mitral valve insufficiency

Mitral valve insufficiency is a disease that negatively affects a person's condition. Timely diagnosis can prolong life and performance.

Mitral valve insufficiency (MIV) - non-closure (or insufficient closure) during the systolic period. The consequence of this is a partial return of blood to the atrium, which leads to an increase in the volume of biological fluid in it and an increase in pressure. This pathology leads to stagnation in the pulmonary arteries.

Mitral valve insufficiency itself is diagnosed infrequently (about 5% of all cases). Basically, this disease develops in conjunction with other heart defects, such as stenosis or aortic pathology.

Degrees of the disease

Mitral regurgitation is classified into three categories based on the strength of the backward movement of blood:

1. 1 degree. Regurgitation in this case is insignificant (no more than 25%), it is observed only near the valve. The patient does not feel any discomfort, there are no symptoms. As a rule, a defect of the 1st degree is discovered by chance, during a routine examination or when contacting a clinic with complaints of another pathology. In this case, the doctor states a slight left-sided expansion of the heart and murmurs during the systolic period.
2. 2 degree. With such a pathology, the reverse flow of blood can reach 50%, reaching the middle of the atrium. As a result of the fact that there is not enough pressure to expel the biological fluid, pulmonary hypertension develops. The patient develops shortness of breath, cough, arrhythmia. During the examination, an ECG is assigned, on which you can see changes in the atrium. In addition, there are also systolic murmurs, there is a more significant cardiac expansion (to the left about 2 centimeters, up and to the right about 0.5 centimeters).
3. 3 degree. With such a lesion, the reverse flow is able to reach the posterior portion of the atrium. Regurgitation can reach up to 90%. Examination reveals left ventricular hypertrophy, systole murmurs, and significant cardiac enlargement. The patient develops edema, increases blood pressure, enlarges the liver.

The prognosis for this disease depends on the extent to which the valve is damaged, on the degree of regurgitation and the dynamics of the disease. Severe mitral insufficiency can lead to very negative consequences, moderate mitral insufficiency allows the patient (with appropriate treatment) to remain functional for many years.

Reasons for the development of pathology

Depending on the rate of development, the disease has two forms: acute (CVA) and chronic (HNMK). In the first case, the disease can form in just a few hours. The second variant of the pathology can develop over several years. And if a person for some reason does not undergo an examination, mitral insufficiency can be detected only after a significant aggravation of the patient's condition.

acute form

An acute type of pathology can be provoked by such factors:

1. Violation of the integrity of chords. Rupture of tissues connecting the heart and papillary muscles can occur, for example, due to chest trauma or inflammation of the myocardium.
2. Violation of the integrity of the mitral valve leaflets, which is a consequence of infective endocarditis.
3. A significant increase in the fibrous ring. This element, located inside the myocardial wall, is able to deform due to a heart attack (partial death) of this muscle.
4. Damage to papillary muscles. As a result of this pathology, the blood flow to the heart area worsens (stops), and a heart attack develops.
5. Operative separation of leaflets in case of stenosis.

Chronic form

Pathology of the chronic type can be formed for the following reasons:

1. Various kinds of inflammation (rheumatism, lupus erythematosus, and so on).
2. Congenital pathologies (myxomatous degeneration, genetic abnormalities of the valve structure).
3. Infectious diseases (endocarditis).
4. Structural damage.

Depending on the time of occurrence of mitral insufficiency, the disease can be congenital or chronic (acquired).

In the first case, the pathology develops during pregnancy due to the impact on the body of the expectant mother of infections or radiation (including x-rays). The cause of the acquired form of the disease can be an infectious or oncological disease, trauma.

Symptoms of pathology

This is due to the fact that the dysfunction is successfully compensated by the capabilities of the organ. Pathology can be detected only by listening. In this case, characteristic noises are ascertained, which are formed when the blood returns to the left atrium, that is, during its contraction. The ventricle increases significantly in size, as it is forced to pass more fluid.

The subcompensation period is characterized by the following symptoms:

• coughing up blood;
• pain in the chest or left arm;
• dyspnea;
• weakness;
• cough;
• constant fatigue;
• arrhythmia.

In case of formation of venous congestion in a small circle at night, attacks of cardiac asthma are possible. Shortness of breath and hemoptysis are the result of stagnation of blood in the pulmonary arteries. First there is a cough, then sputum with blood splashes is visible.

If compression of the pulmonary trunk has occurred, a change in voice is possible. Speech becomes hoarse (Ortner's syndrome). In addition, in half of all variants, mitral insufficiency has atrial fibrillation. Due to the fact that the distribution of blood is disturbed, weakness occurs.

In the presence of anemia, relative NMC is accompanied by arrhythmia, a feeling of fading or "turning over" in the chest. The progression of the disease is fraught with the appearance of a defect of the pale type, the occurrence of acrocyanosis, cyanosis of the lips is possible. At the same time, the pressure and pulse indicators remain normal.

The very first symptom of NMC is a feeling of a strong heartbeat when lying on your side. This sign is manifested due to the expansion of the ventricle. The atrium needs to accommodate more blood, on the basis of this, the number of contractions increases, due to fibrillation, performance is impaired. Arrhythmia leads to dysfunction of the myocardial muscle. The atria do not contract, but tremble. The patient's legs swell, possibly the formation of blood clots.

Diagnosis and treatment of the disease

At an early stage, mitral valve insufficiency is not diagnosed very often. This is due to the absence of pronounced manifestations and the normal state of health of the patient.

With the development of pathology, symptoms appear that interfere with the normal functioning of a person. As a result, the patient goes to the clinic.

Diagnosis of NMC consists in the following activities:

• examination and questioning of a person;
• echocardiography;
• analysis of urine and blood;
• electrocardiography;
• radiography.

Examination and questioning enable the doctor to identify signs of pathology. When listening, the doctor states the presence of a characteristic sound during the period of contraction of the left ventricle. Analyzes indicate the presence of inflammatory processes, protein, sugar. If antibodies are detected, the existence of an infection or inflammatory processes in the organ is assumed. X-ray and ECG determine the size, deformation of the atrium. Echocardiography helps to see the valve defect and assess the extent of its damage.

Additional methods can be used to make a diagnosis of "mitral insufficiency".

Therapeutic measures

With a moderate form of NMC, special therapy is not carried out. In case of violation of the frequency, rhythm of contractions and atrial fibrillation, drugs are prescribed.

If a patient has moderate mitral valve insufficiency, treatment includes a reduction in physical labor and mental stress, giving up bad habits, and a healthy lifestyle. In the acute form of the pathology, diuretics with vasodilators are prescribed. To restore normal circulation, intra-aortic balloon counterpulsation is performed.

In the case of diagnosing a subcompensated degree of the disease, the following are attributed:

• vasodilators,
• diuretic drugs,
• ACE,
• glycosides,
• blockers.

Indirect anticoagulants are used to eliminate atrial fibrillation. When mitral insufficiency was provoked by an infection, antibiotic therapy is performed. Such treatment includes pharmacological agents containing magnesium, vitamins B1, B2, PP.

Drug therapy is aimed at increasing the output and lowering the pressure in the pulmonary vessels:

1. Cardiac glycosides increase systole and reduce the frequency of contractions.
2. Diuretics help relieve congestion and pulmonary pressure buildup.
3. Vasodilators reduce the resistance to ejection into the aorta. This allows you to improve the functioning of the mitral valve, increase cardiac output, reduce ventricular volume, and reduce regurgitation.

Conservative NMC therapy is focused on preventing thromboembolic consequences and maintaining normal heart contractions. With severe symptoms, cardiac surgery may be performed. In the absence of calcification and valve mobility, plastic surgery is performed. Surgical measures are carried out until the occurrence of irreversible processes in the left ventricle.

Such treatment is recommended for small changes in the valve, when plastic surgery, reduction of the annulus can solve the problem.

Surgical intervention is not performed:

• with irreversible processes in the vessels of the pulmonary circulation;
• in children under ten years of age;
• if the disease does not progress rapidly;
• patients who feel well with moderate regurgitation of rheumatic origin.

With NMC, the prognosis depends on the degree of valve and myocardial damage.

Pronounced mitral insufficiency and an unacceptable state of the myocardial muscle can lead to a complex hemodynamic disorder. An unsatisfactory prognosis is expected if chronic heart failure is added to the disease. With a mild or moderate type of illness, the patient is able to maintain normal life for a long time. But be sure to systematically visit a cardiologist and strictly follow his recommendations.