1、 What is aortic valve insufficiency?
Aortic valve regurgitation refers to the reflux of blood from the aortic valve during diastole to the left ventricle, mainly caused by lesions in the aortic valve itself and/or aortic root disease. Patients often have dizziness, palpitations, dyspnea and other symptoms. In severe cases, they may cough pink foam sputum, dyspnea, and paroxysmal sitting breathing at night.
2、 Clinical manifestations of aortic valve insufficiency?
Usually, patients with aortic valve insufficiency have no symptoms for a long time. Even for those with obvious aortic valve insufficiency, the onset of obvious symptoms can last for ten to fifteen years. Once heart failure occurs, it can progress rapidly.
The clinical manifestations of aortic valve insufficiency include: 1. Palpitation.
2、 Difficulty breathing.
3、 Chest pain.
4、 Fainting.
5、 Other symptoms include fatigue, significant decrease in activity endurance, paroxysmal nocturnal dyspnea, or nighttime angina attacks.
When acute aortic valve insufficiency occurs, sudden increase in left ventricular volume load, wall muscle tension, and left ventricular dilation can quickly lead to acute left heart failure or pulmonary edema.
3、 Treatment of aortic valve insufficiency
1. Internal medicine treatment: Avoid excessive physical labor and vigorous exercise, limit sodium intake, and accurately record 24-hour water intake and outflow. The use of digitalis drugs, diuretics, and vasodilators, especially angiotensin-converting enzyme inhibitors, can help prevent deterioration of heart function. Patients with poor heart function should use drugs such as milrinone and levosimendan.
2. Surgical treatment of artificial valve replacement is the main method for treating aortic valve insufficiency, which should be performed before the onset of heart failure symptoms. For valve patients with heart failure, it is necessary to maintain a negative level of water inflow and outflow for 24 hours, maintain the balance of water and electrolytes in the body, and timely supplement potassium ions.
Surgery is divided into valve replacement surgery and valve shaping surgery. If the valve disease is severe, with severe fibrosis and calcification, the valve needs to be removed for valve replacement surgery. If the valve disease is mild and the mobility is good, repair the valve using the patient's own tissue and some artificial substitutes to restore its function, and perform valve repair surgery.
Replacement surgery is divided into biological valve and mechanical valve. Biological valve: a valve that is closer to the human body. Advantages: No need for lifelong anticoagulation. Usually it only takes 3-6 months. Disadvantage: Not durable. The general lifespan is around 15 years. Therefore, biological valves are generally suitable for elderly people over 60 years old.
Mechanical valve: made of carbon or other materials.
Advantages: Long service life, can be used for life without replacement.
Disadvantages: Need to take warfarin for life
III. What are the medication treatments for aortic valve insufficiency?
1、 The main method of anticoagulant therapy is oral anticoagulant pills. The commonly used anticoagulant is warfarin sodium, which is usually taken orally after removing the endotracheal tube after surgery or 48 hours after surgery according to medical advice. In order to ensure the accuracy of drug application, blood tests for prothrombin time and activity should be taken daily in the morning during the first week after surgery. From now on, check 2-3 times a week, gradually extending to once a month or once in February. Maintain the international standard ratio (INR) at 2.0-3.0.
2、 Mastering the factors affecting anticoagulant therapy
1. Enhancing the anticoagulant effect of warfarin ① Medications: Long term use of broad-spectrum antibiotics, cimetidine, steroids, quinidine, platelet drugs, aspirin, diclofenac, and Panadol. ② Liver function impairment, insufficient synthesis of thrombin, and biliary tract lesions. ③ Alcohol can enhance its anticoagulant effect, so one should quit drinking.
2. Reduce the anticoagulant effect of warfarin ① Medications: vitamins K1, K3, sleeping pills, estrogen, rifampicin, oral contraceptives, etc. ② Eat a large amount of foods containing vitamin K1, such as spinach, vegetables, carrots, tomatoes, fresh peas, and pork liver. ③ Input fresh blood.
3、 Mastering common complications and coping measures during anticoagulant therapy
1. Bleeding or oozing: The main complications of anticoagulant therapy are bleeding, such as skin bruising, gum bleeding, nosebleeds, hematuria, melena, vomiting blood, excessive menstrual flow, etc. The above bleeding conditions should be immediately rechecked with PT and INR values, and adjusted according to laboratory results. If there is intracranial bleeding, intra-abdominal bleeding, etc., medication must be stopped and hospitalization must be carried out, or vitamin Kl should be used. After the symptoms disappear, anticoagulant therapy should be resumed based on laboratory results.
2. Embolism: It is another complication of anticoagulant therapy, such as limb artery embolism, which can cause movement disorders, local pain, sensory abnormalities, poor peripheral circulation, weakened or absent arterial pulsation; If cerebral embolism occurs, symptoms such as headache, vomiting, hemiplegia, and coma may occur. Emergency medical attention and active treatment should be sought.
4、 Precautions for anticoagulant therapy
1. Regularly review coagulation indicators.
When changing the batch number or switching to another anticoagulant during the use of anticoagulants, it is necessary to promptly review the coagulation indicators, closely observe, and adjust the dosage. It is recommended to take warfarin sodium from the same manufacturer.
3. Pay attention to whether there are signs of excessive anticoagulation. Urgently check coagulation indicators when necessary.
4. Take medication on time, with accurate dosage and careful recording.
5. Try to avoid external injuries as much as possible.
6. Young women should pay attention to contraception, but women in the reproductive period can become pregnant under the guidance of a doctor 2-3 years after valve replacement surgery. Moreover, using warfarin alone at a dosage of less than 5mg/d is relatively safe and convenient for pregnant women, and the fetal malformation rate is very low.
7. In case of special circumstances such as tooth extraction or elective surgery, anticoagulants should be reduced under the guidance of a doctor.