mitral insufficiency - is a type of defect of the myocardium, which is characterized by incomplete prolapse or by closing the valves of the left atrioventikulyarnogo valve during systole.Regurgitation occurs at each ventricular contraction.The most common type of disorders of the heart valve - a just mitral insufficiency.The disease is found in 50% of people with the presence of heart defects.Basically, mitral insufficiency detected simultaneously with mitral stenosis (right atrioventricular opening is narrowed).Also, there are patients with only one disease - mitral insufficiency.
clinical picture is markedly different in chronic and acute mitral insufficiency of the pathophysiological.The basis of hemodynamic disturbances is mitral regurgitation.The chronic form of mitral insufficiency is shown in the initial stage in afterload.
Causes of mitral insufficiency
mitral regurgitation on the rate of development is divided into chronic and acute form.
acute form of mitral insufficiency is formed within a few hours or minutes after the appearance of:
- rupture of tendon chords (the thread that connects the heart muscle with papillary - internal muscle infarction, due to which the traffic moves the valve leaflets) due to inflammation of membranes infarction (internal), chest trauma, etc .;
- a sharp expansion of the fibrous ring (myocardial infarction) - a dense ring, which is located inside the myocardial wall.Damper blades attached thereto;
- the defeat of the papillary muscles, causing myocardial infarction (due to the cessation of blood flow to heart muscle tissue dies).
- break mitral valve, causing infective endocarditis;
- surgical separation of the leaflets of the mitral valve stenosis.
Chronic mitral insufficiency develops over several months or years due to reasons:
- inflammatory diseases.For instance, rheumatism and various immune system disorders (scleroderma, lupus erythematosus);
- degenerative diseases (inborn errors of structure of certain organs): myxomatous degeneration of the mitral valve (mitral valve thickened or reduced density), Marfan syndrome (a disease of connective tissue, which is inherited);
- communicable diseases (infectious endocarditis - the inner membrane of the heart is inflamed), structural changes (broken structures implanted artificial valve or tearing of the papillary muscles and tendon chords);
- congenital structural features of the mitral valve (shape changes, cracks appear, etc..).
Directly from the time of occurrence of mitral regurgitation is divided into acquired and congenital form.
As a result, the impact of negative factors on the body of a pregnant woman - infectious diseases, radiological or radiation and other developing forms of congenital mitral regurgitation.In the case of adverse factors in the adult - cancer and infectious diseases, injuries, there is acquired mitral insufficiency.
disease due to the formation of divided:
- organic form (backflow of blood into the atrium from the ventricle due to the fact that the butterfly valve is damaged it during the contraction of the ventricles closes the left atrioventricular opening is not complete)
- relative or functional mitral regurgitation.If the butterfly valve is unchanged, and the left atrium from the left ventricle in the opposite direction enters the blood, it is due:
- with stretching of the fibrous ring and the expanded left ventricle;
- changed the tone of the papillary muscles (inside the heart muscle, which allows the movement of the leaflets);
- chord elongated or torn.
Quite often people with a congenital form of the disease.In 14% of cases of isolated mitral insufficiency is caused by rheumatic disease form infarction.In 10% of patients with myocardial infarction reveal ischemic dysfunction of the mitral valve.Also, due to any defect of the system connective tissue developing mitral regurgitation (Ehlers-Danlos syndrome or Marfan syndrome).
Relative mitral regurgitation is formed even in the absence of damage to the valve during ventricular dilatation (left) and advanced fibrous ring.Such changes can be found in myocarditis, coronary heart disease, aortal heart disease and hypertension.
Rarer causes of mitral regurgitation is hypertrophic cardiomyopathy and myocardial wall calcification.When parashyutovidnyh deformations of the valve, the splitting of the mitral leaflets and fenestration developing mitral insufficiency congenital form.
Symptoms of mitral insufficiency
period of compensation may last for several years and may not manifest clinically.Period subcompensation manifested by subjective symptoms: hemoptysis, cough, anginal pain, tachycardia, fatigue, shortness of breath.If the pulmonary circulation increases venous stasis may be an attack of cardiac asthma (usually at night while you sleep).The patient will complain about the appearance of shortness of breath while at rest.
Initially, the cough is dry, then there is a small amount of mucus with blood in the case of increase of the severity of blood stasis in the vessels of the lung.Also, when vessels of the lungs occurs congestion, shortness of breath.
right heart failure clinically akrotsionozom, peripheral edema, enlarged liver, swollen cervical veins, ascites.Ortner Syndrome (Athos), or hoarseness occurs in the case of compression of the pulmonary trunk.Atrial fibrillation patients detected in 50% of cases of mitral insufficiency.
also experience the following symptoms of mitral insufficiency: due to violation of the distribution of blood in the body decreases performance, general weakness.
With the development of anemia symptoms of mitral insufficiency are as heart palpitations, feeling fade attack or irregular heartbeat, and upheavals in the left side of the chest.
With the progression of the disease occurs vice pale type.It is possible the emergence of acrocyanosis and cyanosis of the lips.Blood pressure and heart rate did not change.
Patients with mitral insufficiency did not turn to professionals because they are not experiencing discomfort as possible hearts for a long time successfully compensated.The disease accompanied by a gradual increase in the left ventricle, since he has to pump more blood.As a result, after a long time, the patient begins to feel palpitations, especially lying on his side.
left atrium will be gradually increased in order to accommodate the extra blood from the ventricle, thereby reducing happen too quickly and adversely affect the performance due to atrial fibrillation.Because of abnormal heart rhythm is disturbed muscle pumping function of the myocardium.Instead of atrial declined, they tremble.Impaired blood flow usually leads to the formation of blood clots.It is possible appearance of edema in the lower extremities.
However, all of these symptoms do not play in this case a large role in the diagnosis, since all signs are characteristic of the presence of other heart defects.
degrees of mitral insufficiency
mitral insufficiency is divided into three levels.
♦ mitral regurgitation 1 degree is formed if there is an infectious myocarditis, syphilis, tuberculosis, rheumatic fever, atherosclerosis, and other processes occurring for a long time, which relate to organic disease.Infarction, cardiomegaly, hypertension (combination of heart defects), causing functional impairment and lead to the fact that the fibrous ring expands.
X-rays to determine the pulmonary hypertension and pulmonary congestion excessive blood.A study of intracardiac (ventriculography) will determine the level of return blood volume and ventricular filling.
ejection of blood (abnormal) into the left atrium from the ventricle leads to volume overload, resulting in increased retrograde pressure in the pulmonary circulation.In the future, it is possible the development of pulmonary hypertension.Mitral insufficiency 1st degree difficult to diagnose.
Symptoms of mitral insufficiency of first degree are as follows: the presence of systolic murmur in the upper part of the heart, abnormal phenomenon in the fourth intercostal space is heard well, the pulse wave is growing rapidly in the carotid arteries, weakened I heart sound at pulmonary artery II tone is enhanced and it is possible the emergence III tone.At the top there is a systolic heart trembling on palpation and a sense of displacement left apical impulse.Also, increased body weight, liver, swelling and appear at later stages of the neighboring organs are squeezed.
mitral insufficiency of first degree clinically fatigue even in the case of minor physical activity, stagnation in the lungs, shortness of breath and coughing up blood, which disappears at rest.The thickening of the valve leaflets, tendons and sagging of the walls as is typical for first degree of mitral insufficiency.
♦ 2 degrees of mitral insufficiency is characterized by the fact that developing venous pulmonary hypertension passive form.This degree is clinically manifested by a number of signs of impaired circulation: hemoptysis, heart attack of asthma, cough, palpitations will become more frequent, even at rest, shortness of breath.
diagnostic study shows expansion of the boundaries of the heart to the left of 2 cm, and 0.5 cm on the right, on top of the systolic murmur.Altered atrial components can be detected when carrying out an electrocardiogram.
♦ mitral regurgitation grade 3 is characterized by the development of right ventricular hypertrophy.This degree of clinically enlarged liver, edema, venous pressure rises.
During the examination can reveal that systolic murmurs are more intense and the borders of the heart muscle is significantly expanded.Electrocardiographic examination reveals left ventricular hypertrophy and a sign of the presence of mitral teeth.
prognosis of mitral regurgitation will entirely depend on the dynamics of the disease, how much pronounced valve defect and the degree of regurgitation.Severe mitral regurgitation can quickly lead to severe circulatory disorders.If
joined chronic heart failure, the prognosis is clearly unfavorable.Severe mitral regurgitation may result in death.Moderate mitral insufficiency allows an individual to keep working for a long time with regular monitoring by a cardiologist.
treatment of mitral insufficiency
Before you pick up a patient individual treatment, it is necessary to find out the cause of the disease.For complete recovery is necessary to eliminate the underlying disease, which contributed to the development of mitral insufficiency.In the case of moderate mitral insufficiency, special care is required.
To reduce the heart rate, arrhythmia and atrial fibrillation will be assigned to drugs.Moderate mitral insufficiency is primarily required to limit the emotional and physical stress.In case of bad habits (alcohol and tobacco,), it is necessary to give them up and lead a healthy lifestyle.
If the patient revealed an acute form of mitral insufficiency, appointed diuretics and peripheral vasodilators.In order to stabilize the hemodynamics specialists perform IABP.
If the patient subcompensated stage of mitral insufficiency, appointed diuretic drugs, cardiac glycosides, vasodilators, beta-blockers, ACE inhibitors.In the case of atrial fibrillation appointed indirect anticoagulants.If mitral regurgitation infectious nature, the patient is prescribed antibiotics: medications containing magnesium, vitamin complex (B1, B2, PP).As a rule, a regurgitation of mitral insufficiency of first degree is not progressing, and complications arise in the case of accession of a disease.
main goal of drug therapy is to increase cardiac output and a decrease in the degree of pulmonary hypertension.Cardiac glycosides (Strophanthin, Tselanid, Digoxin) aimed at strengthening the systole and decreased heart rate in the case of atrial fibrillation, and a long course of mitral insufficiency and left ventricular dysfunction.If the power of heart rate did not change in the mitral insufficiency, contraindicated drugs digitalis.
diuretics (spironolactone, Furosemide, Hydrochlorothiazide) aimed at reducing the volume reboot, thereby reducing stagnation and pulmonary hypertension.
Vasodilators peripheral (diltiazem, nifedipine, sodium nitroprusside) aimed at reducing the emission of resistance in the aorta, thus improving the function of the mitral valve and cardiac output increases, decreases in left ventricle size and regurgitation.
Conservative treatment of mitral insufficiency is aimed at the prevention of thromboembolic complications and heart rate control.And when expressed forms of patient complaints and conduct cardiac surgery.If there is no calcification of the valves and valve unit retained mobility, there shall klapanosohranyayuschie intervention - plastic mitral valve annuloplasty.Despite the fact that the risk of thrombosis and infectious endocarditis low klapanosohranyayuschie intervention may be followed by recurrence of mitral insufficiency.
Surgery is aimed at restoring the valve should be carried out in a short time, before the development of irreversible changes in the left ventricle.Surgical treatment is indicated in patients with small changes of the heart valve.Surgeons carried out the replacement of the valves, narrowing rings, plastic rings and the valves.
indications for surgery are: severe form of the defect, which occurs on a large and a small circle with circulatory failure;development of acute mitral regurgitation due to dysfunction papillary muscle chord or separation, as in this case can be fatal within a few days or hours.
contraindication for surgical intervention is: an irreversible change in the pulmonary circulation of the vascular bed, no threat of a rapid progression of the disease in children up to 10 years, and well tolerated by patients moderate or mild regurgitation of rheumatic origin.
♦ plastic surgery helps to normalize blood flow through the left atrioventricular opening, keeping its own mitral valve.The indications for such intervention is mitral regurgitation grade 2 and 3, as well as if there are no marked changes in the valves.Plastic surgery divided into types:
- ring annuloplasty (plastic valve).At the base of mitral valve sewn support ring consisting of a metal base, which is covered with synthetic cloth;
- shorten the chord (muscle tendon, attached to the heart muscle, provide valve movement);
- have mitral valve removed the rear extension portion.