心脏瓣膜疾病

The heart has two halves, a left and a right, each with two chambers – the atrium and the ventricle. Between the chambers are the heart valves which ensure the blood runs only in one direction.

 

There are also heart valves situated between the ventricles and the major arteries – the aorta and pulmonary artery – where they have the same function.

Failure in a valve in the left side of the heart – the aortic or the mitral valve – results in left-sided heart failure. This leads to an accumulation of fluids in the lungs or pulmonary edema.

Valve diseases of the right side of the heart – the pulmonary and tricuspid valve – are rare but can occur as the result of some forms of congenital heart disease or long-term left-sided heart failure. Right-sided heart failure is characterized by fluid accumulation in the body, 尤其是腿部, 腹腔和肝脏.

Malformation of the heart valves can be divided into two categories: narrowed (stenosed) valves and leaking (regurgitant) valves – or a combination of both.

什么导致心脏瓣膜病?

缩小了阀门

这可能是由于:

  • 先天性异常
  • degeneration through atherosclerosis (aortic stenosis only)
  • 风湿热造成的损害
  • excessive calcification in old age (aortic stenosis only).

阀门泄漏

这可能是由于:

  • 瓣膜的细菌感染或发炎
  • excessive floppiness of the leaflets (mitral valve prolapse)
  • enlargement of the heart or aorta – the main blood vessel into which the left ventricle pumps.

What does a malformation of the heart valve feel like?

在温和的情况下, there are no symptoms and generally no cause for worry, although antibiotic treatment to prevent the risk of a valve infection is recommended, 例如 to cover a dental procedure when there is a chance that there will be some bacteria introduced into the bloodstream temporarily.

Serious cases may not be evident for a long time either. There may be no symptoms, even though the heart is already under strain. 主动脉瓣狭窄的病例, it is important to be aware of the following possible symptoms, since this condition may result in sudden death:

  • dizziness or a faint brought on by physical effort
  • 呼吸急促(气促)
  • 用力时心绞痛(胸痛).

医生是如何作出诊断的?

The diagnosis is based on the patient’s case history, examining the heart and by using a stethoscope to listen for any abnormal sounds or murmurs coming from the heart valves or heart muscle.

看看畸形是否严重, the doctor can refer the patient for further examinations, such as echocardiography and cardiac catheterisation.

超声心动图
  • 这是心脏的超声波扫描图. It gives an accurate measure of the degree of the leak and/or stenosis, whether the heart’s pumping ability is impaired and can often give the exact cause of the valve disease.
心导管检查
  • 心房的压力, the ventricles and the great vessels – the aorta and pulmonary artery – is measured using catheters. Through injecting a dye which is visible on an X-ray, the doctor can also assess the degree of the leakage.

医生能做什么?

The doctor can try to find the cause of the valve malformation, or refer the patient to the hospital for further investigation and possible treatment.

使用哪些药物?

预防感染
  • An abnormal valve is more likely to become infected with bacteria. 这可能发生, 例如, if bacteria enters the bloodstream during surgical procedures, 心导管或牙科治疗.上一页entive treatment with antibiotics (such as amoxicillin) is suggested if the patient needs to have any kind of treatment likely to introduce bacteria into the blood.
治疗症状

Diuretics help the body to excrete excessive salts and fluid through the kidneys:

  • Loop diuretics, which have a strong effect, are the main type used
  • Potassium-sparing diuretics may be given to complement the loop diuretic
  • A thiazide-diuretic may be used as an additional diuretic if heart-failure symptoms are severe.
Medicines to improve a poor heart function such as ACE inhibitors or angiotensin-II receptor agonists (ARAs), help the heart work more effectively in the presence of a leaky valve.
Warfarin may be used to ‘thin’ the blood if there is an increased risk of blood clot development.
Nitrate-preparations and vasodilators to relax and dilate the arteries. These are used if the patient cannot tolerate ACE inhibitors or ARAs.

进一步发展和治疗的可能性

A serious untreated malformation can lead to heart failure. Significant valve defects can be treated surgically either by replacement with an artificial valve or by repairing the affected valve (usually specific to the mitral valve).

在这种类型的操作之后, it is necessary to take anti-clotting medication such as warfarin – sometimes permanently, depending on the type of surgery performed and the type of valve replacement.

如果病人不适合做手术, because of another coexisting illness or end-stage heart failure, 药物可以减轻心力衰竭的症状.

基于Dr. Sabine Gill和Dr. Steen Dalby Kristensen

心脏监控器哔哔声

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