Mitral valve prolapse heart - Causes, Symptoms and Treatment .MF .
Mitral valve prolapse - one of the inherent characteristics of the structure of the heart.To make it easier to understand what exactly is this feature, a brief look at some of the nuances of anatomy and physiology of the heart.
So, the heart - a muscular body whose function is to pump blood through the body.The heart consists of two atria and two ventricles.Between the atria and ventricles of the heart valves are located, tricuspid (three-sided) on the right and the mitral (two-folding) on the left.The valves are made up of connective tissue and are similar to a kind of door which close the hole between the atria and the ventricles to blood moving in the right direction - normal blood moves from the atria to the ventricles, atria to reverse casting should not be.At the time of the expulsion of blood from the atrium into the ventricle (atrial systole), the valve is open, but once all the blood came into the ventricle, the valve flaps are closed, and on the blood expelled from the ventricle into the pu
left to right: 1. General diastole of the heart - the atria and ventricles are relaxed;2. systole atrial - atrial reduced, the ventricles are relaxed;3. Systolic ventricular - atrial relaxed ventricles reduced.
If the mitral valve does not completely close up during blood expulsion from the ventricle into the aorta, then talk about it prolapse (sagging) in the cavity of the left atrium at the time of systole (contraction of the left ventricle).
Mitral valve prolapse - is a violation of its connective structure, which leads to incomplete closure of the valves, so that the blood may be a throw back to the atrium (regurgitation).There are congenital (primary) and develop on the background of endocarditis, myocarditis, chest injuries with rupture of chords, heart disease, myocardial infarction (secondary) prolapse.Primary prolapse occurs in approximately 20 - 40% of healthy people and in most cases no significant effect on heart function - vascular system.
In modern medicine, the primary mitral valve prolapse is considered to be rather an innate feature of the structure of the heart, rather than a serious pathology, with the proviso that it is not combined with gross malformations and causes no significant hemodynamic (functions of cardio - vascular system).
Causes of mitral valve prolapse
Here we will focus on the primary mitral valve prolapse, which refers to small anomalies of heart development.Out - of what this anomaly may occur?The primary cause of the disease is genetically determined disorders of collagen type 111.This protein, which participates in the formation of connective tissues in all organs, including the heart.In violation of its formation connective "skeleton" of the valve loses its strength, the valve becomes loose, softer, so it can not provide sufficient resistance to the blood pressure in the left ventricle, which leads to sagging of his leaflets into the left atrium.
is also necessary to take into account the harmful factors affecting the development of the fetus and the connective tissue during pregnancy - smoking, alcohol, drugs and toxic substances, occupational hazards, poor diet, stress.
Signs and symptoms of mitral valve prolapse
Usually, the diagnosis is established in the course of routine newborn screening of children, including by echocardiography (ultrasound of the heart).
Mitral valve prolapse is classified according to the degree of regurgitation (backward throw the blood), determined by ultrasound of the heart with Doppler.There are the following degrees:
- 1 degree - reverse jet of blood in the left atrium is at the level of the valve leaflets;
- 2 degree - the blood stream back to half of the atrium;
- 3 degree - reverse throw blood fills the atria.
If the patient has a congenital prolapse, it is usually a minor regurgitation (grade 1), or not at all.If the prolapse valve is secondary, it can develop hemodynamically significant regurgitation, t. To. The blood returns to the atrium has a negative effect on the function of the heart and lungs.
When prolapse without regurgitation clinical symptoms are absent.Like other small anomalies of heart development (optional chord, patent foramen ovale), suspected of the disease can only be based on the planned examination of the child and of the ECHO - KG, which in recent years is a mandatory method of examination for all children aged 1 month.
If the disease is accompanied by regurgitation, then the psycho-emotional or physical stress can appear complaints spilled pain in the heart, a sense of disruption of the heart, a sense of "fading" of the heart, shortness of breath, feeling short of breath.Since the activity of the heart and autonomic nervous system (the part of the nervous system, responsible for the function of internal organs) are inextricably linked, the patient can be confusing for dizziness, fainting, nausea, a "lump in the throat", fatigue, unmotivated weakness, sweating, tachycardia (rapid heart rate), a slight increase in temperature.All these are symptoms of autonomic crises, particularly evident in a child with prolapse during adolescence, when there is rapid growth and hormonal changes in the body.
In rare cases, when there is a regurgitation of grade 3, to the above complaints are joined manifestations characteristic of hemodynamic disturbances in heart and lung function - pains in the heart and shortness of breath during normal everyday activity, walking, climbing stairs, due to stagnation of blood in thesebodies.They can also join rarely cardiac arrhythmias - sinus tachycardia, atrial fibrillation, and atrial flutter, atrial and ventricular premature beats, syndrome shortened PQ.It must be remembered that sometimes regurgitation may progress, that is, to increase the degree of prolapse.
diagnosis of mitral valve prolapse
On the basis of what a diagnosis?Mitral valve prolapse may be suspected even in the clinical examination of the child.Young children may be accompanied by prolapse, umbilical and inguinal hernia, hip dysplasia (congenital subluxation and dislocation of the hip).On examination of children and adolescents drew attention to the patient's appearance - tall, long fingers, long limbs, abnormal joint mobility, curvature of the spine, chest deformity.
auscultation (listening) are heard or isolated systolic murmurs and clicks (caused by tension tendon chords valve prolapse at the time of its closing), or a combination thereof.
main method of diagnosis - echocardiography (ultrasound of the heart) with Doppler (allows you to display an echo - signal from moving blood structures).Directly ultrasound to evaluate the availability of valve prolapse and its degree of sagging, and Doppler detects the presence and degree of regurgitation.
Also, be sure to be appointed ECG and ECG monitoring to determine the rhythm and conduction disorders (cardiac arrhythmias).
also shown radiography of the chest cavity to determine whether the expanded hearts shadow across, and whether there is stagnation of blood in the vessels of the lungs, which may be indicative of heart failure.
If necessary, samples are assigned to the load (treadmill test - walking on a treadmill, bicycle ergometry).
treatment of mitral valve prolapse in
if mitral valve prolapse is not accompanied by the presence of clinical symptoms, the patient is not assigned to medical therapy.The hospitalization is also not necessary.Displaying the execution of a number of restorative measures and monitoring by a doctor cardiologist with the annual ECHO - CG.
By fortifying measures include: good food, rational mode of work and rest with adequate sleep, fresh air, a general hardening of the body, moderate exercise (doctor's permission).
When manifestations of vegetative - vascular dystonia (vegetative crises) appointed spine massage, physiotherapy, electrophoresis with magnesium preparations at the collar area.Showing herbal sedatives (Leonurus, valerian, sage, hawthorn, rosemary), as well as drugs that improve the nutrition of the heart muscle (magnerot, carnitine, Riboxinum, Pananginum) and vitamins.
When expressed feelings disruptions in the heart, and even more so when confirmed by ECG rhythm disturbances appointed blockers (carvedilol, bisoprolol, atenolol, propranolol, and others.)
On rare occasions (during the development of heart failure, arrhythmias, progressive mitral regurgitation)surgical correction of prolapse can be made.For surgical treatments include recovery operations on the valve (suturing his sagging sash, shortening the tension chord) or a prosthetic valve with an artificial substitute for it.Surgical treatment of isolated congenital prolapse is rarely used due to a favorable course of the disease.
complications of mitral valve prolapse
Can there be complications?Despite the fact that in most cases of mitral valve prolapse occurs with little regurgitation, which does not require special treatment, there is still the risk of complications.Complications are rare (only 2 to 4%) and include the following life-threatening conditions that require treatment in a specialized hospital:
- acute mitral insufficiency - condition, usually arising as a result of the separation of tendon chords for injuries of the chest.It is characterized by the formation of "hanging out" valve, ie the valve is held chords, and its leaf are in free movement, is not fulfilling its function.Clinically, there is a picture of pulmonary edema - dyspnea at rest, especially when lying down;forced sitting position (orthopnea), bubbling breath;stagnant wheezing in the lungs.
- bacterial endocarditis - a disease in which the inner wall of the heart are deposited microorganisms to break into the blood from the site of infection in the human body.In most cases of endocarditis with valvular heart disease develops after a sore throat in children, and the presence of initially modified valve can serve as an additional factor in the development of this disease.After two - three weeks after suffering an infection in a patient develops repeated fever, chills, can be rash, enlargement of the spleen, cyanosis (blue coloration of the skin).It is a serious illness that leads to the development of heart disease, gross deformation of the heart valve dysfunction cardio - vascular system.Prevention of bacterial endocarditis is timely readjustment of foci of acute and chronic infections (carious teeth, diseases of ENT - organs - adenoids, chronic inflammation of the tonsils) and prophylactic antibiotics for procedures such as tooth extraction, tonsillectomy.
- sudden cardiac death - threatening complication, characterized by, apparently, the occurrence of idiopathic (sudden, unreasonable), ventricular fibrillation, which refers to the fatal arrhythmia.
prognosis of mitral valve prolapse
Weather favorable for life.Complications are rare, but the quality of life of the patient is not suffering.However, some patients are contraindicated class sport (jumping, karate), as well as the profession, causing overload the cardiovascular system (divers, pilots).
Regarding military service can be said that according to orders, fitness for military service is decided individually for each patient in the military - medical commission.So, if a young man's mitral valve prolapse without regurgitation or regurgitation of 1 degree, then the patient is fit for service.If there is a regurgitation of grade 2, the patient is fit probation (he was not called upon in time of peace).In the presence of regurgitation grade 3, rhythm disorders or heart failure functional class 11 and above in the Army is contraindicated.Thus, most patients with mitral valve prolapse with a favorable course in the absence of complications can serve.
therapists Sazykina OJ