Mitral insufficiency: symptoms and treatment
Mitral valve insufficiency is a secondary heart failure characterized by incomplete closure of the valves, due to which there is a reverse flow of blood from the left ventricle into the left atrium. At the same time, the volume of blood increases, which leads to a thickening of the valve itself (hypertrophy). The fibrous ring then stretches and, as a consequence, weakens. A similar process occurs in the left ventricle, which causes too much blood to flow into it.
Such a disease is rarely diagnosed as an independent disease and often accompanies other heart defects, for example, mitral stenosis and aortic pathologies. Among adults, the most common is in males, and can also be found in children. In healthy people, one or another degree of such disorder can be diagnosed, which is detected with the help of echocardiography. In the international classification of diseases (ICD 10) this disorder has its own code — I34.0.
There are several reasons for the onset of the disease, depending on whether the mitral insufficiency is primary or acquired. In the first case predisposing factors may be — underdevelopment of the left half of the heart, small size or bifurcation of the folds. In the second, these are previously transmitted infectious diseases or autoimmune disorders. Symptoms of the disease are the occurrence of cough (at the first stages of the disease it is dry, but as the disease progresses, sputum is observed with impurities of blood), pain in the place of the projection of the heart. In addition, the signs of the disease are — shortness of breath and heaviness in the abdomen.
Diagnosis of the disease consists in conducting an examination of the patient, conducting laboratory studies of blood and urine tests, as well as instrumental examinations of the patient, aimed at assessing the functioning of the heart and determining the degree of the disease. Treatment consists of elimination of factors of origin of pathology, carrying out of surgical operation and in reception of medical products.
Mitral valve insufficiency may occur during the formation of the heart during childbearing or as a consequence of previously transmitted infectious disorders. The causes of congenital ailment in children are:
- Underdevelopment of the left side of the heart
- small sizes or split arms
- The wrong length of the chords.
Secondary mitral insufficiency — organic, ie, caused by deformations of the valves, can be expressed against the background:
- rheumatic fever is a common cause of this ailment
- infectious endocarditis;
- Lupus Erythematosus
- Multiple sclerosis;
- performing surgical operations as a therapy for mitral stenosis;
- closed traumatizing of the heart.
The secondary relative insufficiency, which has nothing to do with the changes in the leaflets, occurs when:
- damage to the internal muscles of the ventricles
- tearing chords;
- enlargement of the fibrous ring, which can be triggered by a number of factors — inflammation in the muscles of the heart, increased or decreased cardiac muscles, arterial hypertension, aneurysm formation and impaired blood flow from the left ventricle
All of the above factors can cause the appearance of such an ailment in both adults and children.
There are several types of mitral valve insufficiency. The first of them divides the disease depending on the time of its occurrence:
- congenital — occurs due to the impact of negative factors on the female body during pregnancy
- acquired — is a complication from advanced infectious diseases
The second classification is the difference between the illness and the reasons for its formation. Thus, the ailment can be:
- Organic nature — the flow of blood between the left atrium and the left ventricle is directly related to valve damage
- functional nature — the reverse flow of blood is due to other cardiac pathologies, including ventricular expansion, rupture or removal of chords, muscle tone disorder.
The nature of the course of mitral insufficiency is divided into acute and chronic. The chronic type of ailment is formed within a couple of months or several years from the moment of appearance of predisposing factors, which can be:
- systemic inflammatory disorders
- congenital pathologies
- infectious processes in the body
- structural changes.
Acute mitral insufficiency is expressed in a few hours or even minutes after the negative impact of such factors as:
- break chords;
- a strong expansion of the fibrous ring
- breaks or ruptures of the flaps.
In addition, there is a classification of the disease depending on the severity of the pathological process:
- insignificant — the reverse flow of blood is found at the valves. It is a variant of the norm, why it occurs in healthy people of middle age and children
- moderate — blood flow disturbance is localized at a distance of 1 cm from the valve
- pronounced — the reverse blood flow spreads to the half of the atrium
- severe — the pathological process completely affects the left atrium.
The above characteristics of the disease are typical for adults and children.
Mitral valve insufficiency can sometimes occur without manifesting any symptoms. A vivid expression of symptoms is due to several factors — the size of the lumen between the valves and the volume of recurring blood.
The main symptoms of an ailment are:
- the onset of dyspnea in exercise as well as at rest
- cough, worse with a horizontal position of the body. At the initial stage of the disease development is a usual dry cough, but as the pathological process spreads, sputum is observed, often with blood impurities
- soreness in the region of the heart, aching and pressing character
- swelling of the lower limbs;
- fast fatigue and weakness of the body, which reduces the level of efficiency;
- The severity in the abdomen, in the right rib area — is due to the increase in liver size
- pulse rate irregularity
The signs that can be found only by a specialist include the increase in the volume of veins on the neck, the specific elevation in the left part of the chest, the appearance on the skin of the fingers of the upper and lower extremities of the bluish hue.
Mitral insufficiency in children is diagnosed quite often, often in combination with other heart defects. As you grow older, some children experience a slight or moderate decrease in the volume of the backflow of blood, up to the normalization of the condition.
Untimely or incomplete therapy can initiate the development of complications with mitral valve insufficiency. The main consequences are:
- heart rhythm disorder
- Atrioventricular blockade
- repeated endocarditis;
- heart failure;
- Increased pressure in the heart vessels.
In addition, specific consequences may occur in patients who underwent surgery for the treatment of such a disorder. Such complications are:
- the onset of a thrombus that closes the lumen of a blood vessel
- slowing or completely stopping the passage of the electrical pulse from the atrium to the ventricle
- partial cutting of the joints that hold the artificial valve
- disruption of normal blood flow through the prosthesis due to a thrombus
- the destruction of the prosthesis, which may require a second operation
- accumulation of calcium salts in the transplanted valve
The presence of certain complications depends on the prognosis of the disease in children and adults.
Diagnostic measures for mitral insufficiency are complex and consist of several stages. First of all, the doctor needs to study the patient’s medical history — this is necessary to determine the congenital or acquired form of the disease in adults and children. After this, it is necessary to find out the presence and intensity of the symptoms, which will help to determine the specialist acute or chronic course of the disease. Then a physical examination is performed, during which the doctor examines the condition of the skin, hears the work of the heart with a special instrument (to determine the presence of characteristic features).
The next step in the diagnosis is conducting laboratory tests of blood tests and patient’s urine. A general study is necessary to identify inflammation or related disorders. A biochemical blood test is performed to determine the concentration of uric acid and cholesterol. Immunological analysis makes it possible to evaluate the presence of antibodies.
The instrumental diagnostic techniques include:
- ECG — performed to detect cardiac arrhythmias;
- Echocardiography is the main method for studying the mitral valve in children and adults
- catarrhal cavities of the heart
- CKT and MRI — techniques that allow the specialist to obtain an accurate image of the affected organ
- phonocardiogram — a technique for detecting noise
- CCG — is performed to obtain an accurate image of the heart vessels by using a contrast agent
- Radiography of the lungs.
After receiving all the results of the examinations, the doctor prescribes the most effective medication and surgical procedure.
The basis of therapeutic measures is the reception of medications aimed at removing the causes and signs of ailment. In addition, this method of therapy is recommended for complications. The insufficiency of the mitral valve of the two initial stages of development does not require medical intervention. A more complex current involves performing surgical operations, of which there are several. The first type of intervention is plastic, used for disease in the second and third stages. There are three ways to implement it:
- leaf plastic — the support ring is sewn at the base of the leaflets
- reducing the length of the chords;
- Elimination of the elongated part of the posterior leaf
The second type of surgery is based on valve replacement. Prostheses can be made of biological material, for example, the aorta of an animal. They are often used to treat mitral insufficiency in children and women who in the future want to have a child. In addition, there are mechanical valve prostheses, which are made of medical alloys. In the postoperative period, patients need to take anticoagulants, which are aimed at reducing blood clotting. In cases of implantation of a mechanical valve, medicines must be taken throughout life, with the implantation of a biological valve, medication is not more than three months. With plastic valve use of drug therapy is not required.
Carrying out any type of operation is strictly forbidden in the presence of serious diseases that will inevitably lead to death, as well as in the course of heart failure, which is not amenable to drug treatment.
Prevention of such a disease is divided into primary and secondary, i.e. in the presence of a chronic form of the disease. The rules of primary preventive measures:
- prevention and timely elimination of diseases, at the stage of the appearance of the first clinical signs that can lead to the development of a similar heart defect
- hardening of the body
- Regular examination with a rheumatologist and a cardiologist.
Secondary prevention is to prevent the spread of the disease process. For this, it is necessary to undergo medical treatment of such a disease, in which diuretics and glycosides are often prescribed, as well as preparations for vasodilatation and improvement of the heart muscle condition. Prevention of recurrence occurs in the reception of antibiotics, hardening and treatment of infectious diseases.