To understand pathology, it is necessary to address the issues of anatomy. The mitral valve or bicuspid is located between the left atrium and the left ventricle. It consists of two wings front and rear. Chords are attached to each leaf, starting from the papillary muscles of the ventricle and attached to the valve. These formations hold the valves and do not allow them to bend inside the atria during the contraction of the ventricles.
During atrial systole, the mitral valve opens toward the ventricle and passes blood into it. After that, it closes and the systole of the ventricle begins, during which blood is expelled into the arteries of the pulmonary circulation through the aortic valve. The work of the mitral valve is to create an obstacle to the reverse flow of blood from the ventricles, during their contraction, into the atria.
Mitral valve prolapse (MVP) is a condition in which sagging or protrusion of the posterior and/or anterior valve leaf occurs. As a result of their incomplete closure, and there remains an opening through which blood
throws (regurgitates) back to the atrium. The severity of the condition depends on the degree of regurgitation.
The diagnosis of mitral valve prolapse is made only on the basis of an ultrasound scan with Doppler. Decryption of ultrasound data should be carried out by a cardiologist in conjunction with a specialist in functional diagnostics.
In order to better understand the essence of mitral valve prolapse, it is necessary to understand the purpose of the heart valves and their structure. In a general sense, the heart valve is an internal fold or plate that provides unidirectional blood flow.
The heart consists of four chambers: the right and left atrium, the right and left ventricle. There are four valves between the atria and the ventricles, each of which provides the direction of blood flow in a certain direction.
The mitral valve is located between the left atrium and the left ventricle of the heart. It is a bicuspid valve, that is, consisting of two valves, which prevent blood from entering the left atrium during the process of contraction (systole) of the left ventricle.
Mitral valve prolapse is one of the most common heart diseases. This pathology is characterized by a lack of mitral valve function. There are 3 degrees of severity of the disease, while the first degree is the least dangerous.
Typically, first-degree prolapse is asymptomatic, so it is detected by chance during an ultrasound scan of the heart. However, this disease requires regular medical supervision, as it can be aggravated by concomitant diseases and complications.
Mitral valve prolapse is a problem that occurs more often in young people. The age of 15-30 years is most typical for the diagnosis of this problem. The causes of the pathology are finally unclear. In most cases, MVP occurs in people with connective tissue pathologies, for example, with dysplasia. One of its features may be increased flexibility.
For example, if a person easily bends the thumb on his hand in the opposite direction and reaches them to the forearm, then the probability of the presence of one of the pathologies of connective tissue and MVP is high.
So, one of the causes of mitral valve prolapse is congenital genetic disorders. However, the development of this pathology is also possible due to acquired causes.
- Coronary heart disease;
- Various ides of cardiomyopathy;
- Myocardial infarction;
- Calcium deposits on the mitral ring.
As a result of painful processes, the blood supply to the structures of the heart is disturbed, inflammation of its tissues occurs, the death of cells with the replacement of their connective tissue, compaction of the tissues of the valve itself and the structures surrounding it.
All this leads to changes in the tissue of the valve, damage to the muscles controlling it, as a result of which the valve ceases to completely close, that is, the prolapse of its valves appears.
This pathology affects adults more than children. Mitral insufficiency is often accompanied by defects in blood vessels and stenosis (compression of the lumen). In its pure form is extremely rare.
This defect is less often congenital and more often acquired. Degenerative changes in some cases affect the tissues of the valves and the valve and the structures underneath. In others, chords are affected, and the valve ring is excessively extended.
One of the causes of acute mitral valve insufficiency is acute myocardial infarction, severe dull cardiac trauma, or endocarditis of infectious origin. With these diseases, the papillary muscles, tendon chord rupture, and also the valve flaps come off.
Other causes of mitral regurgitation:
- joint inflammation;
- Hard currency;
- restrictive cardiomyopathy;
- some autoimmune diseases.
With all these systemic diseases, chronic mitral valve insufficiency is observed. Genetic diseases with chromosomal mutations, accompanied by connective tissue defects of a systemic nature, lead to mitral valve insufficiency.
Ischemic valve dysfunction occurs in 10% of cases of post-infarction heart sclerosis. Prolapses, tears, or shortening of the mitral valve with lengthening of the chords of the tendons and papillary or papillary muscles also lead to mitral insufficiency.
Very rarely, mitral valve insufficiency results from calcification of valve cusps or hypertrophic myopathy.
The presence of the following diseases is characteristic of congenital mitral insufficiency:
- parachute deformity of the valve;
- cleavage of the mitral valves;
- artificial fenestration.
Prolapse of the mitral valve of the 1st degree usually occurs with various pathologies of connective tissue. At the same time, its flaps become malleable and bend into the cavity of the atrium with ventricular contraction. Thus, part of the blood flows back, due to which the ejection fraction is reduced. The degree of insufficiency is determined by measuring the volume of regurgitation, and prolapse by the distance of the deflection of the valves. At the first degree, the flaps deviate by 3-6 mm.
This defect is much more often found in children, especially in girls. In this case, we are talking about a congenital pathology that causes an imperfect structure of the connective tissue. At the same time, the base of the valve flaps, as well as the chords responsible for the rigidity of the structure, change.
Among the acquired causes of mitral valve prolapse (MVP) of the 1st degree, there are:
- A rheumatic lesion that develops as an autoimmune reaction to some types of streptococcus. In this case, damage to other valves and joints is also characteristic.
- Coronary heart disease affecting the papillary muscles and chords, which can even rupture during myocardial infarction.
- Traumatic injuries usually lead to more serious manifestations.
- Pathogenesis and causes
- Causes of appearance
- Congenital Causes
- Congenital Causes
- Folk remedies
- Congenital Causes
- Mitral valve prolapse grade 3
- Possible complications
- Mitral valve prolapse during pregnancy
- Mitral valve prolapse (MVP) grade 1: what is it, symptoms and treatment
- How is the treatment
- Possible complications
- What is the danger of the disease, complications
- Prognosis and prevention
- Disease prognosis
Pathogenesis and causes
The mitral valve is a septum made of connective tissue that passes blood from the left atrium into the left ventricle and prevents its reverse current (regurgitation). Mitral valve prolapse is a sagging sash due to its loose fit to the walls of blood vessels. As a result, during systole of the left ventricle, blood flows back into the left atrium, and the amount of blood that must be sent to the aorta decreases.
Prolapses are congenital and acquired. The congenital form occurs with structural disorders of collagen fibers, which leads to hyperplasia of the middle part of the cusps and its replacement with weaker tissue. Such a valve no longer fully closes, becomes malleable and bends into the atrial cavity, letting blood flow through.
Acquired prolapse develops against the background of other diseases, but is rare. It is mainly diagnosed after rheumatic fever, which is observed in children suffering from streptococcal angina. The cause of prolapse can be coronary heart disease, as well as other pathologies that violate the contractile function of the myocardium, cardiomyopathies of various origins, severe myocarditis and endocarditis. The disease can be a consequence of thyroid pathology and a blunt chest injury.
Prolapse of the mitral valve of the first degree usually does not pose a threat to life. Its expressed symptoms are absent, and the defect itself is detected by chance during a routine examination. The danger manifests itself against a background of emotional shock or physical exertion. In this case, the violation causes pain in the left half of the chest, which lasts from several minutes to several hours. Pain increases with inspiration and disappears with physical exertion.
Other symptoms are present:
- a feeling of lack of air in combination with the inability to breathe fully;
- rapid or slow heartbeat, interruptions and extrasystole;
- headache and dizziness;
- loss of consciousness for no apparent reason;
- low-grade fever in the absence of other signs of disease.
The disease is often combined with vegetovascular dystonia. Therefore, during an attack, its symptoms can also be felt (increased blood pressure, weakened intestinal motility, chills, anxiety, pallor or redness of the face, sweating, etc.).
With prolapse of the 1st degree, there are rarely complications. In severe defects with lengthening and thickening of the valves, as well as an increase in the left chambers of the heart, mitral valve insufficiency may be noted, which requires surgical treatment and reconstructive procedures. Against the background of increased sensitivity of the mitral valve to microbial agents, infectious endocarditis may develop.
Causes of appearance
Mitral valve prolapse is an independent disease. It is a syndrome that occurs in many diseases. Depending on the etiology, secondary MVP is isolated – it arises due to other pathologies, and the primary one is also congenital, or idiopathic.
Quite often, idiopathic MVP is detected in children and adolescents. It appears due to congenital dysplasia of the connective tissue. As a result of this disease, other disorders in the structure of the valve apparatus may develop, for example:
- lengthening or shortening of the heart chords;
- incorrect attachment of chords to valve flaps;
- the presence of additional chords;
As a result of structural changes in the connective tissue, degenerative processes occur in the valve cusps, and they become more malleable. Because of this, the valve cannot withstand the pressure created by the left ventricle and bends towards the left atrium. Connective tissue dysplasia can occur for various reasons that affect the baby in the womb, among them the following are distinguished:
- Acute respiratory viral infections during pregnancy.
- The presence of occupational hazards in women.
- The influence of environmental factors on the mother during pregnancy.
- Excessive stress on the body of a pregnant woman.
In approximately 20% of cases, congenital MVP is transmitted through the maternal side. In addition, mitral valve prolapse occurs in other hereditary diseases, such as:
- Morphan’s syndrome.
- Elastic pseudoxanthoma.
- Imperfect osteogenesis.
- Ehlers-Danlos Syndrome.
Secondary MVP (or acquired) may occur as a result of certain diseases. Most often, this pathological condition is caused by:
- Coronary heart disease.
- Chest injury.
- Hypertrophic cardiomyopathy.
- Systemic lupus erythematosus.
- Myocardial dystrophy.
Prolapse in this case occurs due to damage to the valve cusps, papillary muscles, chords, or a malfunction in the work and structure of the myocardium. Also an important role in the mechanism of development of MVP is played by disturbances in the functioning of the autonomic nervous system, a deficiency of micro and macro elements (especially Magnesium) and metabolic pathology.
Another cause of secondary prolapse is stenosis of the aortic valve. As a result of this acquired defect, the opening of the aortic valve narrows and the blood cannot fully pass through it. This creates excess pressure in the left ventricle, which in turn presses on the bicuspid valve.
The pathogenesis of mitral valve insufficiency is associated with pathologies in the following heart departments:
- Mitral valve
- Papillary muscles.
Currently, researchers have identified the following causes of mitral valve insufficiency:
- Past infectious diseases (endocarditis);
- Rheumatic lesions;
- Lesions of the mitral ring with calcification;
- Traumatic lesions of the cusps of the mitral valve;
- Some autoimmune pathologies;
- MVP (mitral valve prolapse);
- Myocardial infarction;
- Cardiosclerosis developing after a heart attack;
- Arterial hypertension;
- Cardiac ischemia;
- Dilated cardiomyopathy.
The causes of the development of the defect are congenital and acquired.
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Anomalies in the development of connective tissue (Marfan and Ehlers-Danlo syndromes). This situation is genetically predetermined.
There are family cases of pathology. In such families, all sibling members have confirmed this diagnosis.
Causes of mitral valve prolapse
How common among all mitral valve pathologies
Depending on the reason that led to the mitral valve prolapse (we examined them above), doctors choose the treatment tactics:
- If the cause of prolapse is rheumatic disease, then prophylaxis is carried out by rheumatologists in the offseason so that the mitral valve is not aggravated.
- Infection on the cusps of the mitral valve is treated with antibiotics. The disease can be completely cured, prolapse will go away, and there will be no regurgitation.
- A dull injury (a punch to the chest or a chest strike at high speed against the steering wheel of a car) can lead to the detachment of one of the chords of the mitral valve leaflet. Then there will also be PMK. Doctors operate on these patients – sew a chord. The valve ceases to fall into the left atrium and the disease goes away.
- With hypertension (high blood pressure), myocardial infarction (death of part of the myocardium), complex treatment of these diseases is carried out.
The prognosis is highly dependent on the cause that caused the disease.
- With hypertension, the prognosis depends on the underlying disease and the severity of heart failure.
- Rheumatic malformations of MK are observed for a long time (maybe a year or decades). They are capable of not bothering people for years. And if complaints appear, then doctors prescribe medications. Medications are taken in courses (a month or two) throughout life. When medications are ineffective, they recommend an operation – prosthetics of the mitral valve (an artificial heart valve is sewn in place of the mitral valve).
- Infectious endocarditis is even conservatively cured completely. The treatment is long – months. The forecast is good.
- Treatment for drug addicts with infectious endocarditis has a very short-term effect. Mortality is extremely high, even after MK prosthetics surgery. Units survive for the first two years. The prognosis is poor.
Mitral valve prolapse itself (without complications) has a good prognosis.
There are two types of mitral valve dysfunction:
- Congenital or primary. Occurs in zi with intrauterine failure to produce collagen type 111, which is the basis of all the connective tissues of the body. As a result, the tissue of which the mitral valve cusps are made becomes soft and does not have the elasticity necessary to completely close the valve.
This type of disease is often inherited and is present in a person from birth. However, a fetal connective tissue defect can also occur due to exposure to harmful factors such as drugs, alcohol, smoking, toxic substances, as well as poor nutrition and stress.
Congenital MVP 1 degree in children. mainly found during the first ultrasound of the heart. Usually, accompanying symptoms are not observed and this condition is considered a variant of the physiological norm and is not dangerous.
- Acquired or secondary. It appears as a result of the occurrence of certain heart diseases, such as rheumatic heart disease, coronary heart disease, myocardial infarction, tonsillitis, scarlet fever and other diseases. These diseases reduce muscle tone, which are responsible for the proper functioning of the mitral valve.
Also, this disease can occur due to a chest injury, in which the destruction of the heart chords occurs.
In the absence of symptoms, a patient with grade 1 MVP with minimal regurgitation does not need treatment. Most often, this category includes children who are diagnosed with this disease during an ultrasound scan of the heart during the medical examination. Usually they can even go in for sports without restrictions. However, it is necessary to periodically be observed by a cardiologist and monitor the dynamics.
Medical assistance may be needed only if this prolapse is accompanied by dangerous symptoms, such as heart pain, heart rhythm disturbances, loss of consciousness, and others. In this case, the treatment is aimed at eliminating the symptoms. Surgical treatment of MVP of the 1st degree is not carried out.
Depending on the negative manifestations accompanying mitral valve prolapse, the following drugs are prescribed:
- sedatives and tranquilizers, including glycine, tenoten, pantogam, phenotropil and other drugs taken with vegetovascular th dystonia;
- anticoagulants, for example, heparin, phenylin, in case of risk of thrombosis;
- beta-blockers, mainly timolol, penbutolol and nebivolol, which are used to restore heart rate;
- drugs for improving the functioning of the myocardium, such as riboxin, panangin, magnerot, which are a source of magnesium and improve electrolyte balance;
- Vitamins B and C to strengthen the heart muscle.
In addition, the patient needs physiotherapy exercises, breathing exercises, spa treatment, massage, relaxation and psychotherapeutic sessions.
You should also adhere to a healthy lifestyle, proper nutrition and moderate exercise.
Traditional medicine along with pharmaceutical drugs give good results in eliminating the symptoms of MVP of the 1st degree.
In this case, the following medications are used that have a sedative effect and strengthen the heart muscle:
- horsetail decoction, which helps strengthen the heart muscle and at the same time is a good sedative;
- tea from a mixture of the following herbs: motherwort, hawthorn, mint and valerian, which has a powerful calming effect;
- tea from a mixture of heather, thorns, motherwort and hawthorn, which also calms well;
- a rosehip decoction as a source of vitamin C, necessary for the heart muscle.
- a mixture of 20 eggshells, juice of 20 lemons and honey in the same volume as eggs and juice.
You should also eat dried fruits, red grapes and walnuts, as containing large amounts of potassium, magnesium and vitamin C.
It should be borne in mind that in some cases with age, an increase in the sagging of the mitral valve is possible, therefore, patients with the 1st degree of prolapse, even in the absence of symptoms, need regular monitoring by a cardiologist (1-2 times a year).
MVP is classified depending on the severity of prolapse, the degree of regurgitation, and etiology.
According to etiology, there are:
- 1. Primary PMK.
- 2. Secondary PMK.
- 1. MVP of the 1st degree – the valves of the bicuspid valve prolapse no more than 6 mm. Regurgitation is negligible and does not lead to severe circulatory disorders. Pathology of this degree in most cases does not manifest clinical and has a neutral course. This condition does not require special treatment, but periodic examinations of the patient and ultrasound are necessary. Sports and physical exercises are not contraindicated for such patients, but strength and weightlifting exercises are prohibited.
- 2. MVP 2 degrees – prolapse within 6-9 mm. There are clinical manifestations of the disease, such patients are prescribed symptomatic treatment. Physical education and sports are allowed only by agreement with a cardiologist, since you need to choose the right load.
- 3. MVP 3 degrees – valve prolapse greater than 9 mm. In this case, severe violations in the structure of the heart occur. The chamber cavity of the left atrium begins to expand, and the walls of the ventricles hypertrophy. Blood is not ejected into the aorta, and severe circulatory disorders develop. Prolapse leads to cardiac arrhythmias and mitral regurgitation. With this form of the disease, surgical interventions are performed that are aimed at prosthetics or suturing of the valves. Patients with a third degree of MVP are prescribed a complex of physiotherapy exercises, which is carried out under the supervision of doctors.
Since the degree of regurgitation does not always depend on the severity of prolapse, there are three stages of mitral valve prolapse. They are determined depending on the severity of the return of blood to the left atrium. Set the level of regurgitation according to the data of ultrasound with doppler:
- 1. The first stage is characterized by regurgitation at the level of valve cusps.
- 2. The second is characterized by the formation of a regurgitation wave, which reaches the middle of the left atrium chamber.
- 3. The third stage is characterized by the appearance of a wave of blood return, reaching the opposite end of the left atrium.
Depending on the relationship to ventricular systole, there are:
Depending on the localization, they distinguish:
- PMK of both wings.
- PMK back sash.
- PMK front sash.
Depending on the presence of auscultatory clinical signs, it is customary to distinguish:
- “Mute” form – pathological murmurs in the heart are not heard;
- auscultatory form – pathological noises of regurgitation are heard.
It should be more extensively explained what the pathology leads to. After the pressure in the left ventricle rises, the blood from it recedes into the left atrium, increasing the indicators of blood volume and pressure here.
Rarely, the disease occurs in patients in their pure form. The number of such people is only 5% of cases. In children, a pure form of insufficiency is rare. The disease itself is most often accompanied by other types of heart disease.
|First||Grade 1 NMC is characterized as moderate. The expression is that the flow of blood entering the left atrium will not be any significant and dangerous.|
Regurgitation will be approximately 25% and concentrated only near the mitral valve itself. For grade 1, treatment and prognosis will be positive, as the symptoms are minor.
|Symptoms are manifested only in systolic murmurs. Another manifestation is a slight expansion of the cardiac border to the left. On the electrocardiogram, no pathological changes are detected.|
|The second||NMK st 2 is the 2nd degree of mitral insufficiency. The bloodstream is able to reach the very middle of the left atrium. Blood reflux can reach up to 50% of the total blood flow.|
Here, an increase in pressure cannot be avoided, since without this the atrium does not get the opportunity to push the blood out. One symptom is the formation of pulmonary hypertension.
|When hypertension already takes place, the patient experiences shortness of breath, coughing. The heartbeat accelerates even in a calm state. An electrocardiogram will show how much the atrial functionality has changed.|
A detailed examination demonstrates systolic type murmurs. Cardiac borders usually expand by two centimeters to the left, and about half a centimeter to the right and up.
|The third||When insufficiency develops to grade 3, the bloodstream is able to penetrate into the atrium up to the posterior wall. The systolic volume can reach 90%. Decompensation begins.|
|Another manifestation is left ventricular hypertrophy, when it loses the ability to push out all the accumulated blood.|
|Signs of grade 3 mitral regurgitation are detected on the ECG, which shows mitral tooth hypertrophy and noise during systole.|
With the help of a phonendoscope you can hear noises. The expansion of the heart borders becomes more pronounced.
Depending on the course of the pathological process, acute or chronic mitral regurgitation occurs.
For reasons of occurrence, ischemic and non-ischemic mitral valve insufficiency occurs.
According to the topography of prolapse:
According to some authors, prolapse of the anterior cusp of the mitral valve of the 1st degree is more common (in about 77% of cases).
It is also customary to isolate a clinically significant anomaly when there are signs of prolapse without regurgitation and an anatomically significant anomaly when MVP is combined with mitral regurgitation and possible valve failure in the future.
As mentioned above, mitral valve prolapse of the first degree is primary and secondary. In the first case, valve prolapse is associated with hereditary features of the valve structure.
Grade 1 prolapse (as well as 2 and 3) is associated with such nosologies as Marfan syndrome, Ehlers ─ Danlo and other collagenopathies.
Secondary MVP is a consequence of various diseases accompanied by structural changes in the mitral valve:
Symptoms of mitral valve prolapse are divided into several groups:
Mitral valve prolapse grade 3
Mitral valve prolapse is most often diagnosed by accident. Since the symptoms of MVP are characteristic of many other diseases, echocardiography (echocardiography) is used to detect prolapse. It allows you to see the full picture of the disease and determine its degree. So, mitral valve prolapse is divided into:
It is believed that patients with MVP 2 and 3 degrees have an increased risk of complications.
For diagnostic purposes, the electrocardiographic method (ECG) is also used. It helps to identify failures in the rhythm of the heart, bradyarrhythmia, tachycardia. In most cases, for patients without heart complaints, concomitant diseases and with mitral valve prolapse of the 1st degree ECG is not performed, limited only to regular echocardiography for the purpose of annual monitoring of the heart condition.
In rare cases, an x-ray of the chest can be prescribed, which will reveal any abnormalities in the structure of the chest. Such deviations can seriously affect the work of the heart, and PMK can thus be said to be acquired, that is, secondary.
First of all, the patient should pay close attention to the normalization of work and rest time, the formation of proper nutrition and the organization of regular physical activity.
The frequency of physical activity and possible sports that will not harm a person with MVP can only be prompted by a doctor.
In the event that the manifestation of symptoms of MVP occurs after stress, psychoemotional stress, and also in the case of depression with prolapse, the use of sedatives or antidepressants is required.
Surgical treatment of MVP is extremely rare. The disease should be 3 degrees, marked by complications and severe malfunctions of the heart, so that surgical treatment is prescribed.
With age, the risk of complications with MVP increases, but, nevertheless, a real exacerbation of the disease is observed only in 5% of cases. With MVP, the following complications are possible:
In addition, there are known cases of sudden death with mitral valve prolapse. These cases are extremely rare and develop in the presence of serious arrhythmias and long QT syndrome.
From this article you will learn: what is mitral valve prolapse of the 1st degree, its causes and symptoms. Treatment and prognosis for the disease.
Mitral valve prolapse (abbreviated as MVP) is the most common congenital or acquired pathology of the structure of the valvular apparatus of the heart. This is a deflection (sagging, sinking) of one of the valves during the contraction of the heart, which may be accompanied by the flow of blood back to the atrium.
If according to the ultrasound of the heart, the sash fails by 3-6 millimeters, then they say about prolapse (or malformation) of 1 degree. If blood flow back into the left atrium joins this situation, then they say about mitral valve prolapse of the 1st degree with regurgitation of the 1st degree.
In the older age group of women, the prevalence of prolapse is 4 times lower. In women, this defect disappears with age; for men, the incidence rate of pathology remains within 2–3%.
The following patients are involved in the treatment and monitoring of patients with this diagnosis: cardiologist, arrhythmologist, cardiac surgeon, neuropathologist.
Mitral valve prolapse is a disease associated with a dysfunction of the valve located between the left atrium and the left ventricle. In this case, the valve flaps bend into the cavity of the left atrium while contracting the left ventricle, passing back some of the blood. The first degree of prolapse is the most common, it does not require surgical intervention.
Mitral valve prolapse (MVP) – such a diagnosis can often be seen in the results of an ultrasound of the heart. However, do not immediately worry: this type of valvular defect is often diagnosed in completely healthy people and requires only periodic monitoring by a cardiologist.
Therapeutic tactics directly depend not only on the severity of the prolapse (sagging) of the valve, but also on the degree of regurgitation (volume of the reverse blood flow).
At the same time, degree 0 regurgitation does not give any painful symptoms: a person feels completely healthy and does not complain of heart function.
pain during exercise
Some patients note the occurrence of pain in the right hypochondrium while running. This is due to insufficient right ventricular functionality to increase the volume of blood flow in the heart. Deviation is recorded during the examination:
With prolapse of the bicuspid valve and 2 degrees of regurgitation on ultrasound (Doppler of the heart), more pronounced signs of mitral regurgitation are recorded. A stream of blood, returning through an incompletely closed valve, reaches the middle of the atrium chamber.
Over 25% of the blood returns to the atrium from the ventricle. In this case, there are symptoms characteristic of stagnation in the pulmonary circulation:
Failure in the pulmonary circulation leads to an increase in the load on the right half of the heart. Already existing symptoms are gradually exacerbated and severe signs of insufficiency of a large circle appear: edema, increased pressure, cyanosis of the skin, insuperable weakness, atrial fibrillation and enlarged liver. Such patients usually receive 1 disability group.
Mitral valve prolapse is life threatening precisely at the 3rd degree of regurgitation: the development of paroxysmal tachycardia, pulmonary edema, endocarditis and other serious complications, up to sudden death, is possible.
Mitral valve prolapse during pregnancy
Minor prolapse of the bicuspid valve and minor mitral regurgitation is not a contraindication to pregnancy; bearing a child in this case is normal.
In this case, there may even occur a temporary decrease in the deflection of valve flaps due to a physiological increase in the size of the left ventricle. However, systolic murmur and clicks return 1 month after delivery.
More severe is the severe degree of regurgitation and mitral valve prolapse during pregnancy: the risk of developing paroxysmal tachycardia attacks is significantly increased. During childbirth, rupture of valve chords is not excluded.
In women with MVP, premature discharge of amniotic fluid and weak labor pain are often recorded. The baby is prone to intrauterine asphyxia and is often born with low weight (hypotrophy).
Symptoms of mitral prolapse of the first degree are usually less pronounced, and in some situations may be absent altogether. Most often, this condition is manifested by pain in the left half of the chest, not associated with myocardial ischemia. It can last for several minutes, and can persist throughout the day. There is no connection with physical activity, but sometimes, the pain syndrome is provoked by emotional experiences.
Other manifestations are:
Since MVP is often combined with vegetative-vascular dystonia, its symptoms may also be associated.
Mitral valve prolapse (MVP) grade 1: what is it, symptoms and treatment
Symptoms directly depend on the degree of regurgitation and the severity of connective tissue dysplasia. In children with congenital MVP are quite common:
These diseases indicate the presence of abnormalities in the structure of connective tissue and very often together with them identify malformations of the valvular apparatus of the heart, including prolapse.
Patients with dysplasia more often than healthy people suffer from tonsillitis and acute respiratory viral infections.
Non-specific symptoms of MVP are:
With a pronounced degree of regurgitation, patients develop shortness of breath and fatigue, significantly reduced performance and physical activity. Also, the occurrence of psychosensory disorders such as:
Symptoms in secondary MVP are similar to those described above, but the clinical manifestations of the underlying disease (rheumatism, myocarditis, coronary heart disease, etc.) join it. Severe types of mitral valve prolapse are dangerous due to their complications in the form of the development of arrhythmia, thromboembolism or infectious endocarditis.
Symptomatically, mitral valve insufficiency is not expressed at first. The owner of the pathology does not feel bad, because the natural functionality of the heart compensates for the insufficiency.
Usually, a pathology is detected by chance – by a therapist, when a specialist hears characteristic noises during admission. These noises are clearly audible if blood begins to flow into the atrium due to the inconclusive closure of the mitral valve.
One can hear how intensively the left ventricle contracts, even if the mitral insufficiency is relative, that is, the volume indicator will not exceed 25%.
The goal of the atrium is to accommodate all the excess blood that comes from the left ventricle. Therefore, its volumes are increasing.
The contractions are too fast and wrong in terms of physiology.
The reason for the subsequent development of heart failure is pronounced regurgitation. When blood flow is impaired, blood clots form, which leads to aggravation of organ damage
Among them, the most obvious are:
The degree of manifestation of mitral valve insufficiency directly depends on the clinical stage of the disease at the time of diagnosis.
There are several stages:
The compensation stage can last up to several tens of years in the absence of severe symptoms.
Only some patients experience discomfort – this is weakness, cold limbs, excessive fatigue. At this stage, the threat to life and health is small.
With significant physical exertion, the patient experiences a rapid heartbeat, and the heart rate is disturbed.
The stage of decompensation occurs when the symptoms become most pronounced. They are observed both in the activity stage and in the resting stage. Characteristic attacks of suffocation, accompanied by a cough. In advanced cases, the decompensation stage goes into the terminal.
Moreover, cases of MVP in women are diagnosed twice as often as in men, and in children and adolescents the difference is not very pronounced.
More than half of people with MVP do not have any specific symptoms. Prolapse is thus diagnosed by chance and in most cases does not require treatment or constant monitoring.
Given that women are more likely than men to suffer from MVP, their clinical manifestations are more pronounced. So, women can suffer from nausea, excessive sweating. and in case of serious physical or emotional stress, bordering on overstrain, a vegetative crisis may occur.
A fairly common symptom of MVP is arrhythmia. which is expressed in a rapid heartbeat, a feeling of tremors and interruptions in the work of the heart. This condition occurs due to excitement, physical activity or the use of strong tea, coffee and energy drinks. In addition, elongated QT syndrome appears in 25% of cases, which, however, rarely manifests itself.
A very striking common symptom of MVP is a variety of psycho-emotional disorders. Often, patients seek medical help precisely because of such deviations. The most common are depressive states with a bias in hypochondriacal experiences. A person is haunted by sadness, indifference to external stimuli, causeless longing, and sometimes anxiety and excessive irritability.
General fatigue and weakness, which often accompany such conditions, pass after a short rest. Sometimes a person may feel a deterioration in the evenings, due to the development of senestopathy – a painful and unpleasant feeling on the surface or inside the body, in organs, for no objective reason.
Each of the above symptoms may relate to another disease that has nothing to do with MVP. That is why diagnosing MVP by symptoms is extremely difficult. The risk of error in this case is quite high.
The presence of specific signs of MVP can provide some information. As already mentioned, mitral valve prolapse is sometimes called “click and noise syndrome,” which is not a beautiful medical invention. In people with valve pathology, clicks or clicks are often heard during heart function, which are explained by excessive tension of the chords. Sometimes voice-static noise is determined. It is constant and does not change in different positions of the body.
Symptoms of this pathological process increase with the development of insufficiency. During a period of compensated mitral regurgitation, symptoms may not occur. This stage can give a long course (up to several years) without any symptoms.
Subcompensated degree of insufficiency is accompanied by:
With the further course of the pathology, insufficiency of the right ventricle of the heart develops. Symptoms appear such as:
On palpation, an increase in the liver is felt. The enlarged atrium and pulmonary trunk squeeze the laryngeal nerve, hoarseness appears – Ortner’s syndrome.
In a decompensated stage, more patients are diagnosed with atrial fibrillation.
Heart murmurs can be heard using phonocardiography or auscultation. In the case of a “mute” form of the disease, pathological noises are not heard in this way, but can be recorded on phonocardiography.
With the help of X-rays, it is possible to detect a change in the size of the heart – an increase or decrease in cavities, a change in configuration, etc.
Electrocardiography performed during the day (Holter monitoring of the heart) may show the following disorders:
With severe regurgitation and signs of heart failure, bicycle ergometry is performed. It shows how much reduced human performance, and allows you to establish the degree of failure.
Diagnosis of mitral valve and heart pathologies is carried out using the following methods:
Mitral malformations include medical and surgical treatment. The medication method is used to correct the general condition of the patient in preparation for surgery or in the stage of defect compensation. Drug therapy includes the following drugs:
For surgical treatment of subcompensated and decompensated acquired mitral defects, the following types of interventions are performed:
After surgical treatment, patients are assigned a rehabilitation course, which includes:
Signs of prolapse of the 2nd or 3rd degree are determined when listening to a heartbeat with a stethoscope. At the first degree, blood regurgitation is not expressed, heart murmur may be absent. But from the expected symptoms, a short click in the middle of systole and a postsystolic murmur at the apex of the heart are sometimes found.
If the patient complains of characteristic symptoms, an ultrasound of the heart is prescribed. The study includes echocardiography and Doppler echocardiography, which most accurately determines mitral valve calcification. The examination shows the degree of sagging of the valves and the volume of regurgitation, the presence of secondary changes in the tissues of the heart, an increase in the volume of the heart chambers (dilatation), violation of the length and thickness of the valves.
Upon physical examination, a patient may have a congenital deformity of the chest, which takes a keel-like or funnel-shaped form. There are signs of Marfan syndrome, which include thinness, spider fingers, a displacement of the heart to the right side (dextrocardia).
Treatment of mitral valve prolapse of the 1st degree is required only with pronounced signs of mitral regurgitation and circulatory disorders. The therapy is aimed at reducing the tone of the parasympathetic nervous system, which involves a change in the rhythm of life and physical activity. The patient is recommended to refuse coffee, alcohol, nicotine, taking sedatives, metabolic agents (Riboxin, Panangin), which improve myocardial nutrition and contain the necessary electrolytes.
Beta-blockers are prescribed to control heart rate. With thromboembolic complications, anticoagulants and antiplatelet agents are indicated. As a restorative therapy, spa treatment is recommended.
With the timely detection and treatment of mitral valve prolapse of 1 degree, the prognosis is favorable. Pathology rarely leads to impaired circulation and disability. Typically, patients do not need dynamic observation, only the restriction of physical activity is shown: running, jumping, professional sports are not recommended.
Prevention concerns mainly secondary prolapse. It includes the elimination of infection, which contributes to the development of valve pathology, the treatment of hypercholesterolemia, preventive diagnosis, regular ultrasound of the heart and cardiologist consultation. Such scheduled examinations will help in time to detect the development of complications and prescribe treatment. Maintaining a high quality of life will help regular physical activity, refusing bad habits and a healthy diet.
This article is posted for educational purposes only and is not scientific material or professional medical advice.
To create a complete picture of the disease of a patient with MVP, a cardiologist also analyzes the following data:
Diagnosis of mitral regurgitation should be based on the following comprehensive measures:
According to x-ray and ECG, the expansion of the left ventricle and atrium is diagnosed.
The most informative diagnostic method is echocardiography, here you can assess the defect and the degree of damage to the valve itself. For a more specific diagnosis in the presence of atrial fibrillation, trans-food echocardiography is used.
This anomaly is recorded quite often in healthy individuals, athletes, whose achievements are associated with great physical exertion, and may indicate some health problems.
Often, doctors of various specialties are faced with clinical symptoms of pathology.
Diagnosis of MVP of the 1st degree is possible on the basis of complaints, anamnesis, examination, results of instrumental examination. When clarifying complaints, it is not possible to establish specific symptoms, and it is possible to suspect the presence of prolapse of the mitral valve cusps.
An objective inspection provides more useful information. Even in childhood, you can find typical signs of prolapse. This is a child of low nutrition with various stigmas of dysembryogenesis (funnel chest, Gothic palate, sandal-shaped slit).
Due to dysplastic processes in the connective tissue, hypermobility of the joints is noted.
The musculoskeletal system also suffers, which will be manifested by progressive transverse flatfoot. There are stretch marks on the skin of the hips and buttocks.
Typical for PMK is the following sound picture during auscultation:
In more than half of patients, an isolated mesodiastolic click is more common. However, such a sound picture is absent in some cases.
Instrumental research is fundamental in diagnosis. The following changes are detected on the cardiogram:
When conducting echocardiography, sagging of one or both valves in the left atrium is visualized. According to indications, angiography and a radionuclide study are prescribed.
How is the treatment
MVP treatment is carried out taking into account the severity of hemodynamic disturbances and clinical manifestations. Conservative therapy consists in eliminating autonomic disorders of central genesis, preventing the occurrence of dystrophic changes in the myocardium and preventing possible complications.
In the event of symptoms of heart failure, beta-blockers (Bisoprolol, Atenolol) and drugs with antiplatelet properties (Warfarin, Acetylsalicylic acid in low doses) are prescribed. These funds are taken daily, for several months or years.
Patients need to normalize their lifestyle:
Also, patients are shown physiotherapy. Reflexology, spinal massage, mud therapy, water procedures, electrophoresis with magnesium and bromine to the cervical-collar zone are recommended.
In the case of severe hemodynamic disturbances, surgical operations are performed, which include suturing or prosthetics of the mitral valve.
Mitral valve prolapse grade 1: healing measures
With a slight change in the structure of the valves (mitral valve prolapse with regurgitation of 1 degree), the absence of constant arrhythmia and other painful symptoms, treatment is not required. A person is recommended to see a cardiologist once a year and correct life principles:
Treatment of MVP and 2 degrees of regurgitation
The appearance of painful symptoms of mitral valve prolapse indicates the need for drug therapy. The treatment regimen includes:
To eliminate the progression of the disease and prevent the severe consequences of mitral regurgitation, cardiac glycosides, diuretics, ACE inhibitors are used (the nonhypertensive dosage of Captopril – about 0,5 mg/kg body weight per day – has a cardioprotective effect). Along with drug therapy, surgical plastic surgery of the bicuspid valve is performed.
The possibilities of modern medicine make it possible to carry out many heart operations with endovascular (transcatheter) or endoscopic access. Cardiac surgeons resort to open surgery only in extreme cases, for example, with combined defects.
In the absence of mitral insufficiency, the outcome of the disease is usually favorable. It is worth noting that a small deflection of the valve flaps in thin people and adolescent children can disappear on their own when observing a rest regimen, appropriate physical activity and good nutrition.
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In addition, the cardiologist usually recommends quitting smoking, strong tea and coffee, and minimizing alcohol consumption. Physical therapy exercises or any other physical activity, with the exception of heavy sports, will be useful.
Mitral valve prolapse of the 2nd degree, and in particular of the 3rd degree, can cause significant regurgitation, which leads to a deterioration in well-being and the appearance of symptoms. In these cases, drug treatment is performed. However, no medication can affect the condition of the valve and the prolapse itself. For this reason, treatment is symptomatic, that is, the main effect is aimed at relieving the person of unpleasant symptoms.
In some cases, symptoms of arrhythmia predominate, then appropriate drugs are needed. In others, sedatives are required, as the patient is very irritable. Thus, medicines are prescribed in accordance with complaints and identified problems.
This may be a combination of symptoms, then the treatment should be comprehensive. All patients with mitral valve prolapse are advised to arrange the regimen so that sleep is of sufficient duration.
Exposure to drugs may not bring the desired effect, as it does not affect the condition of the valve. Some improvement may occur, but it cannot be considered stable in the acute progressive course of the disease.
In addition, complications that require surgical treatment are possible. The most common cause for surgery for MVP is the tearing of the mitral valve ligaments.
At the same time, heart failure will increase very quickly, because the valve cannot close at all.
In general, the prognosis for mitral valve prolapse depends on several factors:
Of course, timely diagnosis and accurate adherence to the prescriptions of a cardiologist play an important role in the success of treatment. If the patient is attentive to his health, then he will “sound the alarm” on time and undergo the necessary diagnostic procedures, as well as start treatment.
In the case of uncontrolled development of pathology and the lack of necessary treatment, the condition of the heart can gradually deteriorate, which will lead to unpleasant, and possibly irreversible, consequences.
In case of mitral valve insufficiency, only a cardiologist should prescribe treatment. You can not self-medicate and resort to folk methods!
Treatment should be aimed at eliminating the cause of mitral insufficiency, that is, at the disease preceding the pathological process.
A mild to moderate degree requires the use of drugs, the action of which is aimed at reducing the heart rate, vasodilator drugs (vasodilators). It is important to lead a healthy lifestyle, not to drink or smoke, to avoid states of physiological overwork and psychological stress. Showing walks in the fresh air.
With mitral valve insufficiency of the 2nd degree, as well as in the third, anticoagulants are prescribed for life to prevent vascular thrombosis.
Treatment of mitral valve prolapse of the 1st degree in some cases is not required. This concerns the detection of such changes in ultrasound in a child who does not experience any symptoms of the disease. At the same time, children do not have restrictions for physical education, but it is not advisable to engage in professional sports.
If there are symptoms of the disease, it is necessary to select therapy to reduce or eliminate them. In each case, the doctor prescribes therapy, taking into account individual characteristics. The main groups of drugs used in the treatment of MVP include:
In this case, it is very important to optimize the lifestyle, because often the manifestations are exacerbated by chronic fatigue and nervous strain. It is necessary:
A cardiologist prescribes treatment depending on the degree and severity of the lesion. An important factor in the choice of therapy is the pathogenesis of the disease in the patient. Certain groups of drugs are prescribed to eliminate the symptoms.
The result is an improved structure of the mitral valve mechanism and the prevention of damage to the ventricle and atrium.
What is the danger of the disease, complications
In the case of a congenital type of MVP of the 1st degree, complications are very rare. More often they occur with a secondary form of the disease. Especially if it has arisen in connection with injuries in the chest or against other heart diseases.
The following effects of the disease occur:
It is especially necessary to treat this disease to women expecting a baby. Basically, MVP of the 1st degree during pregnancy does not pose a threat to a woman or an unborn baby.
At the same time, in 70-80% of women in position, tachycardia and arrhythmias may occur. The likelihood of gestosis, premature amniotic fluid withdrawal, shorter delivery times and decreased labor activity is also increased.
In the article, what is mitral valve prolapse of the 1st degree, its clinical characteristics, the main aspects of diagnosis and treatment. However, this anomaly is not as harmless as it seems at first glance. It can lead to such threatening consequences as infectious endocarditis, separation of chords, sudden cardiac arrest, life-threatening rhythm disorder, perforation of the valve leaflet.
Prognosis and prevention
To prevent the formation of valvular defects, the patient is advised to timely treat the pathologies that cause damage to the heart valves, lead a healthy lifestyle and perform the following:
Thus, mitral valve prolapse of the 1st degree is a rather serious disease, which should be regularly observed by a doctor. However, with timely compliance with therapeutic and preventive measures, it is possible to minimize the symptoms and complications of the disease.
Medical Consultant Vessels And Heart Mitral valve prolapse of degree 1,2 and 3: treatment and prognosis
Mitral valve prolapse is mainly a congenital problem. However, this does not mean that it is impossible to prevent it. At least it is possible to reduce the risk of grade 2 and 3 prolapse.
Prevention can be regular visits to a cardiologist, adherence to diet and rest, regular exercise, prevention and timely treatment of infectious diseases.
Daughters 10 years, two years ago, symptoms of lack of air on inspiration appeared, during the examination, MVP was diagnosed. She started swimming, has been going there for a year and a half. Yesterday at the training session I felt dizzy, the trainer noted a very strong increase in heart rate – 180, after a short rest it became 130, in half an hour – 104.
Elena February 23, 2017 at 00:21
Oleg February 24, 2017 at 04:16
At 17 years old, they were assigned PMKs of the 2nd degree, at 18 years old, the PMKs of the 1st degree, which means “fit with restrictions,” are already in front of the army. After serving, I immediately tried to get a job at the Ministry of Internal Affairs, but alas, for some reason, it was already unusable for some reason, even with restrictions.
Axaul April 17, 2017 at 07:24
Recently, I was also diagnosed with this. With such an illness, is it possible to play sports and lift heavy things?
I have grade 2 prolapse. He went into the army, was reduced to 1 degree. He returned – already 3 degree, I’m afraid of a symptom of sudden death.
Tatyana May 28, 2017 at 16:14
And if at the same time hemoglobin 153, then what should I do?
I read and am horrified, according to signs it looks like the 3rd degree ((. I’m afraid of sudden death, but I’m only 25! I’ll go to the doctor, I hope for the best result. Health for everyone.
A favorable prognosis for mitral insufficiency of 1-2 degrees is given in almost 100% of cases. The patient can remain healthy for many years. It is important to be supervised by specialists, undergo consultations and diagnostic examinations. With such phases of the disease, even pregnancy and bearing a child are allowed. Permission from childbirth in these cases is carried out by Caesarean section.
More severe pathological changes in case of insufficiency lead to severe violations of the circulatory system as a whole. Poor prognosis is usually assumed when a chronic course joins a heart failure. Mortality rates in this category are quite high.
Mitral insufficiency is a serious defect, therefore, its identification, diagnosis, treatment should not be delayed.
The main measures for the prevention of this pathology are aimed at preventing the development of complications. First of all, it is:
Secondary prevention consists of taking drugs that dilate blood vessels (vasodilators), improve blood flow, and lower blood pressure.
Mitral insufficiency can give a relapse even after surgery. Therefore, you need to take care of yourself, take all the drugs prescribed by the doctor, follow his advice.
Prevention can be carried out only with secondary defects, and timely treatment of foci in which a chronic infection is localized, as well as the fight against hypercholesterolemia, is necessary. With a primary change in the valve and an asymptomatic course of the disease, the prognosis is favorable and a normal lifestyle can be maintained.
Mitral valve prolapse – sagging of its walls into the atrial cavity during ventricular contraction. In this case, a reverse blood flow occurs, the volume of which determines the severity of the deficiency. The first degree is the most initial and in most cases is asymptomatic, but is often accompanied by a disorder of the autonomic nervous system.
In patients with grade III prolapse, the prognosis is less favorable, as the configuration of the heart begins to change, and severe hemodynamic disturbances develop. After surgery, the likelihood of a full recovery is quite high. Light physical exertion for this category of patients will be enough, but they can be performed only after consultation with your doctor.
Patients with minor changes in hemodynamics are taken into the army. But with severe clinical symptoms and circulatory disorders, the service will be contraindicated.
The effectiveness of the treatment of mitral heart defects depends on the following factors:
With mitral valve prolapse of the 1st degree, the prognosis for life is almost always positive. Basically, this disease is almost asymptomatic or with minor symptoms, so the quality of life does not particularly suffer. Complications develop very rarely.
Sports activities at the MVP of the 1st degree are allowed almost without restrictions. However, power sports should be excluded, as well as jumping, some types of wrestling associated with strong blows.
Extreme species are also excluded, where athletes experience pressure drops, such as:
The same restrictions apply to the choice of profession. A person with this disease cannot work as a pilot, diver or astronaut.