Mitral insufficiency ( mitral insufficiency ) - Causes, Symptoms and Treatment .MF .
Causes and symptoms Diagnosis Treatment
Mitral insufficiency relates to acquired heart disease and is characterized by lesions of mitral (clamshell) valve.
The mitral valve is composed of connective tissue and is located in the fibrous ring, covering the atrioventricular opening between the left atrium and ventricle.Normally, when blood ejected from the left ventricle into the aorta its flaps are closed completely, preventing the reverse flow of blood into the atrium.The mobility and flexibility of the leaflets provided tendon chords - threads, which originate from the inner wall of the ventricle papillary (papillary) and muscles are attached to the wings, supporting them.
When organic (inflammatory, traumatic, necrotic) defeat connecting the valve flaps of tissue, tendon chords or papillary muscle is a change of form and structure, with the result that the leaf is no longer tightly adjacent to each other and the space is formed bet
mitral insufficiency is a disease resulting from organic heart disease, during which there are violations of hemodynamics (blood flow to the heart and other organs) and develop severe heart failure.This disease is combined with mitral valve stenosis is the most common acquired heart disease among.At the same time isolated, so-called "clean" mitral insufficiency is rare - only 2% of all cases of acquired defects.
Causes of mitral regurgitation
In 75% of cases the cause of failure is a rheumatic disease, especially recurrent attacks of rheumatic fever, in other cases, to the vice cause bacterial endocarditis, atherosclerosis.Very rarely acute mitral insufficiency can cause acute myocardial infarction, heart trauma with damage to papillary muscles and chordae rupture of the tendon.
Symptoms of mitral insufficiency
degree of manifestation of vice symptoms depends on the clinical stage of the disease.
In stage compensation, which can last several years, and sometimes decades, the symptoms are usually absent.The patient may be concerned about fatigue, weakness, chilliness and cold extremities.
progression of changes in the valve flaps, as well as repeated attacks of rheumatic compensatory mechanisms in heart is not enough, so there comes a stage subcompensation .When physical exercise, such as long and fast walking for long distances, active climbing stairs appear shortness of breath, pain in the left side of the chest, heart palpitations (tachycardia), irregular heart rhythm disturbances of the heart (usually atrial fibrillation).In the same period, the patient notices the swelling of feet and legs.
In the later stages (decompensated, severe decompensation and terminal) complaints take on the character of permanent and patient are concerned not only with normal household activity, but also at rest.Shortness of breath may be a manifestation of "the heart" of asthma and pulmonary edema - the patient in the supine position can not breathe, it is in the half-sitting position;there are attacks of choking cough with hemoptysis possible;swelling are observed not only on the course, but also throughout the body;the severity of the patient concerned in the right upper quadrant of the abdomen and an increase in the amount of - the pronounced stagnation of blood in the liver.Dystrophic changes in the internal organs, because the heart muscle is so exhausted that it is able not to provide blood tissues and organs.
diagnosis of mitral insufficiency
In cases where the patient does not note the presence of complaints of the cardiovascular system, the diagnosis can be established by chance during routine medical examination.If the patient goes to the doctor in connection with the above complaint, the diagnosis is established in accordance with the data of examination of the patient.
assume the presence of rheumatic heart lesion process already allow clinical examination results - assessed the complaint and the history of the patient's disease;On examination revealed cyanosis (blue nail phalanges, ears, nose, lips, in the later stages of the whole face, extremities), swelling of extremities, abdominal enlargement;auscultation of the chest auscultated weakening 1 tone, systolic murmur at the apex of the heart - to the point of projection of the mitral valve, and stagnant or bubbling (with pulmonary edema), wheezing in the lungs.In laboratory studies (common blood and urine tests, blood chemistry, immunological analysis of blood) inflammatory markers are determined, indicators of impaired functioning of the liver and kidneys, the indicators specific to rheumatism.
instrumental methods of research and patients are assigned: ECG and ECG monitoring detects arrhythmias, increase (hypertrophy) in the initial stages of the left heart, and then the right;Radiography is assigned to identify the extended shadow of the heart and blood stagnation in the vessels of the lung tissue, especially in pulmonary edema.
visualize anatomical structures of the heart and helps to confirm the diagnosis of echocardiography (ultrasound of the heart).This method allows us to estimate the mobility of the valve leaflets, to evaluate disorders of intracardiac blood flow regurgitation, regurgitant fraction was measured, the pressure in the pulmonary artery, the blood to determine the fraction of ejection into the aorta, measure the effective regurgitant orifice area.Depending on these indicators mitral insufficiency is subdivided into the following degrees:
- minor failure: regurgitation fraction less than 30% (the percentage of blood, threw into the left atrium of the volume of blood present in the left ventricle at the time of reduction);the opening area through which the blood is thrown in the atrium of less than 0.2 square meters.cm;reverse jet of blood in the atria is in the valve leaflets and does not reach half of the atrium.
- expressed insufficiency: regurgitation fraction of 30 - 50%, regurgitation orifice area 0.2 - 0.4 square meters.See, the blood stream fills the half atrium.
- severe deficiency: regurgitation fraction of more than 50%, the opening area of more than 0.4 square meters.See, the blood stream fills the left atrium.
In unclear cases, and because of the impossibility of carrying out ultrasound of the heart through the anterior chest wall can be assigned to transesophageal echocardiography.To determine exercise capacity conducted stress echocardiography - holding ultrasound of the heart before and after the exercise test.
Echocardiography with Doppler study.The figure on the right Set Blood cast arrow to the left atrium through the mitral valve (MV).
Just as with mitral stenosis, in complex clinical situations with controversial results of the survey or before cardiac surgery can be assigned to catheterization of heart cavities with differential pressure measurement in its chambers.If the patient with the defect present ischemic heart disease, your doctor may consider it necessary to conduct coronary angiography (CAG) with the introduction of radiopaque substance in the coronary (heart) blood vessels and assessment of their terrain.
treatment of mitral insufficiency
treatment of heart disease involves prescription drugs and radical way to cure blemish - surgical correction of the valve.
in medical treatment, the following groups of drugs:
- to reduce the total peripheral vascular resistance, in which an increase in the left ventricle will have to push the blood appointed ACE inhibitors and beta - blockers: perindopril 2 - 4 mg once daily, fosinopril 10 -40 mg once a day;Carvedilol 12.5 - 25 mg once a day, Bisoprolol 5 - 10 mg once per day.
- to reduce the blood flow to the stretched right atrium appointed nitrates - drugs nitroglycerin and its analogues: nitrosprey sublingually 1 - 3 doses during an episode of shortness of breath or chest pain, kardiket 20 - 40 mg 20 minutes before physical activity in the early stages and every day fromone to five times per day in the later stages (in severe shortness of breath and frequent episodes of pulmonary edema).
- to reduce the total blood volume and thereby, deletion volume overload of the heart, are assigned diuretics (diuretics). Indapamide 2.5 mg in the morning, veroshpiron 100 - 200 mg in the morning and others
- to reduce thrombus formation and increased clotting appointed antiplatelet andanticoagulants: thrombotic Ass 50 - 100 mg per meal after meal;2. warfarin 5 mg Plavix 75 mg - dose is calculated individually under the strict control of blood coagulation parameters.
- in the presence of atrial fibrillation antiarrhythmic drugs are used to help restore normal rhythm (paroxysmal form) - polarizing mixture intravenous amiodarone, procainamide / O.When a permanent form of atrial fibrillation, cardiac glycosides are appointed (Korglikon, strofantin) and beta - blockers.
- for the prevention of recurrent attacks of rheumatic and during invasive (with the introduction of body tissue) interventions used antibiotics (bitsillin, amoxicillin with clavulanic acid, etc.).
The treatment regimen is determined individually for each patient by the attending physician.
surgical therapies are used valve plasty (suturing the valve leaflets, chordae tendon) and prosthetics.
The figure shows the prosthetic valve mechanical prosthesis.
Surgery is indicated in the second degree of defect (marked impairment) and the second - the third stage of the process (sub - and decompensation).Under severe decompensation use of surgical treatment remains controversial due to severe general condition, and the operation is strictly contraindicated in the terminal stage.
Lifestyle mitral insufficiency
patient must comply with the general principles of a healthy lifestyle and follow the doctor's recommendations, used in many cardiac diseases - exclude alcohol, smoking, fatty, fried, spicy food;limit the amount of fluid intake and salt;a lot of sleep, and often walk in the fresh air.
When the pregnant woman a heart surgeon should be observed in conjunction with the obstetrician and the cardiologist.In the early stages and no severe defect pregnancy can be saved and, if hemodynamic expressed violations strictly contraindicated.Delivery is likely to be conducted by Caesarean section.
complications mitral regurgitation
Complications of untreated
In cases where the patient is not concerned about the complaint, and the degree of vice, as determined by ultrasound of the heart is not heavy, the lack of taking the drugs or surgical treatment does not affect the state of hemodynamics.If the patient presents with active complaints and diagnosis of mitral regurgitation confirmed or diagnosed him severe degree, the lack of treatment leads to disruption of blood circulation in the body and the functions of the cardiovascular system.Without correction of the heart muscle can develop complications, including life-threatening - cardiogenic shock, pulmonary edema, systemic thromboembolism, paroxysmal atrial fibrillation and the risk of thrombus formation and settling them in the vessels of the brain, lung, intestine, heart, femoral artery.Complications occur more rarely than in mitral stenosis.
Complications of surgery
As during any surgery, prosthetics and plastic mitral valve there is a specific operational risk.Mortality after such operations, according to different authors, up to 8 - 20%.Also, the patient may develop post-operative complications, such as blood clots in the cavities of the heart due to work of mechanical prostheses, the development of bacterial inflammation of the valve flaps, including biological and synthetic, the formation of adhesions between the flaps of the valve hole development narrowing (stenosis).Prevention of complications are adequate appointment of anticoagulant drugs, antibiotic therapy in the early postoperative period and during various diagnostic and therapeutic measures in other areas of medicine (bladder catheterization, extraction - tooth extraction or other dental procedures, gynecological surgery, etc...).
Even in the absence of complaints from the heart in a patient adverse prognosis for life, as there is progression of the disease with the development of hemodynamic which untreated leads to severe impairment of bodily functions and death.
When the operation in a timely manner and proper administration of these drugs increased life expectancy, as well as improving quality of life.
therapists Sazykina OJ