative coronary insufficiency). Typically increased shortness of breath, angina, and fainting. The systolic pressure gradient exceeds 65 mmHg. Art. Surgical treatment of aortic stenosis at this stage is possible and necessary.

IV stage(severe heart failure). Worried about shortness of breath at rest, nocturnal attacks of cardiac asthma. Surgical correction of the defect is already excluded in most cases; In some patients, cardiac surgery is potentially possible, but with less effect.

Stage V(terminal). Heart failure is steadily progressing, shortness of breath and edema syndrome are pronounced. Drug treatment achieves only short-term improvement; Surgical correction of aortic stenosis is contraindicated.

Acquired aortic stenosis is most often caused by rheumatic damage to the valve leaflets. In this case, the valve flaps are deformed, fuse together, become dense and rigid, leading to a narrowing of the valve ring.

Causes of acquired aortic stenosis can also include atherosclerosis of the aorta, calcification (calcification) of the aortic valve, infective endocarditis, Paget's disease, systemic lupus erythematosus, rheumatoid arthritis, end-stage renal failure.

Congenital aortic stenosis occurs when there is a congenital narrowing of the aortic mouth or a developmental anomaly - a bicuspid aortic valve. Congenital aortic valve disease usually appears before age 30; acquired - at an older age (usually after 60 years). Smoking, hypercholesterolemia, and arterial hypertension accelerate the formation of aortic stenosis.

Hemodynamic disturbances in aortic stenosis

With aortic stenosis, severe disturbances of intracardiac and then general hemodynamics develop. This is due to difficult emptying of the cavity of the left ventricle, due to which there is a significant increase in the systolic pressure gradient between the left ventricle and the aorta, which can reach from 20 to 100 or more mmHg. Art.

The functioning of the left ventricle under conditions of increased load is accompanied by its hypertrophy, the degree of which, in turn, depends on the severity of the narrowing of the aortic opening and the duration of the defect. Compensatory hypertrophy ensures long-term preservation of normal cardiac output, inhibiting the development of cardiac decompensation.

However, with aortic stenosis, a violation of coronary perfusion occurs quite early, associated with an increase in end-diastolic pressure in the left ventricle and compression of the subendocardial vessels by the hypertrophied myocardium. That is why in patients with aortic stenosis, signs of coronary insufficiency appear long before the onset of cardiac decompensation.

As you decrease contractility hypertrophied left ventricle, stroke volume and ejection fraction decrease, which is accompanied by myogenic left ventricular dilation, increased end-diastolic pressure and the development of left ventricular systolic dysfunction.

Against this background, the pressure in the left atrium and pulmonary circulation increases, i.e., arterial pulmonary hypertension develops. In this case, the clinical picture of aortic stenosis may be aggravated by relative insufficiency of the mitral valve (“mitralization” of the aortic defect).

High pressure in the pulmonary artery system naturally leads to compensatory hypertrophy of the right ventricle, and then to total heart failure.

At the stage of complete compensation of aortic stenosis, patients do not feel noticeable discomfort for a long time. The first manifestations are associated with a narrowing of the aortic mouth to approximately 50% of its lumen and are characterized by shortness of breath during exercise, fatigue, muscle weakness, feeling of heartbeats.

At the stage of coronary insufficiency, dizziness, fainting with a rapid change in body position, attacks of angina pectoris, paroxysmal (night) shortness of breath, and, in severe cases, attacks of cardiac asthma and pulmonary edema occur. The combination of angina pectoris with syncope, and especially the addition of cardiac asthma, is unfavorable prognostically.

With the development of right ventricular failure, swelling and a feeling of heaviness in the right hypochondrium are noted.

Sudden cardiac death with aortic stenosis occurs in 5–10% of cases, mainly in elderly people with severe narrowing of the valve opening.

Complications of aortic stenosis may include infective endocarditis, ischemic disorders cerebral circulation, arrhythmias, AV block, myocardial infarction, gastrointestinal bleeding from the lower parts of the digestive tract.

Diagnosis of aortic stenosis

The appearance of a patient with aortic stenosis is characterized by pallor of the skin (“aortic pallor”), due to a tendency to peripheral vasoconstrictor reactions; V late stages acrocyanosis may occur. Peripheral edema is detected in severe aortic stenosis. Upon percussion, the expansion of the borders of the heart to the left and down is determined; The displacement of the apical impulse and systolic tremor in the jugular fossa are palpably felt.

Auscultatory signs of aortic stenosis are rough systolic murmur above the aorta and above the mitral valve, muffled sounds of the first and second sounds in the aorta. These changes are also recorded during phonocardiography. According to the ECG, signs of left ventricular hypertrophy, arrhythmia, and sometimes blockade are determined.

During the period of decompensation, radiographs reveal an expansion of the shadow of the left ventricle in the form of lengthening of the arc of the left contour of the heart, a characteristic aortic configuration of the heart, poststenotic dilatation of the aorta, and signs of pulmonary hypertension. Echocardiography reveals thickening of the aortic valve flaps, limitation of the amplitude of movement of the valve leaflets in systole, and hypertrophy of the walls of the left ventricle.

In order to measure the pressure gradient between the left ventricle and the aorta, probing of the heart cavities is performed, which makes it possible to indirectly judge the degree of aortic stenosis.

Ventriculography is necessary to identify concomitant mitral regurgitation.

Aortography and coronary angiography are used for the differential diagnosis of aortic stenosis with aneurysm of the ascending aorta and coronary artery disease.

Treatment of aortic stenosis

All patients, incl. with asymptomatic, fully compensated aortic stenosis should be closely monitored by a cardiologist. They are recommended Echocardiography every 6-12 months.

For this group of patients, for the purpose of prevention infective endocarditis It is necessary to take preventive antibiotics before dental (treatment of caries, tooth extraction, etc.) and other invasive procedures. Management of pregnancy in women with aortic stenosis requires careful monitoring of hemodynamic parameters.

The indication for termination of pregnancy is severe aortic stenosis or increasing signs of heart failure.

Drug therapy for aortic stenosis is aimed at eliminating arrhythmias, preventing coronary heart disease, normalizing blood pressure, and slowing the progression of heart failure.

Radical surgical correction of aortic stenosis is indicated at the first clinical manifestations of the defect - the appearance of shortness of breath, anginal pain, and syncope. For this purpose, balloon valvuloplasty can be used - endovascular balloon dilatation of aortic stenosis.

However, often this procedure is ineffective and is accompanied by subsequent relapse of stenosis. For mild changes in the aortic valve leaflets (more often in children with congenital defects), open surgical repair of the aortic valve (valvuloplasty) is used.

In pediatric cardiac surgery, the Ross operation is often performed, which involves transplanting the pulmonary valve into the aortic position.

If indicated, plastic surgery of supravalvular or subvalvular aortic stenosis is performed.

The main treatment method for aortic stenosis today remains aortic valve replacement, in which the affected valve is completely removed and replaced with a mechanical analog or xenogeneic bioprosthesis.

Patients with a prosthetic valve require lifelong anticoagulants. IN last years Percutaneous aortic valve replacement is practiced.

Forecast and prevention of aortic stenosis

Aortic stenosis may be asymptomatic for many years. The appearance of clinical symptoms significantly increases the risk of complications and mortality.

Basic, prognostic significant symptoms serve as angina, fainting, left ventricular failure - in this case average duration life does not exceed 2-5 years. With timely surgical treatment aortic stenosis, the 5-year survival rate is about 85%, the 10-year survival rate is about 70%.

Measures to prevent aortic stenosis come down to the prevention of rheumatism, atherosclerosis, infective endocarditis and other contributing factors. Patients with aortic stenosis are subject to medical examination and observation by a cardiologist and rheumatologist.

Source: http://www.krasotaimedicina.ru/diseases/zabolevanija_cardiology/aortic-stenosis

Aortic valve stenosis: how and why it occurs, symptoms, how to treat

From this article you will learn: what aortic stenosis is, what are the mechanisms of its development and the causes of its occurrence. Symptoms and treatment of the disease.

Aortic stenosis is a pathological narrowing of the large coronary vessel, through which blood from the left ventricle enters vascular system(into the systemic circulation).

What happens during pathology? By various reasons (birth defects development, rheumatism, calcification) the lumen of the aorta narrows at the exit from the ventricle (in the valve area) and impedes the outflow of blood into the vascular system. As a result, the pressure in the ventricular chamber increases, the volume of blood ejection decreases, and over time, various signs insufficient blood supply to organs (fatigue, weakness).

The disease is completely asymptomatic for a long time (decades) and appears only after the lumen of the vessel has narrowed by more than 50%. The appearance of signs of heart failure, angina pectoris (a type of coronary artery disease) and fainting greatly worsens the patient's prognosis (life expectancy is reduced to 2 years).

The pathology is dangerous due to its complications - long-term progressive stenosis leads to irreversible enlargement of the chamber (dilatation) of the left ventricle.

In patients with severe symptoms (after narrowing the lumen of the vessel by more than 50%), cardiac asthma, pulmonary edema, acute heart attack myocardium, sudden cardiac death without obvious signs stenosis (18%), rarely – ventricular fibrillation, equivalent to cardiac arrest.

It is impossible to completely cure aortic stenosis.

Surgical treatment methods (valve replacement, lumen expansion using balloon dilatation) are indicated after the first signs of aortic narrowing (shortness of breath with moderate exertion, dizziness) appear.

In most cases, the prognosis can be significantly improved (more than 10 years for 70% of those operated on). Dispensary observation is carried out at any stage throughout life.

Click on photo to enlarge

Patients with aortic stenosis are treated by a cardiologist; surgical correction is performed by cardiac surgeons.

The essence of aortic stenosis

The weak link of the systemic circulation (from the left ventricle blood flows through the aorta to all organs) is the tricuspid aortic valve at the mouth of the vessel. When it opens, it allows portions of blood into the vascular system, which the ventricle pushes out during contraction and, when closed, prevents them from moving back. It is in this place that characteristic changes in the vascular walls appear.

With pathology, the tissue of the valves and aorta undergoes various changes. These can be scars, adhesions, adhesions connective tissue, calcium salt deposits (hardening), atherosclerotic plaques, congenital valve malformations.

Due to these changes:

• the lumen of the vessel gradually narrows;
• the valve walls become inelastic and dense;
• do not open and close enough;
• blood pressure in the ventricle increases, causing hypertrophy (thickening of the muscle layer) and dilatation (increase in volume).

As a result, insufficient blood supply to all organs and tissues develops.

Aortic stenosis can be:

1. Supravalvular (from 6 to 10%).
2. Subvalvular (from 20 to 30%).
3. Valve (from 60%).

All three forms can be congenital, acquired - only valvular. And since the valvular form is more common, when speaking about aortic stenosis, this form of the disease is usually meant.

Pathology very rarely (in 2%) appears as an independent disease, most often it is combined with other defects (mitral valve) and diseases of cardio-vascular system(cardiac ischemia).

Causes and risk factors

Characteristic symptoms

For decades, stenosis occurs without showing any signs. In the early stages (before the lumen of the vessel closes by more than 50%), the condition may manifest itself as general weakness after serious physical activity (sports training).

The disease progresses gradually: shortness of breath appears with moderate and basic exercise, accompanied by increased fatigue, weakness, and dizziness.

Aortic stenosis with a decrease in the lumen of the vessel by more than 75% is accompanied by severe symptoms of heart failure: shortness of breath at rest and complete disability.

Common symptoms of aortic narrowing:

• shortness of breath (first with severe and moderate exertion, then at rest);
• weakness, fatigue;
• painful pallor;
• dizziness;
• sudden loss of consciousness (with a sudden change in body position);
• chest pain;
• heart rhythm disturbances (usually ventricular extrasystole, characteristic feature– feeling of interruptions in work, “loss” of heartbeat);
• swelling of the ankles.

The appearance of pronounced signs of circulatory disorders (dizziness, loss of consciousness) greatly worsens the prognosis of the disease (life expectancy no more than 2–3 years).

After narrowing the lumen of the vessel by 75%, cardiovascular failure quickly progresses and becomes more complicated:

• attacks of angina pectoris with characteristic acute pain in the chest and attacks of suffocation;
• myocardial infarction with acute chest pain, shortness of breath, weakness, sweating, nausea, vomiting, dizziness;
• cardiac asthma with increased heart rate, choking, coughing, blue face;
• pulmonary edema with suffocation, pronounced blueness of the face (cyanosis), cough with bloody foam, bubbling breathing;
• ventricular fibrillation with frequent and chaotic contractions, impaired contractile function of the heart.

Aortic valve stenosis can cause sudden death without any external manifestations and preliminary symptoms.

Treatment methods

It is impossible to completely cure the pathology. A patient with any form of aortic narrowing needs to be observed, examined and follow the recommendations of a cardiologist throughout his life.

Drug therapy is prescribed in the early stages of stenosis:

• when the degree of narrowing is small (up to 30%);
• does not manifest itself with severe symptoms of circulatory disorders (shortness of breath after moderate physical activity);
• Diagnosed by listening to murmurs over the aorta.

Treatment goals:

1. Suspend the development of stenosis (if acquired).
2. Prevent the development of myocardial ischemia.
3. Correct concomitant conditions (hypertension).
4. Normalize the manifestations of arrhythmia.

At later stages, drug therapy is ineffective; the patient's prognosis can only be improved with the help of surgical treatment methods (balloon dilatation of the aortic lumen, valve replacement).

Drug therapy

The attending physician prescribes a set of medications individually, taking into account the degree of stenosis and symptoms of concomitant diseases.

The following medications are used:

Group of drugs Name of the drug What effect they have

Cardiac glycosides	Digitoxin, strophanthin	Reduce heart rate, increase their strength, the heart works more efficiently
Beta blockers	Coronal	Normalize heart rhythm, reduce the frequency of ventricular extrasystoles
Diuretics	Indapamide, veroshpiron	Reduce the volume of fluid circulating in the body, reduce blood pressure, relieve swelling
Antihypertensive drugs	Lisinopril	Have a vasodilating effect, reduce blood pressure
Metabolic agents	Mildronate, preductal	Normalize energy metabolism in myocardial cells

In the early stages, acquired aortic valve stenosis must be protected from possible infectious complications (endocarditis). Patients are recommended a prophylactic course of antibiotics for any invasive procedures (tooth extraction).

Surgery

Methods of surgical treatment of aortic stenosis are indicated at the following stages of the disease:

• the patient complains of shortness of breath after moderate exercise, weakness, fatigue, dizziness;
• shortness of breath appears after any physical activity (walking on a flat surface) and intensifies with moderate exertion (climbing stairs);
• attacks of acute chest pain and fainting appear after sudden changes in body position.

In late stages (the lumen of the vessel is closed by more than 75%), surgical intervention is contraindicated in most cases (80%) due to possible development complications (sudden cardiac death).

Balloon dilatation (expansion)

Aortic valve plastic surgery

Aortic valve replacement

Ross prosthetics

Lifelong patient:

• is registered with a cardiologist;
• undergoes examination at least twice a year;
• after prosthetics, he constantly takes anticoagulants.

Prevention

Prevention of acquired stenosis comes down to eliminating possible reasons and risk factors for the development of pathology.

Necessary:

1. Treat sources chronic infection (chronic tonsillitis, carious teeth, pyelonephritis).
2. Normalize your diet to prevent the development of atherosclerosis.
3. Stop smoking (nicotine increases the risk of developing cardiovascular pathologies in 47% of cases).

For patients with cardiovascular pathologies great importance has an optimal balance of potassium, sodium, calcium in the diet, so the diet should be discussed with your doctor.

Forecast

Aortic stenosis has been asymptomatic for decades. The prognosis depends on the degree of narrowing of the artery lumen - reducing the diameter of the vessel to 30% does not complicate the patient’s life.

At this stage it is shown regular examinations and observation by a cardiologist.

The disease progresses slowly, so the symptoms of increasing heart failure are not noticeable to others and the patient (14–18% of patients die suddenly, without obvious signs of narrowing).

But in most cases, difficulties arise after the vessel is blocked by more than 50%, the appearance of attacks of angina pectoris (a type of coronary artery disease) and sudden fainting. Heart failure progresses rapidly, becomes complicated and greatly reduces the patient's life expectancy (from 2 to 3 years).

Congenital pathology ends in death in 8–10% of children in the first year of life.

Timely surgical treatment improves the prognosis: more than 85% of those operated on survive for up to 5 years, and 70% for more than 10 years.

Source: http://okardio.com/bolezni-sosudov/aortalnyj-stenoz-551.html

Aortic stenosis: symptoms, treatment, prevention

The human heart is a complex and delicate, but vulnerable mechanism that controls the functioning of all organs and systems.

There are a number negative factors, starting with genetic disorders and ending with an incorrect lifestyle, which can cause malfunctions in the functioning of this mechanism.

Their result is the development of diseases and pathologies of the heart, which include stenosis (narrowing) of the aortic mouth.

general information

Stenosis of the aortic mouth (aortic stenosis) is one of the most common in modern society heart defects. It is diagnosed in every fifth patient after the age of 55 years, with 80% of patients being men.

In patients with this diagnosis, there is a narrowing of the aortic valve opening, which leads to disruption of blood flow into the aorta from the left ventricle. As a result, the heart has to exert considerable effort to pump blood into the aorta through the reduced opening, which causes serious disruption in its operation.

Causes and risk factors

Aortic stenosis can be congenital (occurs as a result of intrauterine developmental anomalies), but more often it develops during a person’s life. The causes of the disease include:

• heart disease of a rheumatoid nature, which usually occurs as a consequence of acute rheumatic fever due to infections caused by a certain group of viruses (group A hemolytic streptococci);
• atherosclerosis of the aorta and valve - a disorder that is associated with lipid metabolism disorders and cholesterol deposition in the vessels and valve leaflets;
• degenerative changes in heart valves;
• infective endocarditis.

Risk factors for the development of the disease include poor lifestyle (in particular, smoking), renal failure, calcification of the aortic valve and the presence of its artificial substitute - the biological tissue from which they are made is significantly susceptible to the development of stenosis.

Classification and stages

Aortic stenosis has several forms, which are distinguished according to different criteria (localization, degree of blood flow compensation, degree of narrowing of the aortic opening).

• by localization of narrowing Aortic stenosis can be valvular, supravalvular or subvalvular;
• by degree of compensation blood flow (according to how much the heart can cope with the increased load) - compensated and decompensated;
• by degree of narrowing aortas are divided into moderate, severe and critical forms.

The course of aortic stenosis is characterized by five stages:

• Stage I(full compensation). There are no complaints or manifestations; the defect can only be determined through special studies.
• Stage II(hidden lack of blood flow). The patient is concerned about mild malaise and increased fatigue, and signs of left ventricular hypertrophy are determined by x-ray and ECG.
• Stage III(relative coronary insufficiency). Chest pain, fainting, etc. appear clinical manifestations, the heart increases in size due to the left ventricle, the ECG shows its hypertrophy, accompanied by signs of coronary insufficiency.
• IV stage(severe left ventricular failure). Complaints of severe malaise, congestion in the lungs and a significant increase in the left heart.
• Stage V, or terminal. Patients experience progressive failure of both the left and right ventricles.

See more about the disease in this animation:

Is this scary? Danger and complications

Quality and life expectancy of a patient with aortic stenosis depends on the stage of the disease and severity clinical signs . People with a compensated form without severe symptoms do not have a direct threat to life, but the symptoms of left ventricular hypertrophy are considered prognostically unfavorable.

Full compensation can persist for several decades, but as stenosis develops, the patient begins to feel weakness, malaise, shortness of breath and other symptoms that increase over time.

In patients with the “classic triad” (angina, syncope, heart failure), life expectancy rarely exceeds five years.

Besides, on late stages diseases exist high risk sudden death– Approximately 25% of patients diagnosed with aortic stenosis die suddenly from fatal ventricular arrhythmias (usually these include people with severe symptoms).

The most common complications of the disease include:

• chronic and acute failure left ventricle;
• myocardial infarction;
• atrioventcular block (comparatively rare, but can also lead to sudden death);
• swelling and congestion in the lungs;
• systemic emboli caused by calcium particles from the valve can cause strokes and visual impairment.

Symptoms

Often, signs of aortic stenosis do not appear for a long time. Among the symptoms that are characteristic of this disease are:

• Shortness of breath. Initially, it appears only after physical exertion and is completely absent at rest. Over time, shortness of breath occurs in a calm state and intensifies in stressful situations.
• Chest pain. Often they do not have an exact localization and appear mainly in the heart area. The sensations can be pressing or stabbing in nature, last no more than 5 minutes and intensify with physical activity and stress. Angina pain (acute, radiating to the arm, shoulder, under the shoulder blade) can be observed even before the appearance of pronounced symptoms and is the first signal of the development of the disease.
• Fainting. Usually observed during physical activity, less often - in a calm state.
• Rapid palpitations and dizziness.
• Severe fatigue, decreased performance, weakness.
• Feeling of suffocation, which may worsen when lying down.

When should you see a doctor?

The disease is often diagnosed accidentally(during preventive examinations) or in later stages due to the fact that patients attribute symptoms to overwork, stress or adolescence.

It is important to understand that any signs of aortic stenosis (rapid heartbeat, pain, shortness of breath, discomfort during physical activity) is a serious reason to consult a cardiologist.

Diagnostics

Diagnosis of stenosis of the defect is complex and includes the following methods:

• History taking. Analysis of patient complaints, past illnesses and family history (cases of heart disease or sudden death in close relatives).
• External inspection. Patients have pallor and cyanosis of the skin, heart murmurs and wheezing in the lungs, and the peripheral pulse in the radial arteries is weak and rare.
• Auscultation aortic stenosis. The method involves listening to the sounds and rhythms of the heart - with aortic stenosis, the second sound is usually weakened or completely absent, and systolic and diastolic murmurs are also noted.
• General blood analysis. It is carried out to determine the level of red blood cells, platelets, leukocytes, as well as the level of hemoglobin.
• General urine analysis. Makes it possible to identify disorders that may affect the course of the disease.
• Electrocardiography. Evaluation method electrical activity heart, allowing to identify disturbances in its functioning.
• Echocardiography. An ultrasound examination that determines the degree of narrowing of the aorta and the most significant indicators work of the heart.
• Coronary angiography with aortography. Invasive procedure, which involves penetration into the vessels of the arms and legs to examine the vessels of the heart and aorta.
. Exercise testing includes a walking test, an exercise bike test, and a treadmill test.

Treatment methods

There is no specific therapy for aortic stenosis, therefore treatment tactics are selected based on the stage of the disease and the severity of symptoms. In any case, the patient must register with a cardiologist and be under strict supervision. It is recommended to undergo an ECG every six months, avoid bad habits, diet and strict daily routine.

Patients with stages I and II of the disease are prescribed drug therapy aimed at normalization of blood pressure, elimination of arrhythmia and slowing down the progression of stenosis. It usually includes taking diuretics, cardiac glycosides, and drugs that lower blood pressure and heart rate.

Radical methods for the initial stages of aortic stenosis include cardiac surgery. Balloon valvuloplasty(a special balloon is inserted into the aortic opening, after which it is inflated mechanically) is considered a temporary and ineffective procedure, after which in most cases a relapse occurs.

In childhood, doctors usually resort to valvuloplasty(surgical valve repair) or Ross's operations(transplantation of the pulmonary valve to the position of the aorta).

At stages III and IV of aortic stenosis, conservative drug treatment does not give the desired effect, so patients undergo aortic valve replacement. After surgery, the patient should Take blood thinners throughout your life which prevent the formation of blood clots.

If it is impossible to perform surgical intervention, they resort to pharmacological therapy in combination with herbal medicine.

Prevention

There are no methods to prevent congenital aortic stenosis or to diagnose it in utero.

Preventive measures for acquired defects include in a healthy lifestyle, moderate physical activity and timely treatment diseases that can provoke a narrowing of the aorta (rheumatic heart disease, acute rheumatic fever).

Any heart disease, including aortic stenosis, is potentially life-threatening. To prevent the development of heart pathologies and defects, very it is important to take responsibility for your health and lifestyle, as well as regularly undergo preventive examinations, which are able to detect diseases even further initial stages their development.