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Journal of V. N. Karazin KhNU. 2016
UDC: 616-01
THE IMPORTANCE OF TIMELY TREATMENT OF THE CAUSES OF HEART FAILURE ON THE EXAMPLE OF THE CLINICAL CASE
Sharif B. J. R., Liuta E. A.
V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
Acquired heart disease complicated by chronic heart failure (CHF), which significantly impairs the quality of life of patients and worsens the prognosis and remains radical surgical treatment with implantation of prosthetic valve. On the example of a clinical case are shown and discussed the results of a late replacement of the mitral valve in patient with acquired heart defect.
KEY WORDS: prosthetic valve, heart failure, acquired heart defect
ВАЖЛИВ1СТЬ СВОеЧАСНОГО Л1КУВАННЯ ПРИЧИН СЕРЦЕВО1 НЕДОСТАТНОСТ1 НА
ПРИКЛАД1 КЛ1Н1ЧНОГО ВИПАДКУ
Шарiф Б. Дж. Р., Люта €. А.
Харювський нацюнальний ушверситет iMeHi В. Н. Каразша, м. Харюв, Украша
Набуп вади серця ускладнюються хрошчною серцевою недостатнютю (ХСН), яка значно порушуе якють життя пащенпв та попршуе прогноз. Радиальним залишаеться хiрургiчне лшування з iмплантацiею штучних клапашв.
На прикладi клiнiчного випадку демонструються та обговорюються результати тзньо! замiни мiтрального клапану у пащентки з набутою вадою серця.
КЛЮЧОВ1 СЛОВА: протезування клапану, серцева недостатшсть, набута вада серця
ВАЖНОСТЬ СВОЕВРЕМЕННОГО ЛЕЧЕНИЯ ПРИЧИН СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ НА ПРИМЕРЕ КЛИНИЧЕСКОГО СЛУЧАЯ
Шариф Б. Дж. Р., Лютая Е. А.
Харьковский национальный университет имени В. Н. Каразина, г. Харьков, Украина
Приобретенные пороки сердца осложняются хронической сердечной недостаточностью (ХСН), которая значительно нарушает качество жизни пациентов и ухудшает прогноз. Радиальным остается хирургическое лечение с имплантацией искусственных клапанов.
На примере клинического случая демонстрируются и обсуждаются результаты поздней замены митрального клапана у пациентки с приобретенным пороком сердца.
КЛЮЧЕВЫЕ СЛОВА: протезирование клапана, сердечная недостаточность, приобретенный порок сердца
INTRODUCTION
Chronic heart failure (CHF) is an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues, despite normal filling pressures (or only at the expense of increased filling pressures) [1]. Chronic heart failure (CHF) developing on the background of
acquired heart defects can be cured only by surgery - a valve replacement.
Even in the event of a delay in seeking surgical treatment, this tactic is optimal for the stabilization stage heart failure and to prevent progression of the disease.
It's much better to do replacement of valve later and prevent progression of CHF stage than not to do it at all [2].
The need for timely treatment, we demonstrated on the example of clinical case.
© Sharif B. J. R, Liuta E. A., 2016
Series «Medicine». Issue 31
OUR PATIENT
70 years old woman, pensioner, worked as a salesman, city resident. Date of admission: 10 -October - 2015.
COMPLAINTS
Fatigue, dyspnea (paroxysmal nocturnal dyspnea (PND)), tachycardia, palpitation, nocturia, dizziness.
ANAMNESIS MORBI
These symptoms bother the patient more than 10 years. In 2012 complaints (symptoms) were worsened, because of this, the patient admitted to Institution of general and urgent surgery V. T. Zaycev NAMS of Ukraine. After lab-tests and instrumental examination the diagnosis was: Combined mitral valve disease with predominance of insufficiency.
Results of echocardiography before surgery (04.10.2012): Combined mitral valve disease with predominance of insufficiency (MV Hg 3+), S of MV = 2,8 cm2. Dilatation of left atrium (4,3x5,2 mm) and left ventricle. Pulmonary hypertension (Hg 40 mm). EF = 77 %.
09.10.2012 the patient underwent mitral valve replacement with mechanical prosthesis St. Jude Medical № 27. The patient has taken all drugs that were prescripted after the surgery. This hospitalization is after increasing in data complaints.
ANAMNESIS VITAE
There was rheumatic fever attack in childhood. She had felt pain in the joins of lower extremities and got a temperature after sore throat. She don't remember which treatment had got. Heart murmur had detected in the survey in adulthood. Other infections, injuries, tuberculosis, sexually transmitted diseases were denied. Hereditary diseases are not identified. Allergological history is not burdened.
OBJECTIVE STATUS
General condition-moderate grave, Conciseness - clear, posture - active, body position - sitting on the chair. Patient can orientate herself in place, time, her personality. Height - 158 sm, weight - 63 kg, BMI - 25,2. Skin and mucosae are pale pink, with redness on the nose. Thyroid: no pathological changes. Skeleto-muscular system - deformity of the
chest after sternotomy. BR - 22-24/min. Lung percussion: intermediate below scapula angles from both sides. Lung auscultation: decreased vesicular breathing, wheezes inferior parts both sides. Borders of the heart: left border - outside of midclavicular left line on 2 cm. Heart auscultation: rhythmic, heart tones - muffled, tone of mechanical valve, accentuated S2 over pulmonary artery. Pulse - rhythmic, 64 bits/min, BP 100/70 mm Hg. Abdomen: normal size, symmetric. Liver: liver margin is 1,5 cm below right rib cage. Spleen: normal. Pasternatsky symptom - negative from both sides. Edemas: absent. Varicose vein disease of lower extremities - absent. Stool: normal, everyday, dark color.
PLAN OF SURVEY IN THE HOSPITAL
Clinical blood test (CBT) and urine analysis, kidneys and liver function tests, electrolytes, lipid profile, INR - international normalized ratio, rheumatic factor, antistreptolysin O, electrocardiography(ECG), chest X-ray, echo-cardiography with Doppler.
RESULTS
Clinical blood test: Normal BC.
Urine analysis: Normal urine test.
Biochemistry test: The increased creatinine and decreased glomerular filtration rate (CKD-EPI GFR) that complies with chronic kidney failure stage 3.
Lipid profile: Hypercholesterolemia Ila type.
Electrocardiography: Regular sinus rhythm with heart rate 59/min. Deviation of electric axis to the left. Left ventricular hypertrophy.
Chest x-ray: Hypoventilation of the lungs. Pulmonary congestion. Pulmonary hypertension.
Heart ultrasound: Status after mitral valve replacement (prosthetic valve) (2012). The prosthesis is functioning correctly.
COMPLETE DIAGNOSIS OF OUR PATIENT
Mechanical prosthesis of mitral valve bileaflet type (09/10/2012) about combined mitral valve disease with predominance of insufficiency. Congestive heart failure with preserved left ventricular pump function (ejection fraction = 76 %), III C functional class by NYHA. Chronic kidney failure Stage 3. Atherosclerosis. Hyperlipidemia IIa type.
Journal of V. N. Karazin KhNU. 2016
TREATMENT
Dietary sodium and fluid restrictions should be implemented in all patients with congestive heart failure. Limiting patients to 2 g/day of dietary sodium and 2 L/day of fluid will lessen congestion and decrease the need for diuretics.
Warfarin 5 mg 1 time/day, spironolactone 25 mg 1 time/day, ramipril 2.5 mg 1 time/day, bisoprolol 2.5 mg 1 time/day, torasemide 10 mg 1 time/day, atorvastatin 40 mg 1 time/day.
REFERENCES
CONCLUSIONS
There is 3 years after surgical treatment of patients with replacement of the mitral valve there was stabilization of heart failure without signs of involution.
Clinical case shows that it is better later surgery, than not to do it at all. For creative development of CHF is required, however, as possible earlier intervention.
1. 2012 ESH/ESC Guidelines for the management of the diagnosis and treatment of acute and chronic heart: the task force for the diagnosis and treatment of acute and chronic heart failure of the Heart Failure Association (HFA) and the European Society of Cardiology(ESC) // European Heart Journal. - 2012. -Vol. 33, Is. 10. - P. 1787-1847.
2. 2012 ESH/ESC Guidelines for the management of valvular heart disease: The joint task force on the management of valvular heart disease of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of 12 Cardiology (ESC) // European Heart Journal. - 2012. - Vol. 33, Is. 10. -P. 2451-2496.
