Mitral valve insufficiency
The mitral valve is a valve located between the left atrium and the left ventricle of the heart that prevents blood regurgitation into the left atrium during systole.
Mitral valve insufficiency or mitral regurgitation is the inability of the valve to prevent blood regurgitation from the left ventricle into the left atrium.
Regurgitation is a rapid flow of blood in the opposite direction to normal movement that occurs during systole.
Mitral insufficiency is rarely found in isolation (about 2% of total heart disease). It is accompanied by aortic valve defects, mitral stenosis.
Distinguish between functional (relative) and organic mitral insufficiency.
Functional mitral insufficiency is caused by an acceleration of blood flow in dystonia, a change in the tone of papillary muscle fibers, dilation (expansion) of the left ventricle, which provides a hemodynamic overload of the heart.
Organic mitral insufficiency develops as a result of anatomical damage to the connective tissue plates of the valve itself, as well as the tendon threads that fix the valve.
Hemodynamic disorders of these types of mitral insufficiency are of the same nature.
Violation of hemodynamics in various forms of mitral insufficiency
Systole is a series of successive contractions of the myocardium of the ventricles and atria of a certain phase of the cardiac cycle.
The aortic pressure is significantly greater than the left atrial pressure, which promotes regurgitation. During systole, there is a reverse blood flow in the left atrium due to incomplete covering of the atrioventricular opening by the valve leaflets. As a result, an additional portion of blood flows into the diastole. During ventricular diastole, a significant amount of blood flows from the atrium to the left ventricle. As a result of this violation, an overload of the left heart occurs, which contributes to an increase in the strength of contractions of the heart muscle. Myocardial hyperfunction is observed. In the initial stages of the development of mitral insufficiency, good compensation occurs.
Mitral insufficiency leads to left ventricular and left atrial hypertrophy, resulting in increased pressure in the pulmonary vessels. Spasm of the arterioles of the lungs causes pulmonary hypertension, as a result of which hypertrophy of the right ventricle develops, tricuspid valve insufficiency.
Mitral valve insufficiency: symptoms, diagnosis
With good compensation for mitral insufficiency, symptoms do not appear. Severe mitral regurgitation is characterized by the following symptoms:
- Shortness of breath and irregular heartbeats during physical activity (then at rest);
- Cardialgia;
- Increased fatigue;
- Cardiac asthma (attacks of severe shortness of breath);
- Pain, swelling in the right hypochondrium, caused by an increase in the liver;
- Swelling of the lower extremities;
- Dry cough with little sputum production, in rare cases with blood impurities;
- Pain in the region of the heart of a stabbing, pressing, aching character, not associated with physical activity.
With compensated mitral valve insufficiency, symptoms may not appear for several years. The severity of symptoms is due to the strength of the regurgitation.
The following methods are used to diagnose mitral regurgitation:
- The ECG reveals signs of overload and hypertrophy of the left ventricle and atrium, in the third stage - the right heart;
- EchoCG - determination of hypertrophy and dilatation of the left heart;
- X-ray examination of the chest organs - determining the degree of pulmonary venous hypertension, the degree of protrusion of the atrial arches;
- Ventriculography - determining the presence and degree of regurgitation;
- Ventricular catheterization - determination of the dynamics of pressure in the ventricles of the heart.
Currently, there is an overdiagnosis of mitral regurgitation. Modern research methods have shown that a minimal degree of regurgitation can be present in a healthy body.
Mitral valve insufficiency grade 1: clinical presentation
Insufficiency of the mitral valve of the 1st degree is characterized by compensation of hemodynamics and the inability of the valve to prevent the reverse flow of blood, which is achieved by hyperfunction of the left ventricle and atrium. This stage of the disease is characterized by the absence of symptoms of circulatory failure, the patient's well-being during physical exertion. When diagnosing mitral valve insufficiency of 1 degree, a slight expansion of the borders of the heart to the left, the presence of systolic murmurs are found. There are no signs of valve dysfunction on the electrocardiogram.
Mitral valve insufficiency grade 2: clinical presentation
Insufficiency of the mitral valve of the 2nd degree is characterized by the development of a passive form of venous pulmonary hypertension. This stage is characterized by a number of symptoms of circulatory disorders: shortness of breath and heart palpitations during physical activity and at rest, coughing, attacks of cardiac asthma, hemoptysis. When diagnosing mitral valve insufficiency of the 2nd degree, the expansion of the borders of the heart to the left (1 - 2 cm), to the right (up to 0.5 cm) and upward, systolic murmurs are found. An electrocardiogram shows changes in the atrial component.
Mitral valve insufficiency grade 3: clinical picture
With mitral valve insufficiency of grade 3, hypertrophy of the right ventricle develops, which is accompanied by characteristic symptoms: enlarged liver, development of edema, increased venous pressure.
Diagnosis of degree 3 mitral valve insufficiency reveals a significant expansion of the boundaries of the heart muscle, intense systolic murmurs. An electrocardiogram shows the presence of a mitral tooth, signs of left ventricular hypertrophy.
Treatment of mitral valve insufficiency, prognosis
Treatment of mitral valve insufficiency is governed by a single rule: a patient with diagnosed mitral insufficiency is a surgical patient. This pathology is not subject to drug correction. The task of the cardiologist is to properly prepare the patient for the operation.
Conservative treatment of mitral valve insufficiency is aimed at controlling the heart rate, as well as preventing thromboembolic complications, and reducing the degree of regurgitation. Symptomatic treatment is also used.
During surgery, the mitral valve is implanted.
The prognosis for mitral regurgitation depends entirely on the degree of regurgitation, the severity of the valve defect and the dynamics of the disease.
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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
