Mitral stenosis is a congenital heart disease 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 a violation of blood circulation and, accordingly, affects the work of all organ systems.
Of course, people who are faced with a similar problem are looking for more information. Why does pathology develop? What are the first signs of mitral stenosis? Are there effective therapies? What should the patient expect? The answers to these questions are important to many readers.
Reasons for 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 connective tissue damage. In turn, lingering tonsillitis or chronic tonsillitis often leads to rheumatism.
- To factorsrisk also includes infectious diseases that affect the tissues of the heart (for example, endocarditis).
- Narrowing (stenosis) of the mitral valve can also be provoked by atherosclerosis, as well as the formation of blood clots inside the heart.
- The disease can develop against the background of heart injuries (including after surgeries, such as mitral valve replacement).
- Other risk factors include syphilis, mitral valve tissue calcification, and aortic insufficiency.
Mitral stenosis: hemodynamics and its features
Normally, the area of the opening between the left atrium and the ventricle is 4 to 6 square centimeters. Against the background of its narrowing, hemodynamic disturbances develop, because the process of passing blood from the left atrium to the ventricle becomes more complicated. The pressure in the atrial cavity rises to 20-25 mm Hg. Art. (normally this figure is 5). An increase in pressure leads to a gradual hypertrophy of this part of the myocardium. This compensatory mechanism helps keep the heart working, but unfortunately the stenosis progresses.
As the disease progresses, there is an increase in pressure in the pulmonary vessels, which leads to the development of pulmonary hypertension. The load on the right side of the heart increases. 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 you take into accountthe area of narrowing of the atrioventricular orifice, then four degrees of mitral stenosis can be distinguished.
- First degree - slight narrowing, hole area 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. see
- The third degree is already pronounced stenosis, accompanied by a narrowing of the hole to 1, 7-2, 2 square meters. see
- The fourth degree is called a critical form of mitral stenosis. The area of the opening between the ventricle and the atrium narrows to 1-1.6 square meters. see
It is worth noting that mitral stenosis occurs in five stages, each of which is accompanied by a set of specific symptoms and complications.
- The first stage is called the full compensation period. The narrowing of the atrioventricular lumen is small, and the heart still copes with its basic functions quite normally. Patients do not show any complaints. If the pathology is diagnosed at this stage, then it is completely accidental.
- 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, the person complains of severe shortness of breath that occurs during physical activity.
- The third stage is the beginning of the development of circulatory failure. At this stage, stagnation of blood is observed both in the small and in the systemic circulation. The heart is greatly enlarged. During the inspection, you can seea strong increase in venous pressure. Due to impaired blood flow, an increase in the liver is observed.
- At 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.
- At the fifth stage, the area of the hole does not exceed 1 square centimeter. The heart is greatly enlarged, venous pressure is increased. Shortness of breath bothers the patient even at rest. Patients also suffer from pronounced edema. More and more free fluid accumulates in the abdominal cavity. Therapeutic treatment has almost no effect.
Mitral stenosis symptoms
The initial stage of the 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 persistent shortness of breath. And if at first breathing difficulties appear only during physical activity, then in the future they disturb the patient even at rest. The list of symptoms also includes a strong cough, which is sometimes accompanied by sputum with blood streaks.
During the night, patients suffer from asthma attacks. There is muscle weakness, constant fatigue, increased fatigue. People suffer from insomnia, and this cannot but affect their emotional state. The appearance of the patient also changes - the lips and the tip of the nosebecome bluish, and purplish-bluish spots with clear edges appear on the cheeks (a kind of “doll blush”).
Patients note rapid irregular heartbeat. Sometimes there are pains in the region of the heart.
As it progresses, other symptoms appear. Mitral stenosis is characterized by the appearance of peripheral edema. You can observe swelling of the patient's neck veins - the vessels are clearly visible under the skin even at rest. Possible accumulation of fluid in the abdominal cavity, as well as between the sheets of the pleura of the lungs (a pronounced circulatory disorder often leads to pulmonary edema).
What complications does pathology lead to?
Mitral stenosis should never be ignored. The fact is that in the absence of therapy, the disease leads to incredibly dangerous complications.
- Some patients develop left ventricular failure, often referred to as cardiac asthma, as a result of the disease. Patients suffer from periodic attacks of breathlessness, which occur both during physical activity and at rest.
- In the pulmonary artery, the pressure rises significantly, which is accompanied by discomfort behind the sternum, as well as severe shortness of breath. Under the influence of pressure, the wall of the vessel can expand, forming an aneurysm. With such a pathology, the risk of rupture of the artery is high, which leads to the death of the patient.
- Sometimes there are various heart rhythm disturbances, in particular atrial fibrillation and flutter.
- Thromboembolism - moreone dangerous consequence of mitral stenosis. Broken blood clots can block a vessel, in particular the 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 increases significantly in size and sometimes compresses 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 orifice, but also to determine the stage and degree of stenosis, to identify complications associated with pathology, to identify the causes.
- First you need to collect a complete history. The doctor will definitely ask what symptoms bother the person, when and as a result of which they occur. 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 patient's physical activity, dietary habits, 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 the heart sounds, notice any pathological changes, the appearance of uncharacteristic diastolic murmurs. The specialist also determines the type of physique, examines the 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 paid primarily to the level of cholesterol - 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 suffering a streptococcal infection, such as tonsillitis, tonsillitis. If C-reactive protein is present in the patient's blood samples, then 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.
- Electrocardiography is also obligatory. This is a simple and affordable study that allows you to determine the increase in the left and right ventricles, to detect certain cardiac arrhythmias. More informative is the daily ECG monitoring.
- Echocardiography is an ultrasound examination that allows you to examine the leaflets of the mitral valve, detect the presence of pathologies, and determine the size of the atrioventricular orifice. Also, during the procedure, a specialist can detect blood clots, neoplasms, accumulation of calcifications on the valve leaflets.
- X-ray allows you to diagnose pulmonary edema. On the pictures you can see that the patient's heart has increased in size.
- Transesophageal echocardiography allows moreinspect the heart, openings and valves in detail. An ultrasound probe is inserted through the esophagus. The wall of this organ is located close to the heart, so the doctor can get an accurate image.
- Sometimes the patient is sent for a consultation with a cardiac surgeon, as well as a rheumatologist.
Research results can only be studied and correctly deciphered 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 permanent form of atrial fibrillation, as well as a decrease in the contractility of the right ventricle, then the doctors prescribe cardiac glycosides, in particular Strofantin, Korglikon.
- Beta-blockers are used to normalize the heart rhythm. "Bisoprolol", "Carvedilol" are considered effective.
- Diuretics help relieve swelling, eliminate congestion in the pulmonary circulation. As a rule, drugs such as Furosemide, Veroshpiron are used.
- The treatment regimen also includes cardioprotectors that protect heart cells from damage ("Ramipril", "Captopril").
- Nitrates are used to dilate blood vessels and lower blood pressure, in particular Nitrosorbide, Nitroglycerin.
- "Heparin", "Aspirin", "Tromboass" 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). Also usedpenicillin antibiotics.
It should be understood that medical 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.
Surgical treatment
Surgical treatment of mitral stenosis is currently the only truly effective way to normalize the heart and prevent further development of the disease.
- Sometimes a percutaneous commissurotomy is performed. The procedure is performed without opening the chest. They enter the heart through the femoral veins. With the help of a special flexible hollow tube, the doctor dissects the site of the accretion of the hole. This technique allows you to double its area.
- Closed mitral commissurotomy involves an incision in the chest. True, the heart is not opened and the heart-lung machine is not used. The doctor enters the heart through the left atrial appendage and removes the fusion with his fingers.
- Sometimes it is necessary to cut the fused leaflets of the mitral valve. This is a full-scale operation, involving the use of artificial circulation equipment and an incision in the heart, followed by suturing.
- If there is a pronounced deformation of the valve system, then mitral valve replacement is performed.
Surgery may not be carried out only at the first stage of development. In the future, without the help of surgeons, it is unlikelycan be dispensed with.
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 break down - this requires the removal of the remnants of the valve and re-prosthetics.
Correct lifestyle
Of course, medication is an important part of therapy. But there are certain rules that patients with mitral stenosis must follow. Doctors' recommendations 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 regime, limit the amount of table s alt - this will help prevent the formation of edema and high blood pressure;
- it is important to observe the correct mode of work and rest, do not overwork, get enough sleep;
- experts recommend avoiding increased physical activity, but keeping fit (for example, long walks in the fresh air will be useful);
- you should try to avoid stressful situations (doctors advise doing meditation practices, as they allow you to maintain emotional balance).
Preventive measures: can stenosis be prevented?
Specific prevention of mitral stenosis, unfortunately, does not exist. Doctors advise avoiding exposure to risk factors.
The background of developmentvarious diseases is a weakened immune system, so it needs to be strengthened in all possible ways. It is important to maintain good physical shape, eat right, periodically take vitamin complexes, spend a lot of time outdoors, engage in outdoor activities, and avoid stress.
It is important to treat tonsillitis and tonsillitis in time. If left untreated, these diseases can become chronic. Slow but constant inflammation in the tonsils can provoke the development of rheumatism, which increases the risk of mitral valve stenosis.
In no case should you refuse scheduled medical examinations. At least once a year, you need to donate blood for analysis (it is important to conduct rheumatic tests), do electrocardiography. Patients who have already had rheumatism should be registered with a rheumatologist and cardiologist, and constantly undergo examinations. The sooner the disease is diagnosed, the greater the chance of success.
Prognosis for patients
Mitral valve stenosis is a dangerous disease. In the absence of surgery, the 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 method of treatment 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 repeatedsurgical intervention. With the help of modern medicine methods, it is possible to prolong the patient's life, eliminate discomfort and symptoms.
