Internal illnesses. Mitral valve prolapse (lecture notes)

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Internal illnesses. Mitral valve prolapse (lecture notes)

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LECTURE No. 8. Mitral valve prolapse

Heart disease is a condition characterized by prolapse of one or both leaflets of the mitral valve into the cavity of the left atrium, which usually occurs in the second half of the ventricular systole (in the exile phase). Prolapse means "bulging".

Etiology. congenital forms noted in the syndromes of Marfan, Emre-Danlos, Holt-Oramp, atrial septal defect, Ebstein's anomaly, Fallot's tetrade.

Possible hereditary pathology of the connective tissue (inheritance by autosomal dominant type).

Acquired Forms noted in ischemic heart disease, rheumatism, neurocirculatory dystonia, hypertrophic cardiomyopathy, thyrotoxicosis, chest trauma.

Pathogenesis. During ventricular systole, blood flows not only into the aorta, but partially back into the left atrium. The amount of reverse blood flow (regurgitation) corresponds to the degree of valvular insufficiency.

Pathological anatomy. More often, prolapse of the anterior leaflet of the mitral valve is noted (44-77%), then the posterior leaflet of the mitral valve (23%) and prolapse of both leaflets of the mitral valve (33%).

Classification. In a clinical setting, mitral valve prolapse is divided into:

1) according to the severity (I - prolapse 3-6 mm, II - prolapse 6-9 mm, III - prolapse more than 9 mm);

2) according to the degree of regurgitation (semi-quantitative assessment in points (1-4));

3) downstream (mild, moderate, severe, asymptomatic (18%)).

Clinic. There are syncopal conditions with lipothymia (sensations preceding loss of consciousness, with a feeling of fear of death), palpitations, interruptions in the work of the heart, stabbing, pressing pains in the heart, shortness of breath.

Accompanying signs are: a narrow shoulder girdle, thin elongated bones, elongated fingers with increased mobility of the joints of the hands, elongated nails, hypomastia in women, unexpressed hair on the chest in men, blond hair, gray-blue eyes.

There are: weakness, fatigue, headache, stabbing pains in the region of the heart, palpitations, fluctuations in blood pressure, dizziness, fainting.

A typical systolic click and late systolic murmur are auscultated. They may not show up at rest. To determine them, it is necessary to conduct a test with exercise or nitroglycerin, since an increase in heart rate reduces the end-diastolic volume.

Rhythm and conduction disturbances may be noted: paroxysmal supraventricular and ventricular tachycardias, extrasystoles, which prevail during wakefulness;

With mitral regurgitation, the frequency of ventricular tachycardia and extrasystoles increases by 2 times, accompanied by the development of circulatory failure, first left ventricular, then total.

Additional diagnostic study. Be sure to conduct an ECG study to identify signs of impaired repolarization, ST wave depression in II, III, aVF left chest leads, T wave inversion, rhythm and conduction disturbances.

Phonocardiographic examination, Holter ECG monitoring for 24-48 hours, echocardiography (to determine signs of prolapse, regurgitation), angiography of the left heart (when deciding on surgical treatment), functional tests with physical activity or nitroglycerin to determine the degree of tolerance.

Flow. Depends on the degree of prolapse of the mitral valve. With asymptomatic and mild course, the disease proceeds for a long time, without progression, with moderate and severe course - for a long time, with progression.

Complications. The main complications include rhythm and conduction disturbances, progression of mitral insufficiency, sudden death (ventricular fibrillation), infective endocarditis, and thromboembolism.

Differential diagnostics. Should be carried out with anomalies in the development of the mitral valve, additional leaflets (up to 3-4), additional chord.

Treatment. With an asymptomatic course and the detection of mitral valve prolapse on echocardiography, it is necessary to conduct periodic examinations every 2-3 years.

β-blockers are used in medium dosage. Antibiotic therapy is used during minor and major surgical interventions to prevent infective endocarditis. Antiarrhythmic drugs Ia (quinidine, novocainamide) are used for supraventricular arrhythmias and group Ib (mexiletine, toklenide) for ventricular arrhythmias. A combination of antiarrhythmic drugs with β-blockers is used. In case of intolerance to drugs, cordarone is prescribed.

Anticoagulant therapy (heparin 40-60 IU/day) is used to prevent thromboembolic complications.

With mitral regurgitation (increasing or severe degree), surgical treatment is performed - mitral valve replacement.

Forecast. With an uncomplicated course, the prognosis is favorable, with a complicated course - serious.

Author: Myshkina A.A.

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