The heart is a muscular pump that ensures continuous movement of blood through the vessels. Together, the heart and blood vessels make up the cardiovascular system. This system consists of the systemic and pulmonary circulation. From the left side of the heart, blood first moves through the aorta, then through large and small arteries, arterioles, and capillaries. In the capillaries, oxygen and other substances necessary for the body enter the organs and tissues, and from there carbon dioxide, metabolic products, are removed. After this, the blood turns from arterial to venous and again begins to move towards the heart. First along the venules, then through smaller and larger veins. Through the inferior and superior vena cava, blood again enters the heart, only this time into the right atrium. A large circle of blood circulation is formed.
Venous blood from the right side of the heart is sent through the pulmonary arteries to the lungs, where it is enriched with oxygen, and returns to the heart again - this is the pulmonary circulation.
Inside, the heart is divided by partitions into four chambers. The two atria are divided by the interatrial septum into the left and right atria. The left and right ventricles of the heart are separated by the interventricular septum. Normally, the left and right parts of the heart are completely separate. The atria and ventricles have different functions. The atria store blood that flows into the heart. When the volume of this blood is sufficient, it is pushed into the ventricles. And the ventricles push blood into the arteries, through which it moves throughout the body. The ventricles have to do more hard work, so the muscle layer in the ventricles is much thicker than in the atria. The atria and ventricles on each side of the heart are connected by the atrioventricular orifice. Blood moves through the heart in only one direction. In the systemic circle of blood circulation from the left side of the heart (left atrium and left ventricle) to the right, and in the small circle from the right to the left.
The correct direction of blood flow is ensured by the valve apparatus of the heart:
Valves:
- tricuspid
- pulmonary
- mitral
- aortic
They open at the right time and close, preventing blood flow in the opposite direction.
Aortic valve
Closes the entrance to the aorta. It also consists of three valves, which look like crescents. Opens when the left ventricle contracts. In this case, blood enters the aorta. When the left ventricle relaxes, it closes. Thus, venous blood (poor in oxygen) from the superior and inferior vena cava enters the right atrium. When the right atrium contracts, it moves through the tricuspid valve into the right ventricle. Contracting, the right ventricle ejects blood through the pulmonary valve into the pulmonary arteries (pulmonary circulation). Enriched with oxygen in the lungs, the blood turns into arterial blood and moves through the pulmonary veins to the left atrium, then to the left ventricle. When the left ventricle contracts, arterial blood enters the aorta through the aortic valve under high pressure and spreads throughout the body (systemic circulation).
The heart muscle is called the myocardium
There are contractile and conductive myocardium. The contractile myocardium is the actual muscle that contracts and produces the work of the heart. In order for the heart to contract in a certain rhythm, it has a unique conduction system. The electrical impulse to contract the heart muscle occurs in the sinoatrial node, which is located in the upper part of the right atrium and spreads through the conduction system of the heart, reaching every muscle fiber
First, both atria contract, then both ventricles, thereby ensuring the flow of blood to all organs and tissues of the body. The heart muscle has two membranes (external and internal). The inner lining of the heart is called the endocardium. The outer lining of the heart is called the pericardium.
Causes and symptoms
Heart valve defects can be congenital or acquired. The main causes of the development of heart valve defects are rheumatism, infections, myocardial and cardiovascular diseases.
Congenital heart valve defects develop before birth and depend on how the pregnancy progressed. Congenital heart valve defects are an extremely rare diagnosis, diagnosed only in 1% of cases. Congenital defects include defects of the aortic and pulmonary valves, which are treated by surgical intervention in the first years of the patient’s life.
Purchased . Acquired heart valve defects include transformations of the valve structure due to infections, inflammation, previous heart attacks, etc. Most of them arise as a result of a gradual change in the structure of the heart; in some cases, rheumatism leads to the defect. All congenital and acquired defects have related symptoms that can appear at any age:
- increased heart rate,
- dyspnea,
- swelling,
- other manifestations of heart failure.
Initially, they appear during physical activity, but as pathologies develop, they will begin to appear in a calm state. Among the types of heart valve defects, mitral valve prolapse is the most common. It occurs during heart contractions when the valve leaflets in the left atrium sag. The walls of the valve lose elasticity and it “leaks”. Prolapse can be primary or secondary:
- Primary prolapse refers to congenital valve defects. Connective tissue pathologies in this case are a genetic predisposition.
- Secondary prolapse is an acquired defect. It occurs due to chest injury, rheumatism or myocardial infarction.
Prolapse does not have serious health consequences, and its symptoms do not interfere with life. However, they may not appear for a long time and most often bother people in old age, which is why they are written off as “age-related.” If you do not pay attention to the symptoms in time, complications may arise, such as arrhythmia and heart failure.
Symptoms also include complaints of pain in the heart area. They arise against the background of anxiety, are not associated with physical activity and are not relieved with medication. The pain is not intense, but long-lasting, accompanied by anxiety and rapid heartbeat.
Conduction system of the heart
The heart, like any organ, has its own nervous system. The nervous system of the heart has several levels. The first and main pacemaker of the heart is the sinus node, located in the right atrium. It is subject to the atrioventricular node, which is located on the border between the atria and ventricles and quite often slows down the heart rate set by the sinus node. Then the nerve impulse goes to the ventricles of the heart along the branches of the Hiss bundle, which are divided into the smallest nerve endings - Purkinje fibers.
Diagnosis and treatment
If you or your loved ones are experiencing the symptoms described above, we recommend getting tested. During diagnosis, the doctor monitors heart parameters at rest and during exercise.
The patient is prescribed:
- daily ECG monitoring,
- echocardiography (ECHO-CG),
- chest x-ray,
- CT and MRI using special equipment that allows you to examine the heart virtually between beats.
Such diagnostics are carried out not only during the initial examination of patients with suspected disease, but also in dispensary groups of patients with an already confirmed diagnosis.
Depending on the diagnostic results, the doctor prescribes the necessary treatment: therapy or surgery.
- Therapy is aimed at preventing, preventing and alleviating relapses of the disease that became the root cause of the defect, as well as treating heart failure.
- Surgical intervention is an extreme necessity, which due to age or complications may not be prescribed for all patients.
Typically, heart valve disease is a mechanical problem that can only be solved with surgery performed by a surgeon. For stenosis, an operation is indicated to separate the fused valve leaflets and widen the atrioventricular opening - commissurotomy. If there is insufficiency, prosthetics are performed: replacement with a biological or mechanical analogue.
Heart valve surgery
Often heart defects do not manifest themselves for a long time, because the heart adapts to working under overload. In the case where the heart defect is “moderate” and does not lead to serious overload of the heart, in some cases they are limited to observation or drug therapy. But when the defect is severe, it must be treated surgically.
The following operations are performed on heart valves: reconstruction or complete replacement of a damaged valve.
Heart valve reconstruction
Sometimes during surgery it is possible to preserve the valve flaps and only correct their shape. This procedure is called valve repair.
.
Sometimes the shape of the valve can be restored by strengthening its base with threads, or by sewing a special ring to the base, while the valve’s own flaps are preserved. This procedure is called annuloplasty.
, it is possible only for the mitral and tricuspid valves.
Valve reconstruction can largely restore its function. For severe heart valve damage, valve replacement surgery may be the only treatment option. The results of these operations exceed the effect of drug therapy. Today, heart valve surgery can be performed on patients of any age group.
Access for operations on the aortic valve or on several valves simultaneously is made through an incision in the center of the sternum. When performing operations on the mitral valve, it is possible to use the “keyhole technique,” when surgical access is made through a small incision in the projection of the mitral valve: on the side and below the chest.
When it is impossible to save the leaflets of the native valve, or if they are preserved, there is a high probability of the defect returning and repeated surgery, the native valve is excised and implanted in its place
artificial
valve prosthesis
.
The most commonly performed surgeries are mitral valve reconstruction. In this case, the own valve is preserved - this is very important.
, Ross surgery is performed to treat aortic disease.
. The damaged aortic valve is replaced with the patient's own pulmonary valve, which is similar in structure, and an artificial prosthesis is implanted instead of the excised pulmonary valve.
When the aortic valve and aortic wall are damaged, it may be necessary to replace the ascending aorta with a valve-containing aortic graft
(sometimes called a conduit). In this case, not only the aortic valve is replaced, but also the adjacent ascending aorta.
Your attending physician will inform you about the possibility of reconstructive surgery on the heart valve in your case. In some cases, the question of the possibility of valve reconstruction is decided during the operation: if reconstruction is not possible, then an operation is performed to replace the damaged valve.
Diagnosis of heart valve diseases
After listening to the symptoms you describe and examining your medical record, the doctor will measure your pulse and blood pressure and listen to your heart using a stethoscope.
If your doctor suspects that you have a heart disease, he may ask you to undergo a series of special diagnostic tests that will help make an accurate diagnosis and prescribe the necessary treatment.
One of these research methods is a non-invasive method, i.e. which does not require any internal intervention.
Another type of research is invasive: with the help of instruments inserted into the body, which, as a rule, causes only minor inconvenience to the patient.
Chest X-ray
This test allows the doctor to obtain valuable information about the size of the heart, heart chambers and the condition of the lungs.
Electrocardiogram (ECG)
An electrocardiogram monitors the electrical current passing through the heart and stimulates the chambers to contract. An ECG is especially useful in diagnosing abnormal heart rhythms and rates.
These studies also show muscle enlargement or damage, and the presence of congestion on one side or another of the heart.
Echocardiogram (EchoCG)
This test is carried out using a “small” microphone placed on the surface of the chest, which emits high-frequency sound waves.
Sound waves are reflected back (hence the term "echo") from each layer of the heart wall and valves and then displayed on a monitor screen. The “echo” image from different points allows you to see a cross-section of the heart at the moment of its operation.
During the echo, the speed of blood flow is also recorded, the direction of blood movement is monitored: is the blood moving in the normal forward direction or is there a reverse movement (as in the case of valve insufficiency).
A narrowed (or stenotic) valve causes increased blood flow. The degree of valve stenosis is in many cases accurately determined by the increased blood flow velocity.
This test will not only show how the heart valves work, it will also provide useful and comprehensive information about the size of the heart chambers, as well as the thickness and function of the heart muscle.
Cardiac catheterization and angiogram
These tests are done by inserting a thin, hollow tube (catheter) through a vein or artery in the arm or groin area and into the chambers of the heart, using X-rays.
During catheterization, the pressure in the chambers of the heart is measured and the volume of blood in the bloodstream is determined.
Angiography consists of the injection of a radiopaque contrast agent, which is visible using X-rays and allows you to evaluate the work of the heart in pumping blood, the function of the valve and the patency of the arteries (coronary) that supply blood to the heart muscle.
Despite the fact that similar studies have been routinely carried out before, it is not at all necessary that they are needed in your case if the information obtained by echocardiography is complete and accurate.
In many cases, the only invasive test required before surgery is a coronary angiogram if it is determined that the patency of one or more arteries is impaired.
If there are blockages in the coronary arteries, the doctor will usually perform bypass surgery at the same time as heart valve surgery.
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How to recognize prolapse?
Since in the first and second degrees the disease can occur without symptoms, you need to contact a good cardiologist in Rostov (Western) to diagnose it. A doctor can determine congenital prolapse by a number of external signs, including: above average height and elongated limbs, as well as hypermobile joints.
When visiting a cardiologist, the patient can list the following complaints, after which the doctor will prescribe an ultrasound scan:
- Frequent dizziness and faintness;
- The appearance of shortness of breath;
- Arrhythmia and interruptions in cardiac function;
- Fatigue and panic attacks;
- Chest pain.
In this case, the cardiologist will write a referral and tell you how much an ultrasound will cost to make a diagnosis. You will also need to do an x-ray and an ECG. Daily monitoring of cardiac activity and bicycle ergometry are prescribed.
The reason for clarifying the cost of ultrasound will also be noises that the doctor may detect at the appointment. To establish their cause, you will also need to do ultrasound diagnostics.
