Mitral stenosis is a congenital heart disease, which is characterized by a narrowing of the opening between the left ventricle and the atrium. Such a change in the structure of the heart leads to circulatory disorders and, accordingly, affects the work of all organ systems.
Naturally, people who are faced with a similar problem are looking for additional information. Why does pathology develop? What are the first signs of mitral stenosis? Are there effective therapies? What should a patient expect? Answers to these questions are important to many readers.
Causes of the development of the disease
Mitral stenosis of the heart is an acquired disease. Scientists identify several main reasons for the development of such a pathology.
- According to statistics, in about 80% of cases, mitral stenosis is the result of rheumatism - a group of diseases that are accompanied by damage to the connective tissue. In turn, lingering tonsillitis or chronic tonsillitis often leads to rheumatism.
- Infectious diseases also result in risk factors, as a result of which heart tissues are affected (for example, endocarditis).
- Atherosclerosis, as well as the formation of blood clots inside the heart, can also provoke narrowing (stenosis) of the mitral valve.
- The disease can develop against the background of heart injuries (including after operations, for example, mitral valve prosthetics).
- Other risk factors include syphilis, calcification of mitral valve tissue , and aortic insufficiency.
Mitral stenosis: hemodynamics and its features
Normally, the area of the hole between the left atrium and the ventricle is from 4 to 6 square centimeters. Against the background of its narrowing, hemodynamic disturbance develops, because the process of passing blood from the left atrium to the ventricle is complicated. Atrial pressure rises to 20–25 mmHg. Art. (normally this indicator is 5). An increase in pressure leads to a gradual hypertrophy of this part of the myocardium. This compensatory mechanism helps maintain heart function, but, unfortunately, stenosis progresses.
As the disease develops, an increase in pressure in the pulmonary vessels is observed, which leads to the development of pulmonary hypertension. The load on the right heart is increasing. Gradually, dystrophic and sclerotic processes begin in the myocardium, which leads to a decrease in the contractile function of the heart.
Forms and stages of development of pathology
If we take into account the area of narrowing of the atrioventricular foramen, then four degrees of mitral stenosis can be distinguished.
- The first degree is a slight narrowing, the area of the hole is 3 square centimeters.
- If we are talking about the second degree of stenosis, then the size of the hole is 2.3-2.9 square meters. cm.
- The third degree is already pronounced stenosis, accompanied by a narrowing of the hole to 1.7-2.2 square meters. cm.
- The fourth degree is called the critical form of mitral stenosis. The area of the opening between the ventricle and the atrium narrows to 1-1.6 square meters. cm.
It is worth noting that mitral stenosis proceeds in five stages, each of which is accompanied by a set of specific symptoms and complications.
- The first stage is called the period of full compensation. The narrowing of the atrioventricular lumen is small, and the heart is still quite normal with its basic functions. Patients do not show any complaints. If pathology is diagnosed at this stage, then by accident.
- The second is the stage of relative circulatory failure. The hole narrows, the left side of the myocardium begins to increase. At this stage, some symptoms already appear - venous pressure rises slightly, a person complains of severe shortness of breath, which appear during physical activity.
- The third stage is the beginning of the development of circulatory failure. At this stage, blood stasis is observed both in the small and in the large circle of blood circulation. The heart is significantly increased in size. During the examination, you can notice a strong increase in venous pressure. Due to impaired blood flow, an increase in the liver is observed.
- In the fourth stage, circulatory failure is already pronounced. In a large circle, blood stagnation occurs, which leads to the formation of edema, the development of ascites. At this stage, episodes of atrial fibrillation are often observed.
- In the fifth stage, the area of the hole does not exceed 1 square centimeter. The heart is significantly enlarged, venous pressure is increased. Shortness of breath disturbs the patient, even at rest. Patients also suffer from severe edema. In the abdominal cavity, more and more free fluid accumulates. Therapeutic treatment has almost no effect.
Symptoms of mitral stenosis
The initial stage of development of the disease is most often asymptomatic. Obvious signs of mitral stenosis appear if the atrioventricular opening is reduced to 2 square centimeters. Patients suffer from constant shortness of breath. And if at first difficulties with breathing appear only during physical activity, then in the future they disturb the patient and at rest. The list of symptoms can also include a strong cough, which is sometimes accompanied by the release of sputum with streaks of blood.
At night, patients suffer from asthma attacks. There is muscle weakness, constant fatigue, and increased fatigue. People suffer from insomnia, and this cannot but affect their emotional state. The patient’s appearance also changes - the lips and tip of the nose acquire a bluish tint, and crimson-cyanotic spots with distinct edges appear on the cheeks (a kind of “doll blush”).
Patients note a rapid irregular heartbeat. Sometimes there are pains in the heart.
As you progress, other symptoms appear. Mitral stenosis is characterized by the appearance of peripheral edema. You can observe the swelling of the cervical veins in the patient - the vessels are clearly visible under the skin, even at rest. It is possible the accumulation of fluid in the abdominal cavity, as well as between the sheets of the pleura of the lungs (severe circulatory disorders often lead to pulmonary edema).
What complications does the pathology lead to?
Mitral stenosis cannot be ignored in any case. The fact is that in the absence of therapy, an ailment leads to the appearance of incredibly dangerous complications.
- Some patients develop a disease of the left ventricular failure, often referred to as cardiac asthma. Patients suffer from periodic attacks of suffocation, which occur both during physical activity and at rest.
- In the pulmonary artery, blood pressure rises significantly, which is accompanied by discomfort behind the sternum, as well as severe shortness of breath. Under the influence of pressure, the vessel wall can expand, forming an aneurysm. With such a pathology, the risk of artery rupture is high, which leads to the death of the patient.
- Sometimes various heart rhythm disturbances appear, in particular, atrial fibrillation and flutter.
- Thromboembolism is another dangerous consequence of mitral stenosis. Broken blood clots can clog a vessel, in particular a pulmonary artery, which in the absence of immediate medical attention can also result in death.
- Against the background of the disease, the left half of the heart significantly increases in size and sometimes squeezes nearby nerves and blood vessels.
Diagnostic measures
When the slightest violations appear, you should always consult a doctor. Diagnosis of mitral stenosis is a complex process that includes many procedures. It is important not only to confirm the presence of narrowing of the atrioventricular opening, but also to determine the stage and degree of stenosis, to identify complications associated with pathology, and to identify the causes.
- First you need to collect a complete medical history. The doctor will ask you what symptoms bother the person, when and as a result of which they arise. It is also important to find out whether the patient had a sore throat in childhood, whether there was chronic tonsillitis, whether the child was registered with a pediatrician. Of course, the specialist is interested in information about the lifestyle, for example, the physical activity of the patient, the characteristics of nutrition, the presence of bad habits. All this information is important in the diagnosis of a disease such as mitral stenosis.
- Auscultation and physical examination are equally important. The doctor can listen to heart sounds, notice any pathological changes, the appearance of uncharacteristic diastolic murmurs. Also, a specialist determines the type of physique, examines skin tissue.
- Blood and urine tests are mandatory. Such studies help determine the presence of an inflammatory process in the body.
- Very informative is a biochemical blood test. During a laboratory study, attention is primarily paid to cholesterol levels - it rises in the presence of atherosclerosis. Blood is also checked for the presence of antistreptolysin-O - this is a special substance that is formed after a streptococcal infection, for example, tonsillitis, tonsillitis. If C-reactive protein is present in the patient’s blood samples, this indicates the presence of an acute inflammatory process.
- The list of diagnostic procedures includes a coagulogram. The study makes it possible to assess the risk of blood clots and, if necessary, adjust the treatment regimen.
- Mandatory is electrocardiography. This is a simple and affordable study that allows you to determine the increase in the left and right ventricles, to detect certain heart rhythm disturbances. More informative is the daily monitoring of the ECG.
- Echocardiography is an ultrasound examination that allows you to examine the cusps of the mitral valve, detect the presence of pathologies, determine the size of the atrioventricular opening. Also, during the procedure, a specialist can detect blood clots, neoplasms, accumulation of calcifications on valve flaps.
- Radiography allows you to diagnose pulmonary edema. In the pictures you can see that the patient's heart has increased in size.
- Transesophageal echocardiography allows you to examine the heart, holes and valves in more detail. An ultrasound probe is inserted through the esophagus. The wall of this organ is close to the heart, so the doctor has the opportunity to get an accurate image.
- Sometimes a patient is sent for a consultation with a cardiac surgeon, as well as a rheumatologist.
Research results can be studied and correctly decrypted only by a doctor.
Drug therapy and its features
After a complete diagnosis, the doctor will be able to draw up an effective treatment regimen.
- If the patient has a constant form of atrial fibrillation, as well as a decrease in contractility of the right ventricle, then the doctors prescribe cardiac glycosides, in particular Strofantin, Korglikon.
- Beta-blockers are used to normalize heart rate. Effective are Bisoprolol, Carvedilol.
- Diuretics help relieve swelling, eliminate congestion in the pulmonary circulation. As a rule, such drugs as Furosemide, Veroshpiron are used.
- Cardioprotectors that protect heart cells from damage (Ramipril, Captopril) are also included in the treatment regimen.
- To dilate blood vessels and lower blood pressure, nitrates are used, in particular, Nitrosorbide, Nitroglycerin.
- "Heparin", "Aspirin", "Thromboass" are used to thin the blood. This reduces the likelihood of blood clots, the development of thromboembolism.
- During the acute phase of rheumatism, it is mandatory to take anti-inflammatory drugs (Diclofenac, Ibuprofen, Nimesulide). Penicillin antibiotics are also used.
It should be understood that drug treatment of mitral stenosis is not able to save a person from this disease. Medicines are used only to relieve symptoms and slow down the further development of the disease.
Surgery
Surgical treatment of mitral stenosis today is the only really effective way to normalize the heart and prevent the further development of the disease.
- Sometimes percutaneous commissurotomy is performed. The procedure is performed without opening the chest. They penetrate the heart through the femoral veins. With the help of a special flexible hollow tube, the doctor dissects the place of fusion of the hole. This technique allows you to double its area.
- Closed mitral commissurotomy involves a chest incision. True, the heart is not opened and the heart-lung machine is not used. The doctor penetrates the heart through the ear of the left atrium and eliminates finger splicing.
- Sometimes, dissection of the fused mitral valve flaps is required. This is a full-blown operation involving the use of cardiopulmonary bypass and heart incision with further suturing.
- If there is a pronounced deformation of the valve system, then mitral valve prosthetics are performed.
Surgery may not be carried out only at the first stage of development. In the future, it is hardly possible to do without the help of surgeons.
Of course, such procedures are associated with some complications. For example, there is always a risk of tissue infection with the further development of inflammation. The operation often leads to the formation of blood clots. As for artificial valves, sometimes the material of the prosthesis begins to deteriorate - this requires the removal of valve residues and re-prosthetics.
Adjust lifestyle
Of course, taking medication is an important part of therapy. But there are certain rules that patients with mitral stenosis should follow. The recommendations of the doctors are as follows:
- the diet should be balanced, along with food the body should receive all the necessary nutrients;
- you need to monitor the drinking regimen, limit the amount of table salt - this will help prevent the formation of edema and an increase in blood pressure;
- it is important to observe the correct mode of work and rest, not to overwork, get enough sleep;
- experts recommend avoiding increased physical exertion, but keep fit (for example, long walks in the fresh air will be useful);
- you should try to avoid stressful situations (doctors advise you to engage in meditative practices, as they allow you to maintain emotional balance).
Preventive measures: is it possible to prevent the development of stenosis?
Unfortunately, specific prophylaxis of mitral stenosis does not exist. Doctors advise avoiding exposure to risk factors.
A prerequisite for the development of various diseases is weakened immunity, so it must be strengthened by all possible means. It is important to maintain good physical shape, eat right, take vitamin complexes from time to time, spend a lot of time in the fresh air, engage in recreational activities, and avoid stress.
It is important to treat tonsillitis and tonsillitis in time. If untreated, such diseases can become chronic. A sluggish, but constant inflammatory process in the tonsils can provoke the development of rheumatism, which increases the risk of mitral valve stenosis.
In no case should you refuse to have planned medical examinations. At least once a year, you need to donate blood for analysis (it is important to conduct a rheumatic test), do electrocardiography. Patients who have already undergone rheumatism should be registered with a rheumatologist and cardiologist, constantly undergo examinations. The sooner the disease is diagnosed, the greater the chance of success.
Predictions for Patients
Mitral valve stenosis is a dangerous disease. In the absence of surgery, five-year survival (from the time of diagnosis) among patients is about 50%. Even with a mild course of the disease, taking the right medications and the right lifestyle, people live only up to 45-50 years.
The only effective treatment option today is surgery. Mitral stenosis can be overcome, however, in about 30% of cases over the next 10 years, patients develop postoperative restenosis, which requires repeated surgical intervention. Using the methods of modern medicine, you can extend the life of the patient, eliminate discomfort and symptoms.