What is it and what is the danger of mitral valve prolapse? The disease is a defect in which the valves of the left atrioventricular valve bulge into the atrial region in the systole phase. There are several diagnostic methods for detecting the pathology in question: auscultation, echocardiography, phonocardiography.
Who is diagnosed?
The percentage of children who have mitral valve prolapse (ICD-10 code is I34.1.) Is approximately 2-16%. The age of children, in which the disease manifests itself most often, falls on puberty. The likelihood of this pathology increases in those people who have other diseases of the cardiovascular system. With congenital heart disease, the frequency of concomitant lesions of mitral valve prolapse is 37%, if there are hereditary heart diseases, then the frequency of development of the corresponding disease is from 60 to 100%. Rheumatism increases the likelihood of developing prolapse by 30-47%. Women 35-45 years old are most susceptible to this type of pathology. The treatment of mitral valve prolapse is discussed later in the article.
Classification
MVP is a secondary disease. In fact, it is a clinical and anatomical consequence of congenital or acquired cardiac pathologies.
Etiologically determined is the classification of PMC on:
- Primary - congenital or idiopathic.
- Secondary - acquired.
Primary
- The emergence of an idiopathic form is due to the congenital nature of dysplastic lesions of the connective tissue, in which the defect under consideration is not the only investigative pathology, there are also investigative anomalies in the form of lengthening or shortening of the chords, improper fixation of the chords, the presence of extra chords, etc.
- The emergence of a congenital form is accompanied by a process of structural-myxomatous degeneration of the mitral valves, as well as an increased level of their compliance.
- The occurrence of dysplastic changes in connective tissue is caused by a wide variety of unfavorable factors of intrauterine development and organ formation, ranging from environmental and ending with specific diseases of the mother during pregnancy (infectious diseases, gestosis, etc.)
- 10-20% of cases of MVP are due to maternal inheritance.
- Some genetically determined pathologies have MVP as a concomitant symptomatic characteristic.
Secondary
It is a concomitant pathological feature of the following diseases:
- coronary artery disease;
- myocardial infarction;
- rheumatism;
- systemic lupus erythematosus;
- hypertrophic cardiomyopathy;
- physical trauma to the thoracic region, etc.
Thus, in the above cases, mitral valve prolapse is of an investigative nature due to damage to valve structures, as well as functional myocardial disorder.
Complication
Prolapse entails a complication - mitral regurgitation.
Functional disorders of the nervous system, metabolic disorders and lack of magnesium in the body are the leading factor in the development of mitral valve prolapse.
What happens with this pathology?
The mitral valve is a bivalve that separates the cavity of the ventricle from the left atrium. The attachment of these valves to the papillary muscles occurs with the help of chords.
Let us compare the picture of the functioning of the cardiac system without pathology and with a defect in the form of mitral valve prolapse of degree 2:
- The normal functioning of the cardiac system involves sagging mitral cusps in the diastole phase, ensuring free flow of blood from the left atrium to the left ventricle. During the systolic phase, the cusps rise under blood pressure, while the left atrial ventricular opening closes with cusps.
- Since the disease in question is, in essence, a structural and functional violation of the valve mechanism, during the systolic phase, the valve flaps deflect to the left atrium. In this situation, there may be a complete or partial overlap of the atrioventricular opening and the formation of a defect, the result of which is the process of backflow from the left ventricle to the left atrium. This is a process of mitral regurgitation.
Mitral insufficiency reduces myocardial contractile function. The consequence of this is a violation of the circulatory process.
A complication of the primary form of mitral valve prolapse is pulmonary hypertension (70% of clinical cases), and systemic hemodynamics suffer from arterial hypotension.
Classification Factors
Above, we noted the principle of separation of prolapse into primary and secondary.
There is also one more reason for the classification: localization of deflection, which is represented by:
- prothoracic mitral valve prolapse;
- posterior mitral valve prolapse;
- bicuspid mitral valve prolapse.
By sound form emit:
- "Mute" form of prolapse;
- auscultatory.
The degrees of severity reflected on the ECG are also the basis for the classification:
- prolapse of the first degree: sash deflection within 3-6 mm;
- prolapse of the second degree: sash deflection within 6-9 mm;
- prolapse of the third degree: deflection of the valves within more than 9 mm.
The formation time of mitral valve prolapse relative to systole is another classification factor. Deflection can be early, late and holosystolic.
Degrees
Mitral regurgitation, or rather, its degree recorded by Doppler echocardiography, allows us to distinguish three degrees:
- the first degree of mitral regurgitation - at the level of the location of the valves;
- the second degree of mitral regurgitation - affects the middle of the left atrium;
- the third degree of mitral regurgitation - affects the opposite end of the atrium.
How does mitral valve prolapse of degree 2 manifest itself?
Symptoms of MVP and consequences
The clinical manifestations of this pathology can vary significantly in severity, which depends on the degree of connective tissue dysplasia, regurgitation factor, as well as autonomic abnormalities.
There are frequent cases when the symptoms are completely absent and the pathology is diagnosed by chance during a planned ECG.
So, what are the most common symptoms of mitral valve prolapse?
What is accompanied by?
In childhood, it is very often detected along with the following diseases:
- umbilical and inguinal hernias;
- hip dysplasia;
- increased mobility of the joints;
- orthopedic pathologies: scoliosis, flat feet, chest deformation;
- visual impairment: myopia, strabismus;
- nephroptosis;
- varicocele.
All of the above diseases indicate a pathology of the structures of the connective tissue. In this group of patients, the frequency of acute respiratory viral infections with a more complicated course with mitral valve prolapse in a child is much higher than in healthy children.
Symptoms of neurocirculatory dystonia
Very often, the pathology manifests itself against the background of neurocirculatory-dystonic syndrome, the symptoms of which are: palpitations, sweating, fainting and dizziness, malfunctioning of the heart, migraine, etc. Significant hemodynamic disturbances cause shortness of breath and increased fatigue. Often it is accompanied by affective disorders in the form of depressive states and asthenic symptoms.
Secondary prolapse is manifested against the background of the underlying disease and is accompanied by its symptoms.
The spectrum of mitral valve prolapse effects is very wide, since pathology covers the “motor center” of the whole organism. Among the dangerous consequences, pathologically dangerous arrhythmias, infectious endocarditis, thromboembolic syndromes and even sudden death can be distinguished.
The causes of mitral valve prolapse are not fully understood.
Diagnostics
The "mute" form of prolapse does not show any auscultatory symptoms.
This form allows you to capture isolated clicks and systolic murmurs.
Phonocardiography reflects auscultatory factors.
Ultrasound of the heart allows a more accurate and detailed determination of the pathology. The degree of deflection of the valves and the regurgitation degree are clearly visible on it. In the case of the extensive nature of dysplastic changes in the connective tissue, the result of ultrasound signals the dilatation of the aorta, dilatation of the pulmonary artery, prolapse of the tricuspid valve and an open oval window.
An X-ray examination shows either a normal heart size or a reduced one.
ECG
On the ECG and the results of daily monitoring of the ECG, there are manifestations of persistent or transient disturbances in the repolarization properties of the ventricular myocardium, sinus tachycardia, extrasystole, paroxysmal tachycardia, sinus bradycardia, WRW syndrome, atrial ciliary activity are also visible.
Mitral regurgitation of the second or third degree takes place, accompanied by cardiac arrhythmias and signs of heart failure, electrophysiological examination of the heart may be indicated.
MVP should be differentiated from congenital or acquired heart disease, atrial septal aneurysms, myocarditis, bacterial endocarditis, as well as cardiomyopathy.
Do they take the mitral valve prolapse into the army?
According to the Schedule of Diseases, with mitral valve prolapse, they are enlisted in the army if the disease is accompanied by heart failure of FC I. In this case, the pathology does not pose a threat to the health of the conscript. A sick young man will be able to engage in physical training along with healthy colleagues. Heart prolapse and the army are compatible in those cases when the disease is asymptomatic, does not cause discomfort and does not require inpatient treatment.
Drafting of young men with a diagnosis of “mitral valve prolapse of the 2nd degree” to the army is carried out according to category “B-4”. Such recruits can be sent to communications, radio engineering and other military units.
The situation is different if mitral regurgitation is increased. Mitral prolapse in the army in this case can lead to new complications: mitral insufficiency, arrhythmias, or infectious endocarditis. Exemption from drafting also relies on young people in whom the ailment is accompanied by a violation of the heart rhythm, conduction or heart failure of FC II.
The most pronounced stage 3 disease. An increase in the deflection of the valve walls leads to a significant outflow of blood. Against the background of increased regurgitation, significant malfunctions in the circulatory system develop. As a result of this, cerebral circulation and heart rhythm are disturbed, heart failure appears. In the presence of serious complications, the army and prolapse are not compatible.
To get category “B”, the young man needs to confirm the diagnosis and its compliance with the conditions of the Disease Schedule on an additional examination. This can be done using an electrocardiogram, an echocardiographic test method, bicycle ergometry and a 6-minute walk test.
Mitral valve prolapse treatment
The therapeutic approach to the treatment of this type of disease takes into account the severity of autonomic and cardiovascular clinical symptoms, and it is also important to take into account the characteristics of the dynamics of the main pathology. Many are interested in what kind of mitral valve prolapse treatment is required.
The first and unfairly ignored point of the treatment methodology includes the obligatory normalization of the patient’s lifestyle, it is necessary to adjust the mode of work and rest, and sleep mode, and physical activity in favor of a healthy lifestyle.
Medicinal methods for the treatment of mitral valve prolapse are aimed at eliminating neurovegetative symptoms, preventing dystrophic changes in the myocardium, as well as preventing the development of an infectious form of endocarditis.
Patients who have a pronounced symptomatology of this disease, need to be prescribed:
- sedatives;
- cardiotrophic preparations (vitamin complexes, potassium and magnesium preparations, asparaginates);
- anticoagulants;
- beta-blockers.
If minor surgeries are planned for mitral valve prolapse, such as tooth extraction or tonsillectomy, prophylactic antibiotics are recommended.
If mitral regurgitation becomes hemodynamically significant and heart failure progresses, mitral valve replacement is recommended.
Predictive Criteria
In the case of an asymptomatic course, the diagnosis of mitral valve prolapse has a rather favorable prognosis. In this case, outpatient monitoring with an ECG every 2-3 years is recommended.
The prognosis of the dynamics of secondary mitral valve prolapse is determined by the course factors of the primary disease.
In other cases, the symptom complex of the course of the disease is taken into account, followed by the determination of therapeutic tactics.
What is this and what is dangerous mitral valve prolapse, we now know.