Mitral heart diseases

Description:

Heart disease call the permanent pathological changes of heart breaking its function. More often they are caused by organic changes of one or several heart valves or the corresponding openings, for example, atrioventricular (between an auricle or a ventricle). Disturbances of cordial function arise owing to insufficiency of the valve or narrowing (stenosis) of the corresponding opening.
Mitral heart disease is noted most often. At a rheumatic endocarditis the mitral valve most often is surprised (to 96% of all cases), is more rare – aortal, is even more rare – three-leaved.

Symptoms Mitral heart diseases:

The mitral stenosis twice meets at women more often. The main complaints of patients – the short wind developing at physical efforts, sometimes heartbeat, very seldom heartaches.
Emergence of an asthma is explained by increase in pulmonary stagnation at an exercise stress in connection with the strengthened emission of blood in a small circle. An asthma sometimes is followed by cough, owing to hypostasis of a mucous membrane of bronchial tubes, in a phlegm blood streaks occasionally come across. Cough arises during walking more often and sometimes is the main or only complaint of the patient. At an exercise stress easily there is heartbeat (tachycardia).
The asthenic state, quite often lines of physical infantility is characteristic of patients with mitral defect. The person often has yellowish and pale color, tsianotichna lips. Sometimes the cerise flush of cheeks owing to the strengthened allocation by a liver of histamine-like substances meets.
Mitral insufficiency seldom happens an independent disease, it presents to a thicket only a stage to evolutions of mitral defect, this stage is followed by development of a stenosis with its dominance in a clinical picture.
Subjective symptoms at mitral insufficiency come down to an asthma and heartbeat at physical efforts.
The clinical course of mitral insufficiency is unequal; at unsharp degree of insufficiency of the valve working capacity remains long, patients even play sports.
At sharply expressed insufficiency the cordial decompensation which in the beginning is shown an asthma at an exercise stress, and in process of progressing – stagnation, both in small, and in a big circle of blood circulation early develops.
Rheumatic process can cause damage to several valves and openings of heart; in this case speak about the combined defect (for example, insufficiency of the aortal and mitral valve, a stenosis of the mouth of an aorta and insufficiency of the mitral valve and so forth). Less often 3 valves or openings are surprised. The combined defects cause deep disturbances of cordial function, proceed hard, quite often leading to a bystry decompensation.

Reasons Mitral heart diseases:

Usually rheumatic defeat of the left atrioventricular (mitral) valve is the reason of defect.
At rheumatism all structural elements of heart – an endocardium (including heart valves), a myocardium, a pericardium and vascular system are involved in pathological process. However disease, as a rule, is defined by extent of defeat of the valve device.
The fibrous fabric which is formed on the valve causes an uneven thickening of shutters which become more dense and less mobile. Cicatricial wrinkling of the expanded fabric quite often shortens shutters in this connection insufficiency of the valve develops. At the same time plays a role and defeat of shutters with fibrous consolidation and shortening, and change of the subvalvular device due to cicatricial shortening of chords and sclerous change of papillary muscles. In later stages of development of defect on shutters of the valve calcium salts are laid that increases its rigidity and leads to sharp restriction of mobility.
However the rheumatic endocarditis not always causes defect, sometimes process comes to an end with full treatment or passes into the regional sclerosis of the valve which is not causing disturbance of its function.
Adhesion, and then accretion of shutters of the mitral valve is the main reason for a mitral stenosis. Lines of an union of shutters are called commissures. From the beginning of a disease of an endocarditis before formation of the expressed stenosis passes sometimes several years. According to foreign authors, the pure mitral stenosis develops more often when rheumatic process proceeds rather easily.
Except the main reason for formation of a stenosis (rheumatic defeat of the valve), there are still secondary nonspecific factors. Hemodynamic influences which the working valve is constantly subject concern to them, according to a number of authors; at the same time there are anguishes of inside layers of shutters, especially in the field of commissures. Places of anguishes become covered by blood clots, and their further organization leads to accretion of shutters and progressing of defect.
When narrowing the left atrioventricular opening intake of blood from the left auricle in a left ventricle is at a loss, a part of blood (residual volume) remains in an auricle that causes its overflow.
At insufficiency of the mitral valve a part of blood from a left ventricle at the time of a systole gets back into an auricle (regurgitation) that besides causes its overflow.
Owing to the increased krovenapolneniye and supertension in a cavity of the left auricle the last increases in sizes, and his muscle hypertrophies.
At a pure mitral stenosis the left auricle increases moderately and only in rare instances reaches the huge sizes (atriomegaly). At the same time there can be rhythm metastasis ad nervos – a ciliary arrhythmia, atrial premature ventricular contraction. The left auricle (especially its ear) at a mitral stenosis is the place of frequent localization of pristenochny blood clots.
The important place in clinic of a mitral stenosis is taken by disturbance of pulmonary blood circulation as at the same time pressure in the left auricle increases, then in pulmonary veins, capillaries and in system of pulmonary arteries, and then – and in a right ventricle of heart that leads to its hypertrophy.
As pressure in pulmonary veins and capillaries is increased, there is blood plasma transudation in interstitial tissue of lungs, and sometimes and in a gleam of alveoluses, and it causes a stagnation picture, characteristic of a dekompensirovanny mitral stenosis, in a small circle with a pneumorrhagia and a chronic intersticial fluid lungs. Sometimes on this background growth of connecting fabric around alveoluses with the subsequent development of fibrosis is noted that complicates lung ventilation and gas exchange even more.
Because the muscle of a right ventricle hypertrophies, it usually extends a little (myogenetic dilatation). Development of relative insufficiency of the three-leaved valve can be a consequence of this expansion.
At the same time developments of stagnation from a right ventricle extend in the right auricle, in a big circle of blood circulation that is clinically shown by swelling of cervical veins, a congestive liver, hypostases. So, at a dekompensirovanny mitral stenosis arises total over time (full heart failure.
At mitral insufficiency the left auricle as a part of the blood coming to a left ventricle during a systole comes back in an auricle sharply increases. During a diastole of ventricles all mass of blood comes from the left auricle to a left ventricle which extends and hypertrophies. The increased pressure in the left auricle creates supertension in a small circle that besides causes a hypertrophy of a right ventricle.

Treatment Mitral heart diseases:

In a stage of compensation are necessary the appropriate mode capable to prevent those complications which can accelerate approach of heart failure; periodic assessment of activity of rheumatic process and at its recurrence – complex antirheumatic therapy in a hospital.
The patient has to avoid everything that can cause an asthma, heartbeat (hard physical work, bystry walking, a nerve strain). It is necessary to exclude overcooling, to abstain from alcohol intake and smoking. Medicamentous therapy, in addition to prevention and treatment of rheumatism in the period of aggravations, consists in treatment of heart failure.
(Commissurotomy) patients with a mitral stenosis are subject to surgical treatment. At mitral insufficiency apply operation of prosthetics of the valve.