Internal illnesses. Mitral stenosis (lecture notes)

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Internal illnesses. Mitral stenosis (lecture notes)

Lecture notes, cheat sheets

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LECTURE No. 10. Mitral stenosis

Mitral stenosis is a heart disease caused by a narrowing of the left atrioventricular orifice, which creates obstacles to the movement of blood from the left atrium to the left ventricle. Women get sick more often.

Etiology. The causes of development are organic lesions (rheumatism), congenital malformations (Lutembashe syndrome - mitral stenosis with simultaneous damage to other organs).

Pathogenesis. There is an fusion of the mitral valve cusps, tendon filaments along the free edge. The area of the mitral orifice decreases (normally 4-6 cm²). In the cavity of the left atrium, pressure rises, the pressure gradient between the left atrium and the left ventricle increases, which facilitates the passage of blood.

Hypertrophy and tonogenic dilatation of the left atrium develop, systole lengthens. The pressure in the pulmonary veins and capillaries, the pulmonary artery increases. There comes a reflex spasm of the pulmonary arterioles (Kitaev's reflex), which leads to an increase in pressure in the pulmonary artery. The load on the right ventricle increases, the emptying of the right atrium becomes difficult. There comes myogenic dilatation of the left atrium, pronounced stagnation in the pulmonary circulation, myogenic dilatation of the right ventricle, hypertrophy of the right atrium.

When the valve opening is reduced to 1,5 cm² development of noticeable hemodynamic disturbances is noted.

Compensation is short-lived, since the load falls on the left atrium and right ventricle.

Clinic. Patients with asthenic physique, are infantile, the skin is pale, cyanosis of the face (facies mitralis) is noted.

Appear: shortness of breath, weakness, palpitations, periodically coughing, sometimes hemoptysis, suffocation at night, occasionally - dysphonia and dysphagia. The borders of the heart are enlarged upward and to the right, a clapping I tone, presystolic murmur, a bifurcation of the II tone, "cat's purr", a weak, irregular pulse are heard.

Additional diagnostic study. The ECG shows P-mitrale - expansion of the P wave and splitting of its apex in I, II left chest leads, lengthening of intra-atrial conduction, left atrial hypertrophy, signs of right ventricular hypertrophy.

X-ray examination establishes an increase in the left atrium, right ventricle, bulging of the left atrial appendage, venous congestion in the lungs and arterial hypertension.

With FCG at the apex, there are: an increase in the amplitude of the I tone (Q interval - I tone less than 0,07 s), mitral valve opening tone (QS) (II tone interval - QS less than 0,12 s), presystolic and mesodiastolic murmurs, an increase in amplitude II tone and its splitting on the pulmonary artery.

An echocardiographic study shows fibrosis of the mitral valve cusps, their unidirectional movement, an increase in the cavity of the left atrium and right ventricle.

When deciding on surgical treatment, angiography is performed.

Complications. These include congestion in the pulmonary circulation, hemoptysis, cardiac asthma, high pulmonary hypertension, pulmonary aneurysm, dilatation of the heart cavities, atrial fibrillation and flutter, thromboembolism, a spherical thrombus in the left atrium, symptoms of compression (recurrent nerve, subclavian artery).

Treatment. Operative is more often performed: mitral commissurotomy. Symptomatic therapy is carried out with circulatory failure and an active rheumatic process.

Forecast. Depends on the stage and complications; on average, 7 years after the appearance of the clinic, patients become disabled, and die over the next 3 years; most die at age 40. With timely commissurotomy and subsequent active antirheumatic therapy, the prognosis is favorable.

Author: Myshkina A.A.

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