Mitral stenosis – narrowing of the left atrioventricular opening – the most common of acquired heart defects, is almost always a consequence of rheumatic endocarditis. The majority of patients are women. In rare cases the picture of mitral stenosis is associated with left atrial myxoma.
A decrease in mitral orifice area more than twice the pressure in the left atrium increases, the hypertrophied atrium. In the future there is venous congestion in the lungs and reflexively increases pressure in the pulmonary artery, which gradually leads to congestion and an increase in the right heart. After a period of compensation, which sometimes covers the decade, is developing right ventricular failure.
Approximately two thirds of patients indicate that attacks of rheumatic fever in the past. If the defect is small and there is no undue stress, the feeling for many years may be satisfactory. In typical cases, early complaint is the shortness of breath when climbing a hill. In more severe cases, breathlessness provoked any pressure, agitation, fever, and other factors, more frequent rate. Attacks of cardiac asthma may occur in the supine position at night.
There are palpitations, cough, hemoptysis, heaviness in the chest, dizziness, fainting. Appearance of the patient usually does not change and only for severe mitral stenosis evident cyanosis. Pulse and blood pressure remain normal or marked tendency to tachycardia and hypotension, later developed atrial fibrillation, paroxysmal at first, then rack.
Echocardiography allows the most early and reliably detects mitral stenosis, estimate its severity, define the size of the cavities, and sometimes to identify parietal thrombus. X-ray study in direct and oblique projections of the esophagus with contrast allows us to estimate the configuration of the heart. With a slight mitral stenosis silhouette of the heart cannot be changed. The diagnosis in most cases can be diagnosed as outpatients.
Complications – atrial fibrillation, atrial fibrillation, right ventricular failure, embolism in the bodies of a large circle; infarction pneumonia, recurrent bronchopulmonary infection, globular thrombus in the atrium; recurrence of rheumatism with a further progression of the defect. Infective endocarditis is rare in this vice.
Patients should be observed cardio rheumatology and hospitalized for complications. Patients with isolated mitral stenosis with dyspnea and no signs of active rheumatism without a significant increase of heart should be directed to the heart surgeon with whom decide whether surgery. Approximately 20% operated in the years to develop restenosis.
Another form of acquired heart disease is mitral prolapse. Mitral prolapse is caused by tension chords or papillary muscles weakening. Prolapse may accompany Marfan syndrome, atrial septal defect, hypertrophic cardiomyopathy. Chord may be damaged rheumatic or septic process. Prolapse of posterior cusp meets the bowl.
Most young people mitral prolapse is not accompanied by significant symptoms, does not affect the well-being and is a random finding on an echocardiogram. Some patients may be palpitations, pain in the heart, prone to fainting. These feelings can generate mistrust; appear decreasing tolerance loads.
The prognosis of mitral prolapse without regurgitation is favorable. With the development of mitral regurgitation prognosis is determined by its severity. Possible accession of infective endocarditis, are rarely break chords (with the development of severe acute mitral insufficiency), thromboembolism to the brain. If the prolapse is accompanied by another disease, then it usually determines the course of the illness and prognosis.
Treatment in most cases is not required. W-blockers or amiodarone usually help reduce pain and arrhythmia. The tendency to thromboembolic complications prescribe antiplatelet agents. With mitral regurgitation it is necessary prevention of infective endocarditis. When significant mitral regurgitation appears should consult with the cardiologist about the possibility of mitral valve replacement.