Heart Defects in Adults

Apr 7, 2012 , Translated by Kristina Knazko

srdecni-vady-v-dospelosti.jpg - kopie
srdecni-vady-v-dospelosti.jpg - kopie
Heart defects in adults can be congenital or acquired. Congenital include those that were not detected during childhood. Acquired heart defects in adults typically mean defects of the valves separating individual parts of the heart. Heart defects in adults come in varying severity and manifestations. In the case of valve defects, severity and symptoms depend on which valve is affected and to what extent. The most common valve defects are narrowing of the aortic valve and narrowing and incompetence of the mitral valve.

Heart Defects in Adults

Adult heart defects primarily include acquired valve defects. The presence of congenital heart defects in adults is quite rare nowadays due to prompt surgical treatment immediately after birth or in early childhood. However, it is possible that a congenital heart defect was not detected in childhood and is subsequently diagnosed in adulthood.

Congenital Heart Defects in Adults

There are a number of congenital heart defects that manifest immediately after birth. These usually require immediate surgery. However, sometimes a defect is not diagnosed, and is revealed only in adulthood.

  • Manifestations of congenital heart defects in adults include shortness of breath, fatigue, decreased performance and a heart murmur. Depending on the type of defect, the individual may experience cyanosis (bluing of the lips and finger tips) as well.
  • Diagnosing the type of congenital heart defect in adults is done by a cardiologist; a doctor specialized in heart diseases and defects.
  • Treatment of heart defects is usually surgical and the responsibility of a cardiologist.

The most common congenital heart defects in adults according to frequency are:

  • Atrial septal defect, an opening between the right and left atria
  • Ventricular septal defect, an opening between the ventricles
  • Open ductus artery connecting the aorta and pulmonary artery
  • Tetralogy of fallot

Acquired Heart Defects in Adults

Acquired heart defects in adults typically include valve defects. Valves prevent backflow of blood inside the heart. They also help deoxygenated blood flow from the right atrium into the right ventricle, and from there through the pulmonary artery into the lungs. Here the blood is oxygenated and flows through the pulmonary veins into the left atrium and ventricle, from where it is expelled into the aorta and distributed throughout the body. The human body is exposed to various harmful effects during its life-time which can damage the valves in the heart.

The Emergence of Valve Defects in Adults

Damage to the valves occurs with rheumatic fever, can develop as a consequence of various cardiac infections or the valves can simply degenerate over the years and gradually calcify. Severe valve defects can develop as a result of myocardial infarction. Sometimes the cause of valve failure may be advanced atherosclerosis, and less often by diseases of the connective tissue or other diseases. Some heart defects do not necessarily manifest in adults and can be the result of an incidental finding during an unrelated heart exam.

Types and Symptoms of Valve Defects

Valve defects are the most common heart defects in adults. Valves can be damaged in the sense of their narrowing, which restricts blood flow from one chamber into another, or the valve does not work properly in the sense that blood returns back into the previous chamber. Because there are a number of valves in the heart, symptoms depend on which valve is affected.

  • The most common heart defect in adults is aortic stenosis; narrowing of the aortic valve. It develops as a result of calcification, preventing the cusps from moving. The problem causes incomplete blood flow from the left ventricle into the aorta. The blood pressure in the aorta is so weak that insufficient amounts of oxygenated blood reach the body. Low blood pressure results in restricted blood flow to the brain, causing dizziness and fainting. Because the heart works against increased resistance due to the narrowed area, it is strained. This leads to thickening of the muscle in the left ventricle, which causes higher demands on the flow of oxygenated blood from the coronary arteries. Flow of oxygenated blood to the cardiac cells may not be sufficient in this case and leads to manifestations such as chest pains and the emergence of angina pectoris. Heart failure can occur during long-term excessive stress. The solution for this defect is open heart surgery, or special treatment methods performed by an invasive cardiologist.
  • Another defect is aortic valve incompetence. This type of defect develops from a number of causes, such as endocarditis, rheumatic fever as well as aortic dissection or Marfan's syndrome. Valve incompetence means that the valve in not able to close completely, leading to backflow of blood (regurgitation). This causes strain on the left ventricle. Symptoms are similar to aortic stenosis.
  • Mitral stenosis, narrowing of the bicuspid valve situated between the left atrium and left ventricle, is quite rare nowadays. This causes accumulation of blood in the right atrium, increasing pressure inside it and leading to its distention. This is transferred to the pulmonary vein, lungs and often to the right half of the heart as well. Blood clots often form in the distended left atrium, which can cause a brain or pulmonary embolism.
  • Mitral incompetence develops during failure of the left heart, or during disease of the cusps of the valves. This causes backflow of some of the blood from the left ventricle to the left atrium, decreasing the volume of blood being expelled into the body. It is usually manifested by shortness of breath and a heart murmur.
  • Tricuspid valve narrowing and incompetence, situated between the right atrium and right ventricle, is one of the rarest illnesses. Its narrowing often develops following prolonged rheumatic fever, and incompetence during right ventricle failure usually occurs during the transfer of stasis from left-sided defect.
  • Acquired pulmonary valve defects are extremely rare.

Diagnosing Heart Defects in Adults

When diagnosing congenital heart defects in adults, an ECHO (echocardiograph) must be performed. This is an ultrasonic examination of the heart, where ultrasounds penetrate varying depths into tissues and their reflections create an image. An ECHO enables determination of the size of the heart, including its chambers, the condition of the valves and blood flow. A physical examination can reveal an acquired congenital heart defect when a doctor detects a heart murmur. An ECHO is used to confirm the diagnosis. If unsure, a heart catherization can be performed where thin tubes are introduced into the heart.

Treatment of Heart Defects in Adults

Congenital heart defects in adults usually require surgery. Surgery is performed by a specialist in cardiac surgery whose responsibility is to remove the heart defect. In the event of less severe valve defects, treatment can be pharmacological, i.e. by the administration of medications preventing the development of atrial fibrillation, blood clots and hypertrophied ventricles. Significant valve defects need to be surgically treated, where a valve replacement is usually performed. In certain cases, plastic surgery of the valve may be possible, enabling valve repair without the implantation of a prosthetic.

Prognosis of Heart Defects in Adults

Individuals suffering from certain heart defects can usually live relatively normal lives. Often, however, symptoms of these defects restrict the patient. Prognosis varies with different heart defects, especially depending on the degree of disability. Without correct and prompt treatment, a patient's prognosis may be very poor and in the most severe cases, the patient may be at risk of death following acute heart failure.

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