Internal illnesses. Mitral valve prolapse (most important)

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Internal illnesses. Mitral valve prolapse (most important)

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11. MITRAL VALVE PROLAPSE

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 ventricular systole (in the exile phase). Prolapse means "bulging".

Etiology. Congenital forms are noted in the syndromes of Marfan, Emre-Danlos, Holt-Oram-pa, atrial septal defect, Ebstein's anomaly, Fallot's tetrade.

Acquired forms are observed in coronary heart disease, rheumatism, neurocirculatory dystonia, hypertrophic cardiomyopathy, thyrotoxicosis, and chest injuries.

Pathogenesis. During ventricular systole, blood flows not only into the aorta, but partially back into the left atrium.

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 syncope with lipothymia (a feeling of fear of death), palpitations, interruptions in the work of the heart, stabbing, pressing pains in the heart, shortness of breath.

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

Accompanying signs: 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.

A typical systolic click and late systolic murmur are auscultated. To determine, it is necessary to conduct a test with physical activity or nitroglycerin.

Diagnostic study. ECG study: identifying signs of repolarization disorders, ST wave depression in II, III, aVF, left precordial leads, T wave inversion, rhythm and conduction disturbances.

Conducted phonocardiographic study, Holter ECG monitoring for 24-48 hours, echocardiography, angiography of the left heart, functional tests with physical activity or nitroglycerin to determine the degree of tolerance.

Flow. In asymptomatic and mild cases, the disease proceeds for a long time, without progression; in moderate and severe cases, it lasts for a long time, with progression.

Differential diagnosis. Anomalies in the development of the mitral valve, additional leaflets (up to 3-4), additional chord.

Treatment. In asymptomatic cases, periodic examinations every 2-3 years are necessary.

b-blockers are used in medium dosages. Antibiotic therapy before minor and major surgical interventions. Antiarrhythmic drugs A (quinidine, procainamide) for supraventricular rhythm disturbances and group B (mexiletine, toclenide) for ventricular arrhythmias.

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

Author: Myshkina A.K.

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