Mitral valve prolapse
Author Ольга Кияница
The mitral valve prolapse (PMP) is characterized primarily by myxomatous degeneration of the mitral valve valves. Young people are more likely to have a complete loss of both the anterior and the posterior folds and chord components. This is the extreme form of myoxomatous degeneration, known as Barlow's syndrome. However, in the elderly, PMK is characterized by fibro-elastic disturbance, sometimes with a combined chordal fracture due to lack of connective tissue support. These anatomical anomalies lead to incomplete closure of the mitral valve openings during systole, which leads to regurgitation.
The mitral valve prolapse is defined by about 2-3% of the population in the United States. [1 - Freed LA; Levy D; Levine RA; Larson MG; Evans JC; Fuller DL; Lehman B; Benjamin EJ Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999; 341 (1): 1-7]
Over time, the expansion of the mitral ring may develop, which leads to further progression of mitral regurgitation (MR). Acute severe MI leads to symptoms of congestive heart failure without dilatation of the left ventricle. Conversely, chronic or progressive-severe MI can lead to dilatation and ventricular dysfunction, neurohormonal activation and heart failure. Increased pressure in the left atrium can lead to hypertrophy of the left atrium, atrial fibrillation, stagnation of blood in the lungs and pulmonary hypertension.
Video: Mitral valve prolapse: heart disease, which is vital in time to recognize!
The mitral valve is one of four heart valves. It opens and closes to control the blood flow between the left atrium and the left ventricle. The valve consists of two valves - front and rear.
With mitral valve prolapse, one or both valves of the valve have too large dimensions or chords (bundles attached to the lower side of the valves and connected to the ventricular wall) are too long. Due to such a violation, the valve bends back or "sucks" to the left atrium, taking the form of a parachute. Additionally, during each heart contraction, the closure of the valve is not sufficiently tight, which results in the return of a portion of blood from the ventricle to the atrium.
The mitral valve prolapse is also called the flexible mitral valve syndrome and the Barlow syndrome in the name of the doctor who first described the PMC.
There are several degrees of PMK:
- The first is the deflection of the valve flaps 3-6 mm.
- The second one is the deflection of the valve flaps 6-9 mm.
- The third is the deflection of the valve flaps 6-12 mm.
The deflection of the valve flap into the cavity of the left atrium up to 3 mm is considered to be within the normal range.
With a prolapse, a very small amount of blood can flow, moving back from the ventricle into the atrium. At the same time, the valve, as a rule, still works well, and the heart normally pumps blood.
Only 2% of people have other structural problems with the heart along with mitral valve prolapse.
It was previously thought that the mitral valve prolapse is present in a significant proportion of the population, mainly determined by women. Today, with newer and more accurate echocardiographic criteria, it is established that the anomaly affects a very small percentage of the population, and is most often diagnosed in people aged 20-40 years.
Video: Work of the heart with mitral valve prolapse
The mitral valve prolapse usually develops as an isolated pathology, most often on the background of hereditary connective tissue disorders, including Marfan syndrome, Ehlers-Danlos syndrome, incomplete osteogenesis, and elasticity of the pseudoksanthoma. In fact, 75% of patients with Marfan syndrome have PMC due to excessive mitral valve secretion as a result of their myxomatous degeneration. The PMC is also described together with a defect in the interstitial septum and hypertrophic cardiomyopathy.
The mitral valve prolapse is considered a hereditary disease with increased gene expression in male patients (2: 1). The most common form of inheritance is the autosomal dominant, but X-linked inheritance is also described.
Data from a study by the Framingham Heart community showed that PMC occurs in 2.4% of the population.
Demographics related to age and gender:
- PMC is observed in people of all ages.
- The prevalence of PMC is the same for men and women in the Framingham Heart study. [2 - Freed LA; Levy D; Levine RA; Larson MG; Evans JC; Fuller DL; Lehman B; Benjamin EJ Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999; 341 (1): 1-7]
- However, complications associated with PMK are more common in men.
- In a Mayo Clinic study, women are more likely to undergo surgical intervention due to mitral vice than men, and are at high risk for long-term mortality, but after the operation of the valve, compared with men, predictions are more favorable. [3 - Avierinos JF; Inamo J; Grigioni F; Gersh B; Shub C; Enriquez-Sarano M. Sex differences in morphology and outcomes of mitral valve prolapse. Ann Intern Med. 2008; 149 (11): 787-95]
Most people with mitral valve prolapse have no symptoms. However, in some cases, the following symptoms are noted:
- Irregular heartbeat or frequent heartbeat, especially when lying on the left side.
- Chest pain - abrupt, dull or compressive, lasting from several seconds to several hours, usually not associated with myocardial ischaemia (that is, it is not a threat of heart attack).
- Fatigue and weakness, even after a slight strain.
- Heaviness when lifting from a chair or bed.
- Intermittent breathing.
- Low energy level, often mistakenly associated with chronic fatigue syndrome.
Some patients experience more pronounced symptoms of dystonia, which may be considered:
- Increased anxiety
- Disorders of digestion
- Extreme fatigue
- Panic attacks
Symptoms associated with concomitant illnesses, such as Marfan's syndrome or hyperthyroidism (elevated thyroid hormones) may also be determined.
When to seek medical help with mitral valve prolapse
- You need to contact a doctor if the symptoms persist or are repeated, for example, chest pain appears and disappear, a heightened heartbeat or dizziness from time to time is disturbing.
- After the mitral valve prolapse has been diagnosed, you need to contact a doctor if the symptoms of the disease worsen or do not disappear, or there are symptoms of congestive heart failure (swelling of the legs or shortness of breath). This means that there is pronounced mitral regurgitation, due to which the blood in a large volume rushes from the left ventricle to the atrium.
- People who have heart beats should consult a doctor about using antibiotics to prevent heart valve infections during minor surgical procedures or dental treatment.
- Women who are in a position should have regular examinations sent to doctors by women's consultation.
Emergency care should be sought immediately in the following cases:
- Symptoms of heart failure suddenly deteriorated.
- There is a cardiac rhythm disorder, accompanied by dizziness, darkening in the eyes, or an abnormal condition, or there is a constant and uncomfortable feeling that the heart is "trembling" or "banging".
- Pain in the chest is strong and does not pass.
If there are typical signs of a mitral valve prolapse, the doctor will ask questions about the symptoms, the general state of health, lifestyle and medications.
Physical examination does not always help to identify signs that indicate a mitral valve prolapse. In particular, with auscultation, a "click" can be noted with each opening of the valve or a heart-shaped noise like the "feline mucus".
Diagnostic tests help to eliminate serious heart disease, also help to evaluate the contractile function of the heart and the working capacity of the valves. These tests are non-invasive, painless and fast. The most commonly used diagnostic methods are:
- Electrocardiogram (ECG) : records the rhythm and electrical activity of the heart from different leads. This information is very useful for the diagnosis of various heart problems, such as cardiac arrhythmias, myocardial infarction or cardiac hypertrophy.
- Echocardiogram (echocardiography): based on the analysis of sound waves (ultrasound), which is displayed in the moving image of the heart on the video screen. This method of research can evaluate the performance of all heart valves, as well as determine the degree of flexion of the mitral valve back when it is closed. Usually, echocardiography is sufficient to establish a diagnosis of mitral valve prolapse, but in some cases the method does not allow for anomalies to be determined.
- Holter monitoring: A small device records heart rhythms and electrical activity of the heart for a long period, usually 24 hours. This time the device is constantly with the patient, usually near the breast. The activity of a human heart is maintained during the recording period, so any anomalies observed on the ECG may be related to what the person did and felt at that time. This test may be recommended if a person experiences dizziness, fainting or palpitations.
- Stress tests: similar to the usual ECG, except that they show the heart's response to stress, which is usually presented as a physical activity. When connecting ECG electrodes, a person walks on a treadmill or cycling. Most people with symptoms, especially chest pain or signs of rhythm disorders, should undergo a stress test, because in these cases, often, there are occluded heart diseases.
The mitral valve prolapse usually does not require special treatment, except for a calm condition, since most people do not have a concomitant serious heart disease. There are no special dietary restrictions. However, in some cases you need to adhere to the following recommendations:
- A person with PMK should avoid competitive sports, especially if he has a symptom of "clicks" or "murricking" with significant mitral insufficiency.
- Caffeine, alcohol, and various stimulants should be limited in quantity, especially if there are other than PMCs, cardiac disorders.
- It is important to consume enough fluid. Dehydration can provoke deterioration of the flow of mitral valve prolapse.
- If a woman is pregnant, she should tell her obstetrician or midwife that she has a mitral valve prolapse.
- Most women with PMC do not require special precautions.
- Sometimes you may need to take antibiotics, especially if you need to have a urinary catheter, have an infection or a heart failure indicative of mitral insufficiency.
If a patient with PMK often develops arrhythmias, a rapid heartbeat is observed, then beta-blockers may be required.
In rare cases, progression of mitral regurgitation or excessive prolapse (greater than 12 mm) may require surgical intervention. In this case, the valve is reconstructed. Improvements in heart surgery over the past 10 years have shown a lesser need for replacing a mitral valve with an artificial prototype.
The mitral valve prolapse has a widely varying prognostic conclusion, although most patients with PMP remain asymptomatic with almost normal life expectancy. Approximately 5-10% of the cases progresses to severe mitral regurgitation. In general, in young patients (under the age of 50) with normal left ventricular function and absence of symptoms, the quality of life is practically not reduced.
The prognostic conclusion is favorable in the absence or minimization of the following risk factors:
- The presence of severe heart disease (heart failure, thromboembolic lesions, atrial fibrillation, or need for cardiac surgery).
- Age older than 50 years.
- Increase left atrium.
- High degree of regurgitation.
- Determination of test fibrillation during baseline echocardiography.
There is an increased (up to 50-60%) risk of atrial and ventricular arrhythmias in patients with myxomatous PMC. In such cases, the risk of sudden death is 0.4-2%, with an increase in it, when patients have signs of dilatation and left ventricular dysfunction, severe MR, or increased thickness of the mitral valve.
With mitral valve prolapse, the following complications may occur:
- Heavy MR
- Atrial fibrillation
- Infectious endocarditis
- Sudden cardiac death
- Cerebrovascular ischemic lesions
The most commonly encountered is mitral regurgitation. The heavy flowing MR is mainly related to the rupture of chord components.
Risk of development of MR increases in the following cases:
- The age of the patient is over 50 years old.
- Male gender
- There is a concomitant illness in the form of hypertension.
- Body mass index (BMI) increased.
- The thickness of the mitral valve folds is increased.
- Determine the dilation of the left atrium and left ventricle.
MR, diagnosed on the basis of the presence of systolic noise, is associated with an increased risk of adverse events, including progressive valve dysfunction, infective endocarditis, and sudden death.
It is important to keep in mind that the heart muscle becomes stronger when exercising, but like other muscles in the body. For example, aerobics can help strengthen the heart, so they are recommended to people with mitral valve prolapse. Walking, swimming, cycling and jogging for no more than 30 minutes at a time are also considered safe and helpful. If a person with BMI exercises and while feeling tired or experiencing any other symptoms, you need to slow down or take a break.
Video: Mitral valve prolapse. An illness of superfluid people
The valvular heart apparatus consists of four components, among which the mitral valve is of particular importance. The quality of his work depends on hemodynamics for a large range of blood circulation. In the case of the definition of the mitral valve disease, treatment is mandatory, mainly in the surgical way, which allows improving the quality and duration of the patient's life.
Among all heart defects, prolapse of the mitral valve is quite common. The disease is of three degrees of severity, and the most favorable prognosis is given by the prolapse of the mitral valve of the 1st degree. For proper treatment and prevention of disease, its symptoms should be properly identified.
Mitral regurgitation is associated with cardiac malformation and can occur at any age, both in adults and in children. Depending on the course, a milder or more severe symptomatology is indicated. In the latter case, surgical intervention is mandatory, which helps to improve the quality of life of the patient.