心瓣膜病,老年性心瓣膜病,老年心衰

老年性心瓣膜病可以并发哪些疾病?

老年性心瓣膜病可以并发出现心律失常、心力衰竭、钙化性主动脉瓣闭锁不全、钙化性主动脉瓣狭窄、感染性心内膜炎、脑血管意外等并发症。

  1. 心律失常 – 退行性心脏瓣膜病患者约80%存在心律失常,常见有:房性心律失常、房室传导阻滞、病态窦房结综合征。严重的心律失常可导致心力衰竭甚至猝死。一项对88例退行性心脏瓣膜病患者分析表明,并发心律失常者占56.8%,其中房颤占23.9%,期前收缩占17%,束支传导阻滞占11.4%,房室传导阻滞占4.6%。
  2. 心力衰竭 – 有报道显示35%~50%患者有充血性心力衰竭表现,心功能多在Ⅱ~Ⅲ级之间。另一项研究表明,62.5%的退行性心脏瓣膜病患者发生心力衰竭,其中绝大多数为左心衰,合并心力衰竭患者的年病死率达15%。
  3. 主动脉瓣闭锁不全 – 由于瓣膜的钙化、僵硬、变形,最终导致瓣膜闭锁不全或狭窄。有报道显示,退行性心脏瓣膜病患者中,主动脉瓣钙化者占69.2%,合并主动脉闭锁不全者占37.2%。
  4. 主动脉瓣狭窄 – 流行病学资料显示,65岁以上老年人中,主动脉瓣钙化引起狭窄的占2%~9%,75岁以上老年人中轻中度钙化性主动脉瓣狭窄者占5%,重度狭窄者占3%。随着年龄的增加,平均每年主动脉瓣口面积会减少0.1cm2。
  5. 心脏性猝死 – 是退行性心脏瓣膜病最严重的并发症,由于退行性心脏瓣膜病可引起致命的心律失常、心力衰竭、瓣膜狭窄与闭锁不全,因此猝死的发生并不少见,据报道约有20%~25%退行性心脏瓣膜病患者易发生猝死。
  6. 感染性心内膜炎 – 由于退行性心脏瓣膜病检出率不断增高,由本病引起的感染性心内膜炎的发生率较以往有所增加,有报道为15%。
  7. 神经系统并发症 – 有资料显示,一旦二尖瓣环钙化,则心源性栓塞性卒中的危险性增加2~4倍。国内的一项研究证实二尖瓣钙化并发脑梗死者占26.8%,说明二尖瓣钙化是血栓形成的基础。

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