For more than 30 years there has been a so-called heart-lung machine, which for a short time, but can replace the pumping function of the heart, although, of course, it cannot be completely replaced. And this fact makes us worry about the motor of the body, because we cannot live without it.

For mammals of the order of primates, to which humans belong, a 4-chambered heart is characteristic, i.e. it consists of 4 chambers - 2 ventricles (left and right), and 2 atria (also left and right). The right parts of the heart are responsible for pumping blood through the so-called "small" circle of blood circulation, i.e.

The right atrium communicates with the right ventricle using the tricuspid (tricuspid) valve, and the left atrium communicates with the left ventricle through the mitral (bicuspid) valve, the lesion of which will be discussed in this article.

Manifestation of symptoms of the disease

Any suspicion of heart disease should be the reason for an urgent visit to a cardiologist. Myxomatous degeneration of the leaflets of the mitral valve manifests itself depending on the degree of progression of the pathology.

• a person's working capacity, his endurance decreases, persistent fatigue appears;
• there is pain in the chest;
• cardiac arrhythmia appears - the heartbeat can increase without physical exertion, there are noticeable interruptions in the work of the heart;
• fainting, dizziness, nausea are possible;
• there is a feeling of shortness of breath, accompanied by shortness of breath and cough.

To date, doctors do not identify effective methods of prevention that can prevent or stop the progression of this pathology. If the doctor detects systolic murmurs and only small changes in the structure of the heart, he may recommend regular medical examinations without prescribing drug therapy. Thus, it is possible to trace the development of the disease and its possible progression.

• give up bad habits: alcohol, nicotine, caffeine drinks;
• eat a balanced diet: less fatty and salty foods, more fresh vegetables and fruits. It is worth reducing the consumption of cholesterol-containing foods. It is better to steam or cook food, it is better to refuse fried foods;
• moderate physical activity;
• spend more time outdoors;
• have a good rest after a working day.

With a more complex form of pathology, the doctor prescribes drugs to minimize the progression of severe symptoms caused by hypertrophy and changes in the structural parts of the heart.

If heart failure is detected, the patient is prescribed medications that will remove excess fluid from the body, and help maintain the capacity of the heart muscle, and increase the blood flow rate.

As a rule, drugs are combined. This allows you to reduce symptoms and improve the patient's well-being. Therapy of pathology directly depends on the presence of concomitant diseases (especially for liver and kidney pathologies).

Important! You cannot take medications without a doctor's prescription, since they may be characterized by personal intolerance and negatively affect the development of pathology.

Myxomatous degeneration of the mitral valve leaflets has a favorable prognosis if the pathology was detected in the early stages and does not differ in pronounced symptoms. The disease can develop at a fairly early age, while manifesting itself rather rapidly. This manifestation requires early diagnosis and surgical therapy.

But, as a rule, the valve degenerates slowly and moderately over more than one year. Even if systolic murmurs are detected, the patient may have an asymptomatic period.

When heart failure develops, the average life span is about a year. But this is only an approximate figure, which is influenced by many factors. Therefore, after the diagnosis is made, it is necessary to fully follow the recommendations and prescriptions of the doctor.

The heart is not only, as many think, an organ of love, but also the engine of our body. It has a large number of functions, but perhaps the most important is the pumping of blood through the vessels of our body, which nourishes organs and tissues with oxygen and allows us to exist.

Myxomatous MK degeneration

MD MK is a disease characterized by hardening of the mitral valve cusps, which prevents them from closing completely and contributes to the occurrence of regurgitation (reverse flow) of blood into the left atrial cavity.

Thickening of the leaflets of the mitral valve

Stretching and thickening of the mitral valve leaflets causes a violation of the closure of the latter, which contributes (due to the higher pressure in the left ventricle than in the left atrium) the reverse flow of blood into the left atrial cavity.

This, in turn, causes hyperfunction with subsequent hypertrophy of the left atrium and relative insufficiency of the valves of the pulmonary veins, and subsequently, hypertension in the pulmonary circulation, which causes most of the symptoms of this disease.

I degree - the flaps are thickened up to 3-5 millimeters, while the closure of the valve is not disturbed, therefore, the patient has no clinical manifestations, because of this, it is possible to identify the disease at this stage only when examining diseases of other systems or during preventive examinations.

Any special treatment for myxomatosis of the mitral valve of the 1st degree does not require, even restrictions on physical activity are not given, the main thing is to lead a healthy lifestyle, try not to get sick with various viral and streptococcal infections and periodically conduct preventive examinations (most often it is recommended 2 times a year).

Degenerative mitral valve disease

II degree - the thickening of the leaflets reaches 5-8 millimeters, the closure of the valve is impaired, there is a reverse flow of blood. Also, the examination reveals single chord breaks and deformation of the mitral valve contour. At this stage, the doctor prescribes lifestyle, nutrition and the frequency of preventive examinations.

III degree - thickening of the leaflets exceeds 8 millimeters, valve closure does not occur, complete chord separation is observed. At the same time, the patient's condition deteriorates sharply, symptoms of acute left ventricular failure occur, therefore urgent specialized treatment of this patient is needed and early seeking medical help is very important at this stage.

In recent years, the number of patients suffering from pathologies of the cardiovascular system has increased. Mitral myxomatosis is a progressive condition that has a significant impact on the functioning of the valve leaflets in people of different ages.

In addition, this pathology is accompanied by a violation of the structure of the connective tissue and this is expressed in mitral valve prolapse. To date, experts have not been able to identify the reasons for the development of such a disease in the human body, but it is believed that the development of such a problem is due to a hereditary fact.

Diseases of the cardiovascular system

Mitral myxomatosis refers to a common heart disease that is diagnosed in people of different age groups. In modern medicine, several names for such a pathology are used, and most often experts use terms such as valve prolapse and degeneration.

Prolapse is a bulging or sagging of the leaflets of the heart valve in the direction of the proximal chamber of the organ. In the event that we are talking about mitral valve prolapse, then this pathology is accompanied by bulging of the valves towards the left atrium.

Prolapse is one of the most common pathologies that can be detected in patients of absolutely any age.

Mitral myxomatosis can develop for various reasons and experts distinguish primary and secondary prolapse:

1. primary valve prolapse means a pathology, the development of which is in no way associated with any known pathology or malformations
2. secondary prolapse progresses against the background of many diseases and pathological changes

Experts say that the development of both primary and secondary prolapse can occur during adolescence.

More information on mitral valve prolapse can be found in the video.

The development of secondary mitral valve prolapse usually occurs as a result of the progression in the patient's body of inflammatory or coronary diseases, which result in dysfunction of the valves and papillary muscles.

The degree of the disease

Characteristics of the degrees of myxomatosis of the mitral valve

Specialists identify several stages in the development of such a disease, and it is on them that the prognosis and possible therapy depend:

1. When a patient is diagnosed with the first degree of the disease, the valve flaps thicken up to 3-5 mm. As a result of such changes, there is no violation of their closure, therefore, a person does not have pronounced symptoms. Usually doctors are not worried about such a pathological state of appetite and they recommend that he undergo preventive examinations at least several times a year, as well as lead a healthy lifestyle.
2. The second degree of pathology is characterized by stretched and more thickened valves, the size of which is 5-8 mm. This pathological condition is complemented by a change in the contour of the mitral opening and even the appearance of single chord ruptures. In addition, with the second degree of myxomatosis of the mitral valve, there is a violation of the closure of the leaflets.
3. At the third degree of pathology, the mitral leaflets are greatly thickened, and their thickness reaches 8 mm. In addition, there is a deformation of the mitral ring, which ends with stretching and tearing of the chords. A characteristic symptom of this degree of the disease is the complete absence of closure of the valves.

• stroke
• mitral valve insufficiency
• lethal outcome

Causes and symptoms of manifestation

The symptomatology of the pathology directly depends on the degree of degeneration. In the initial stages, systolic murmurs are heard by the cardiologist. With the progression of the disease, the size of the heart and blood circulation increase, therefore, signs of a pronounced character begin to appear:

• endurance decreases;
• shortness of breath appears;
• appetite worsens;
• fainting is possible;
• coughing begins.

Additional complaints include:

• pain in the chest area;
• paroxysmal heartbeat (can be observed at rest or with slight exertion);
• interruptions in the work of the heart due to extrasystole;
• shortness of breath (shortness of breath);
• feeling tired for no apparent reason.

Important! Any signs of heart problems require urgent attention to a cardiologist. Timely identification of pathology increases the chance of complete recovery.

Pain in the heart area is of a different nature, depending on the development of the disease. A ruptured hypertrophic left atrium or valve flap can be fatal.

Myxomatous degeneration of the mitral valve is considered a fairly common pathology. But today they have not identified the true reason for its development. Some people may have a natural or genetic defect.

The disease is more exposed to people with growth problems and the formation of cartilage tissue. This is a connecting thread between this pathology and non-standard development, degeneration of connective tissues in the valve flaps.

Doctors are conducting research to identify the influence of the hormonal factor on the progression of this disease.

Shortness of breath on exertion

The clinical picture of this disease directly depends on the stage of the disease and the degree of compensation of the body.

The first degree in the overwhelming majority of cases has no clinical manifestations, since there is no regurgitation (reverse flow of blood) and, in general, the hemodynamics of the body is not disturbed. There may, of course, be general symptoms - dizziness, increased fatigue, decreased exercise tolerance, but these symptoms are found in a huge variety of other diseases and even in completely healthy people.

In the second degree, there are already small tears of the chord, and there is also regurgitation, although its level is not critical, the patient will feel it physiologically and clinically. There is a decrease in performance, general weakness, shortness of breath during physical exertion worries, and with such a load, at which there were no such symptoms before (for example, climbing to the third floor).

Also, such patients may be disturbed by tingling in the region of the heart, rhythm disturbance, which also begins after a short physical activity.

But all these symptoms may not be, if you notice at least a few of these, then you should immediately consult a doctor, because early treatment increases the chances of a full recovery several times.

Foamy cough streaked with blood

For the third degree, due to the depletion of the compensatory ability of the organism, all of the above symptoms are characteristic, but since due to the complete separation of the chord, the closure of the valves is severely disturbed or absent altogether, the symptoms will be very pronounced.

Dizziness worries, which often leads to fainting. Sometimes patients are worried about angina pain in the region of the heart, which does not subside even after taking nitrate drugs such as nitroglycerin.

Khusnutdinova R.G.

myxomatosis mitral valve

2. Etiology and pathogenesis

4. Clinical picture

Mitral valve prolapse is the deflection of one or both leaflets of the mitral valve into the left atrial cavity during left ventricular systole. This is one of the most common forms of dysfunction of the valve apparatus of the heart.

By origin, primary (idiopathic) and secondary mitral valve prolapse are distinguished. Primary mitral valve prolapse is associated with connective tissue dysplasia, which is also manifested by other microanomalies of the structure of the valve apparatus (changes in the structure of the valve and papillary muscles, impaired distribution, improper attachment, shortening or lengthening of chords, the appearance of additional chords, etc.).

Connective tissue dysplasia is formed under the influence of various pathological factors affecting the fetus during its intrauterine development (gestosis, ARVI and occupational hazards in the mother, unfavorable environmental conditions, etc.).

In 10-20% of cases of mitral valve prolapse is inherited maternally. At the same time, in 1/3 of families of probands, relatives with signs of connective tissue dysplasia and / or psychosomatic diseases are identified.

Dysplasia of connective tissue can also be manifested by myxomatous transformation of the valve leaflets associated with a hereditary disorder of the structure of collagen, especially type III. At the same time, due to the excessive accumulation of acidic mucopolysaccharides, the leaflet tissue (sometimes also of the valve ring and chordae) proliferates, which causes the prolapse effect.

Secondary mitral valve prolapse accompanies or complicates various diseases. With secondary prolapse of the mitral valve, as with primary, the initial inferiority of the connective tissue is of great importance.

So, it often accompanies some hereditary syndromes (Marfan syndrome, Ehlers-Danlo-Chernogubov syndrome, congenital contracture arachnodactyly, osteogenesis imperfecta, elastic pseudoxanthoma), as well as congenital heart defects, rheumatism and other rheumatic diseases, non-rheumatic carditis, some forms of cardiomyopathy , vegetative dystonia syndrome, endocrine pathology (hyperthyroidism), etc.

Mitral valve prolapse can be a consequence of acquired myxomatosis, inflammatory damage to valve structures, impaired contractility of the myocardium and papillary muscles, valve-ventricular imbalance, asynchronous activity of various parts of the heart, which is often observed in congenital and acquired diseases of the latter.

Dysfunction of the autonomic nervous system is undoubtedly involved in the formation of the clinical picture of mitral valve prolapse. In addition, metabolic disorders and micronutrient deficiencies, in particular magnesium ions, are important.

Structural and functional inferiority of the valvular apparatus of the heart leads to the fact that during the period of systole of the left ventricle, sagging of the leaflets of the mitral valve into the cavity of the left atrium occurs.

When the free part of the valves prolapses, accompanied by their incomplete closure in systole, isolated mesosystolic clicks associated with excessive tension of the chords are recorded auscultatory.

Loose contact of the valve leaflets or their divergence in systole determines the appearance of systolic murmur of varying intensity, indicating the development of mitral regurgitation. Changes in the subvalvular apparatus (lengthening of the chords, a decrease in the contractile ability of the papillary muscles) also create conditions for the onset or intensification of mitral regurgitation.

There is no generally accepted classification of mitral valve prolapse. In addition to differentiating mitral valve prolapse by origin (primary or secondary), it is customary to distinguish auscultatory and "mute" forms, indicate the localization of prolapse (anterior, posterior, both leaflets), the degree of its severity (I degree - from 3 to 6 mm, II degree - from 6 to 9 mm, III degree - more than 9 mm), time of onset in relation to systole (early, late, holosystolic), the presence and severity of mitral regurgitation.

Mitral valve prolapse is characterized by a variety of symptoms, depending primarily on the severity of connective tissue dysplasia and autonomic shifts.

Complaints in children with mitral valve prolapse are very diverse: increased fatigue, headaches, dizziness, fainting, shortness of breath, pain in the heart, palpitations, a feeling of interruption in the work of the heart.

In most cases, with mitral valve prolapse, various manifestations of connective tissue dysplasia are found: asthenic physique, high growth, reduced body weight, increased skin elasticity, poor muscular development, joint hypermobility, poor posture, scoliosis, chest deformity, pterygoid scapula, flat feet, myopia ...

You can find hypertelorism of the eyes and nipples, a peculiar structure of the auricles, a Gothic palate, a sandal fissure and other small developmental anomalies. Visceral manifestations of connective tissue dysplasia include nephroptosis, anomalies in the structure of the gallbladder, etc.

Often, with mitral valve prolapse, changes in heart rate and blood pressure are observed, mainly due to hypersympathicotonia. The borders of the heart are usually not expanded. Auscultatory data are most informative: more often isolated clicks or their combination with late systolic murmur are heard, less often - isolated late systolic or holosystolic murmur.

Clicks are recorded in the middle or end of systole, usually at the apex or at the fifth point of auscultation of the heart. They are not carried out outside the region of the heart and do not exceed tone II in volume, they can be transient or permanent, appear or increase in intensity in an upright position and during physical exertion.

An isolated late systolic murmur (rough, "scraping") is heard at the apex of the heart (preferably in the position on the left side); it is carried out into the armpit and is strengthened in an upright position.

Holosystolic murmur, reflecting the presence of mitral regurgitation, occupies the entire systole, is stable. In some patients, the "squeak" of chords is heard associated with vibration of the valve structures. In some cases (with a "silent" variant of mitral valve prolapse), auscultatory symptoms are absent.

The symptomatology of secondary mitral valve prolapse is similar to that of the primary one and is combined with manifestations characteristic of a concomitant disease (Marfan syndrome, congenital heart defects, rheumatic heart disease, etc.).

Mitral valve prolapse must be differentiated primarily from congenital or acquired mitral valve insufficiency, systolic murmurs caused by other variants of minor cardiac anomalies or dysfunction of the valve apparatus. The most informative is EchoCG, which contributes to the correct assessment of the revealed cardiac changes.

5 Diagnostic algorithm for suspected MD MK

Mitral valve degeneration is diagnosed on the basis of the patient's complaints, which we talked about above (in the section "MK degeneration - clinical manifestations"), but even in their absence, the patient should be examined using special methods, which we will discuss below.

Further, the doctor prescribes general clinical tests for the patient, such as a general blood test, a general urine test and a biochemical blood test. Most often, there are no changes in them, but with the third degree of insufficiency in the general blood test, anemia can be detected, or vice versa, signs of blood thickening (an increase in the level of red blood cells, platelets, hemoglobin and a decrease in the ESR level), this is due to the release of the liquid part of the blood into the third space (lungs ).

The "gold" standard for detecting valve failure and chord rupture is ultrasound examination of the heart with Doppler. This method allows you to identify the stage and degree of decompensation of the disease, and this can be done even before the child is born, which means that it is early to identify and prescribe early treatment.

Not highly specific methods, but necessary for early diagnosis of the disease are ECG examination and X-ray examination of the chest organs. In the first case, we will reveal signs of hypertrophy of the left heart, and in the third stage, hypertrophy of the right heart will join, as well as various supraventricular tachyarrhythmias such as atrial fibrillation or flutter, supraventricular extrasystoles.

X-ray examination will show signs of pulmonary hypertension, bulging of the left atrial arch, as well as expansion of the borders of the heart (in the third stage, the development of the "bovine" heart).

To clarify the diagnosis, special research methods can be used - catheterization of the left and right ventricles, as well as left ventriculography, which will help to clarify the presence of the disease and its degree.

6 Modern methods of treatment

Mitral valve repair

Treatment of mitral valve degeneration depends on the stage and degree of compensation of the body, and this directly depends on the patient's request for help from a doctor. At the first stage, special treatment is not required, it is enough to follow a healthy lifestyle, limit yourself to excessive physical exertion, adhere to proper nutrition and limit yourself to salty foods.

In the second stage, treatment is not limited to a healthy lifestyle and diet. After establishing a diagnosis and identifying the degree of decompensation, doctors prescribe various cardiotonic drugs, which are designed not only to improve hemodynamics, but to relieve the left heart. In the second stage, treatment is most often limited to medication.

In the third stage, it is difficult to limit treatment only with medicines, therefore, surgical intervention is necessary to replace the valve, and an early operation is desirable in order to avoid damage to other organs, since heart diseases affect all systems of the body to one degree or another.

These operations, although they are high-tech, most often take place without serious complications, so you need to decide on an operation for your own health.

Remember! Early treatment of the disease is the key to a long life!

Changes depending on the severity of the disease

This pathological condition of the human heart has other names. Doctors can voice the diagnosis to a patient using the terms mitral valve prolapse or endocardiosis.

The mitral valve separates the left atrium from the left ventricle. Under normal conditions, it prevents blood from flowing back from the atrium to the ventricle of the heart. For some reason, most often due to a genetic predisposition or infections of a viral nature, degeneration of the valve leaflets occurs in a person - their stretching and thickening.

This process is called MVP (mitral valve prolapse), its development in the patient causes disturbances in the work of the heart. There is a reverse flow of some of the blood from the atrium into the ventricle - this phenomenon is called regurgitation. The development of the disease leads to a change in the patient's condition, the appearance of noise during the work of the heart.

The myxomatous process leads to further changes in the functioning of the organ. The result is an increased size of the left ventricle, and subsequently the whole heart, arrhythmia, heart failure, and disturbances in the work of other valves.

Mitral myxomatosis goes through three stages of development (degrees). Each of them has its own characteristics, requires a different approach to therapy.

First-degree myxomatous degeneration of the valve is expressed in a slight thickening of its leaflets - less than 5 millimeters. In this case, the flaps completely close, there are no manifestations of the disease at all. In this condition, observation by a cardiologist and a change in the usual way of life with a revision of the attitude to bad habits, nutrition, physical activity is required.

The second stage of the disease is diagnosed when the valve is thickened in the range from 5 to 8 millimeters, while its valves are stretched, their closure is disturbed, and the shape of the opening between them changes.

0 Signs of myxomatous degeneration are absent on ultrasound scanning, but initial changes can be detected by examination of histological materials

I Indistinct thickening of the valves - no more than 0.03–0.05 cm; the opening of the mitral valve takes the shape of an arch

II A pronounced increase in the valves up to 0.08 cm with a violation of their full closure, the involvement of chords in the process

There are not very many reasons for the development of myxomatous degeneration of the mitral valve leaflets. The most common are:

• rheumatism;
• chronic rheumatic heart disease;
• secondary atrial septal defect;
• congenital defects;
• hypertrophic cardiomyopathy;
• cardiac ischemia.

Pathology always develops secondarily. An important role is played by a hereditary predisposition to the occurrence of myxomatous degeneration.

In the early stages of the formation of pathological changes, the patient does not present complaints, or they are due to the main problem. As the progression progresses:

• increased fatigue;
• palpitations;
• sharp fluctuations in blood pressure;
• anxiety;
• panic attacks;
• pain in the apex of the heart, not associated with physical activity;
• increased shortness of breath;
• reduced resistance to physical and daily stress;
• heart rhythm disturbances;
• the appearance of edema in the lower 1/3 of the lower leg and feet.

The severity of symptoms increases as the degree of leaflet prolapse increases.

Mitral myxomatosis is determined by the results of several studies:

• assessment of patient complaints;
• history data;
• objective examination;
• additional survey methods.

During the examination, the characteristic auscultatory signs of pathology are:

• systolic click;
• average systolic murmur;
• holosystolic murmur.

A distinctive feature of the auscultatory picture in myxomatous degeneration is its variability (the ability to change from visit to visit).

From an additional examination, the doctor prescribes:

• holter monitoring;
• Ultrasound of the heart (transthoracic, transesophageal) is the only method to visualize pathological changes;
• samples with dosed physical activity;
• radiography of the lungs;
• MSCT;
• electrophysiological research.

Such an extensive diagnostics is necessary to determine the further tactics of patient management and control over the ongoing therapy.

Myxomatous degeneration of the mitral valve leaflets of grade 0-I does not require aggressive measures. At the same time, doctors choose a wait and see tactic, regularly assessing the patient's condition. No specific treatment is performed. The patient is given a number of general recommendations:

• exclude heavy physical activity;
• normalization of body weight;
• therapy of concomitant diseases;
• healthy sleep;
• physiotherapy;
• proper nutrition.

Patients with a higher degree are shown symptomatic treatment:

• β-blockers;
• calcium antagonis;
• aCE inhibitors;
• antiarrhythmic drugs.

Of great importance is the influence on the mental status of the patient. For these purposes, magnesium preparations, sedatives are used.

Surgical correction is carried out with a pronounced clinic, an increase in the degree of myxomatosis.

The patient management tactics are determined individually by the cardiologist.

What is the problem

Myxomatosis of the mitral valve is a disease based on an increase in the volume of its valves due to the spongy layer located between the ventricular and atrial surfaces of the valve. Such a process occurs due to a change in the chemical composition of cells, when the content of mucopolysaccharides in them increases significantly.

The outcome of all such deviations is valve prolapse, gradually leading to a number of pathological processes:

• the phenomenon of fibrosis on the surface of the valves;
• thinning and lengthening of the tendon chords;
• damage to the left ventricle, its degeneration.

The changes are irreversible, leading to aggressive patient management tactics.

The distinctive properties of pathology are considered:

1. Affects persons over 40 years of age.
2. It is more often diagnosed in men.
3. The presence of mitral regurgitation (reverse blood flow when the heart muscle relaxes after contraction).
4. The progressive course of the disease.
5. The formation of heart failure.

The severity of the disease is determined by the degree of prolapse (sagging) of one or two valves into the left ventricular cavity. The severity of myxomatous degeneration is determined by ultrasound of the heart.

Ways to confirm the diagnosis and conduct an examination

The diagnosis of myxomatous degeneration can be made using several types of diagnostics. During the initial examination of the patient, the doctor may suspect the presence of an illness while listening to the heart tone with a stethoscope.

• ultrasound examination;
• chest x-ray;
• decoding of the data obtained when taking an electrocardiogram;
• laboratory analyzes.

Such diagnostic methods make it possible to study the changes that have occurred in the valve, identify possible threats to the further development of pathology, and prescribe treatment.

Khusnutdinova R.G.

With the "mute" form, treatment is limited to general measures aimed at normalizing the autonomic and psychoemotional status of children, without reducing physical activity.

With the auscultatory variant, children who tolerate physical activity satisfactorily and have no noticeable abnormalities according to ECG data can engage in physical education in the general group. Exclude only exercises associated with sudden movements, running, jumping. In some cases, an exemption from participation in competitions is necessary.

When mitral regurgitation, pronounced violations of the processes of repolarization on the ECG, and distinct arrhythmias are detected, a significant limitation of physical activity with an individual selection of the exercise therapy complex is necessary.

In the treatment of children with mitral valve prolapse, the correction of autonomic disorders, both non-drug and drug, is of great importance. In violation of ventricular repolarization (according to ECG data), drugs are used that improve myocardial metabolism [potassium orotate, inosine (for example, riboxin), vitamins B5, B15, levocarnitine, etc.].

Drugs that correct magnesium metabolism are effective, in particular orotic acid, magnesium salt (magnerot). In some cases (with persistent tachycardia, frequent ventricular extrasystoles, the presence of an extended Q-T interval, persistent violations of the repolarization processes), the appointment of I-blockers (propranolol) is justified, if necessary, antiarrhythmic drugs of other classes.

With pronounced changes in the valve apparatus, prophylactic courses of antibiotic therapy are indicated (especially in connection with surgical intervention) in order to prevent the development of infective endocarditis. Necessarily conservative or surgical treatment of foci of chronic infection.

With mitral insufficiency, accompanied by severe, resistant to treatment, cardiac decompensation, as well as with the addition of infective endocarditis and other serious complications (pronounced arrhythmias), it is possible to perform surgical correction of mitral valve prolapse (reconstructive surgery or mitral valve replacement).

The prognosis for mitral valve prolapse in children depends on its origin, the severity of morphological changes in the mitral valve, the degree of regurgitation, the presence or absence of complications. In childhood, mitral valve prolapse, as a rule, proceeds favorably.

Complications of mitral valve prolapse in children are rare. The development of acute (due to chordal separation, with pulmonary venous hypertension) or chronic mitral insufficiency, infective endocarditis, severe arrhythmias, thromboembolism, sudden death syndrome, most often of an arrhythmogenic nature, is possible.

The development of complications, the progression of valvular disorders and mitral regurgitation adversely affect the prognosis. Mitral valve prolapse that occurs in a child can lead to difficult-to-correct disorders in a more mature age.

1. Childhood diseases. A. A. Baranov // 2002.

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Disease diagnosis methods

Pathology is determined while listening to the heart. The doctor hears a systolic murmur in the mitral valve.

For the final diagnosis, the physiological state of the person is examined and an EchoCG (ultrasound diagnosis of the heart) is prescribed. Echocardiogram allows you to determine the tacking of the valves, their structure and the possibility of the functioning of the heart muscle.

• the anterior, posterior, or both flaps thicken by more than five millimeters in relation to the mitral ring;
• enlarged left atrium and ventricle;
• contraction of the left ventricle is accompanied by sagging of the valve cusps to the atrium;
• the mitral ring expands;
• tendon filaments are lengthened.

An electrocardiogram is mandatory. The ECG records all kinds of heart rhythm disturbances.

Additional diagnostic methods include chest x-ray.

The presence of pathology is indicated by systolic murmurs in the heart, which the doctor can hear during auscultation (listening). To confirm the diagnosis, appoint:

• electrocardiogram;
• echocardiography (a type of ultrasound of the heart);
• chest X-ray.

At the initial stage, when myxomatous degeneration of the mitral valve leaflets does not interfere with the work of the heart and does not affect the general condition of the body, active treatment, and even more so, surgical intervention, is not required. However, the patient must be registered with a cardiologist and undergo regular examinations.

There are no effective drugs that could completely stop and eliminate this pathological disease. Therefore, with the progression of the pathology, those medications are prescribed that help to eliminate the symptoms and significantly slow down the dangerous process.

These drugs include those that remove excess fluid from the body, are aimed at maintaining the performance of the heart muscle and at improving blood circulation, at regulating the heart rate.

In the case when the pathology has led to mitral insufficiency and blood regurgitation, surgery may be indicated (you can watch the video on the Internet resource), in which it is possible:

• preservation of the valve with plastic leaflets or their replacement;
• prosthetics (the affected mitral valve is removed, and a biological or artificial prosthesis is placed instead).

Mitral valve prolapse is the deflection of the mitral valve leaflets into the left atrium during systole. The most common cause is idiopathic myxomatous degeneration. Mitral valve prolapse is usually benign, but complications include mitral regurgitation, endocarditis, valve rupture, and possible thromboembolism.

Mitral valve prolapse is usually asymptomatic, although some patients experience chest pain, shortness of breath, and manifestations of sympathicotonia (eg, palpitations, dizziness, pre-syncope, migraines, anxiety).

Symptoms include a clear mid-systole click followed by a systolic murmur in the presence of regurgitation. Diagnosis is by physical examination and echocardiography. The forecast is favorable.

Mitral valve prolapse is a common condition. The prevalence is 1-5% among healthy people. Women and men suffer equally often. Mitral valve prolapse usually follows a youthful growth spurt.

A presumptive diagnosis is made clinically and confirmed by two-dimensional echocardiography. Holosystolic displacement of 3 mm or late systolic displacement

Considering myxomatous degeneration of the mitral valve leaflets, the question arises what is it? So, this is a pathological condition that is not the most dangerous for the body: with the timely detection of a defect, there are measures of influence and preventive programs are recommended.

It is a myxomatous degeneration of the valve leaflets, stretching or an increase in their thickness, which, with the progression of the disease, begins to interfere with the complete closure of the valve at the time of systole and cannot resist reverse blood flow. Most often, this defect is diagnosed in older and middle-aged people.

In total, there are three degrees of development of the pathological process:

• the first degree is characterized by an increase in the thickness of the valves in the range from 3 mm to 5 mm, which do not interfere with the closure;
• on the second, the thickening reaches 8 mm, which leads to deformation of the valve, single chord breaks and a violation of the closure density;
• at the third stage, with an increase in the thickness of the valves over 8 mm, the valve does not close and blood regurgitation (reverse flow) occurs, in which part of it returns to the atrium.

The causes of the appearance of pathology can be many factors.

The initial stage is not life-threatening, but the progression of myxomatous degeneration and the transition to later stages can lead to mitral valve insufficiency, stroke, infective endocarditis, and death.

To date, there are no definite reasons that can lead to this defect. In some cases, heredity is a dangerous factor. A regularity was revealed according to which patients with such pathology have problems with growth. Doctors do not exclude the influence of hormonal disruptions, but this factor is still under study.

Myxomatosis is caused by the Leporipox myxomatosis virus, which is carried by blood-sucking insects, most commonly mosquitoes. Outbreaks of the disease can occur at any time of the year, but are most common in the spring and summer when fleas, mosquitoes and other stinging insects are active.

Myxomatosis is a dangerous disease that can kill all rabbits.

The Myxoma virus belongs to the smallpox group. First diagnosed in Uruguay in the 19th century. It appeared in Russia at the beginning of the 20th century, and since that time it has mutated into several strains. The virus is characterized by its rapid spread, pervasive ability, and resistance to most chemicals.

The disease is epidemic in nature and causes mortality up to 90% of the total livestock. The disease is not 100% fatal, and with timely treatment, the prognosis of cure is quite favorable.

Features of the development of myxomatosis of the mitral valve and methods of its treatment

In recent years, the number of patients suffering from pathologies of the cardiovascular system has increased. Mitral myxomatosis is a progressive condition that has a significant impact on the functioning of the valve leaflets in people of different ages.

In addition, this pathology is accompanied by a violation of the structure of the connective tissue and this is expressed in mitral valve prolapse. To date, experts have not been able to identify the reasons for the development of such a disease in the human body, but it is believed that the development of such a problem is due to a hereditary fact.

Diseases of the cardiovascular system

Mitral myxomatosis refers to a common heart disease that is diagnosed in people of different age groups. In modern medicine, several names for such a pathology are used, and most often experts use terms such as valve prolapse and degeneration.

Prolapse is a bulging or sagging of the leaflets of the heart valve in the direction of the proximal chamber of the organ. In the event that we are talking about mitral valve prolapse, then this pathology is accompanied by bulging of the valves towards the left atrium.

Prolapse is one of the most common pathologies that can be detected in patients of absolutely any age.

Mitral myxomatosis can develop for various reasons and experts distinguish primary and secondary prolapse:

1. primary valve prolapse means a pathology, the development of which is in no way associated with any known pathology or malformations
2. secondary prolapse progresses against the background of many diseases and pathological changes

Experts say that the development of both primary and secondary prolapse can occur during adolescence.

More information on mitral valve prolapse can be found in the video.

The development of secondary mitral valve prolapse usually occurs as a result of the progression of inflammatory or coronary diseases in the patient's body, the result of which is dysfunction of the valves and papillary muscles. In the event that systemic lesions of the connective tissue are observed, then valve prolapse becomes one of the characteristic symptoms of such a disorder.

The degree of the disease

Characteristics of the degrees of myxomatosis of the mitral valve

Specialists identify several stages in the development of such a disease, and it is on them that the prognosis and possible therapy depend:

1. When a patient is diagnosed with the first degree of the disease, the valve flaps thicken up to 3-5 mm. As a result of such changes, there is no violation of their closure, therefore, a person does not have pronounced symptoms. Usually doctors are not worried about such a pathological state of appetite and they recommend that he undergo preventive examinations at least several times a year, as well as lead a healthy lifestyle.
2. The second degree of pathology is characterized by stretched and more thickened valves, the size of which is 5-8 mm. This pathological condition is complemented by a change in the contour of the mitral opening and even the appearance of single chord ruptures. In addition, with the second degree of myxomatosis of the mitral valve, there is a violation of the closure of the leaflets.
3. At the third degree of pathology, the mitral leaflets are greatly thickened, and their thickness reaches 8 mm. In addition, there is a deformation of the mitral ring, which ends with stretching and tearing of the chords. A characteristic symptom of this degree of the disease is the complete absence of closure of the valves.

Medical practice shows that the first stage of the disease is considered not dangerous, since it does not cause deviations and failures in the functioning of the heart. At stages 2 and 3, a return of a certain volume of blood back is observed, since the process of closing the valves is disrupted. Such a pathological condition requires mandatory attention, since the risk of developing various complications increases.

Degeneration of the valve leaflets can progress with age, which can lead to the development of various abnormalities.

Most often, the patient develops complications in the form of:

• stroke
• mitral valve insufficiency
• lethal outcome

With such a pathology, forecasts can be disappointing, therefore, timely diagnosis of the disease plays an important role. When detecting myxomatosis of the mitral valve, it is important to prescribe effective treatment as early as possible, which will avoid the development of many complications.

Symptoms

The initial stage of mitral myxomatosis is usually accompanied by the absence of characteristic symptoms and this is explained by the fact that there is no disturbance of the circulatory process, and there is no regurgitation at all.

In the event that the pathology moves to the next stage of its development, then this causes the following symptoms:

• the patient's working capacity is noticeably reduced, and any minimal stress causes rapid fatigue and weakness
• shortness of breath often occurs with exertion of any kind and is accompanied by this constant feeling of shortness of breath
• periodically there are painful sensations in the heart in the form of tingling, but they are short-lived
• frequent dizziness occurs, which cause arrhythmia and the result of this is perhaps a light-headed state
• an additional sign of the disease is the appearance of a cough, which is dry at first, but gradually accompanied by sputum discharge and, in some cases, with blood streaks

During the examination, the specialist will notice a violation of the functioning of the cardiovascular system while listening to the heart. The doctor pays attention to the murmurs that result from the backflow of blood to the ventricle. With such a pathological state of the body, the patient needs a more thorough examination, the appointment of the necessary studies and the study of the anamnesis.

Symptoms

Myxomatous degeneration of the mitral valve is a gradually progressive condition that affects the anatomy and performance of the valve leaflets in middle-aged and old people.

The exact causes of the disease have not been determined, but it is known that a similar problem is associated with heredity.

As a rule, in the early or middle stages of the disease, a heart murmur is determined that does not show symptoms for several years or a lifetime.

In the later stages of the disease, complications are possible, manifested in arrhythmias, heart failure, sudden death in severe cases.

Myxomatous degeneration of the mitral valve is a common heart condition. This disease has many names (degeneration, endocardiosis, or valve prolapse). This disease is associated with the mitral valve, which separates the left atrium and the left ventricle. All names are descriptions of age-related degeneration of the structural parts of the heart valves, which is manifested by stretching and thickening of the valve leaflets.

In this case, the closure of the leaflets is disrupted and regurgitation (reverse blood flow) through one or a pair of valves with audible heart murmurs manifests itself. Subsequently, degenerative changes and an increase in the return blood flow intensify, the parts of the heart expand. Other complications (cardiac arrhythmias, insufficiency and other dangerous conditions) may also appear.

Symptoms

MD signs

The incubation period of the virus in the rabbit's body is from 5 to 14 days, depending on the specific strain of the disease. At the beginning of the development of the disease, signs can only be noticed with close examination. Red spots appear on the rabbit's body.

Additional signs gradually begin to appear.

There are a number of characteristic manifestations of myxomatosis infection:

• Eye lesions. The mucous membrane turns red and begins to secrete milky mucus. The eyes start to swell.
• Inhibited, slow movements.
• Body temperature 42 degrees.
• Deterioration of the coat structure. To the touch, the wool becomes stiff, begins to fall out in clumps.

With myxomatosis, the rabbit's eyes swell, and small bumps appear on the body.

There are two types of myxomatosis: edematous and nodular.

The specific symptoms of myxomatosis depend on its form:

1. Edematous. It develops very quickly and most often causes the death of a rabbit. This form of myxomatosis is practically incurable. Symptoms of the disease are swelling of the eyes, nasal cavity of the rabbit. Pus is released from them. Gradually, tumors cover the entire body of the animal. Diseases of the genital organs of rabbits often develop. The ears hang down. The rabbit refuses food. Death occurs in 10 days.
2. Nodular. Death in this form of the disease is rare, since the virus is amenable to therapy. Symptoms of nodular myxomatosis are small bumps (nodules) that form throughout the body. Most of all the bumps are formed on the head of the rabbit. They are mainly localized around the ears and eyes. In the second stage of the disease, conjunctivitis develops. The eyes become filled with pus, breathing becomes difficult, and a flow from the nose appears.

Rabbit owners often do not pay attention to the first signs of pet infestation. The animal can stay in this state for 2 weeks. When the disease becomes severe, the rabbit is completely immobilized. It is impossible to get the animal out of this state.

The rabbit's photo shows vivid symptoms of myxomatosis.

Myxomatosis can cause the development of concomitant diseases in an animal that worsen its condition. Most often, pneumonia develops, which clearly becomes the cause of the death of a rabbit.

Sick animals are the source of myxomatosis infection. The virus persists in secretions from the eyes and nose, as well as in the subcutaneous tissue and parenchymal organs. In nature, wild hares are carriers of the virus (find out what the differences are between a hare and a rabbit).

Rabbit breeders noticed that the most destructive spread of the disease manifests itself during the period of mass emergence of mosquitoes. On the glands of all blood-sucking insects, the virus can persist for several months.

The myxomatosis virus is transmitted through secretions from the eyes and nose.

The virus does not die even when the dead animal is buried in the ground. In such conditions, myxoma lives for 2 years! The virus enters the rabbit's body in all possible ways: through the respiratory tract, blood, genitals during mating, in utero.

Myxomatosis in rabbits

• Causes and ways of infection
• Symptoms and forms of the disease
• Treatment features
• Prevention of myxomatosis

Myxomatosis in rabbits is a rather complex and serious disease. It is characterized by the fact that the animal has a certain number of cones. The causative agent is a virus, which is why, if one animal falls ill, then literally the next day all the others will certainly fall ill.

The myxomatosis virus in rabbits very quickly spreads to all individuals in the rabbitry.

This disease affects both wild and domestic rabbits equally. And you should be extremely attentive to the owners who breed animals for meat. After all, if the treatment is not carried out on time, then the meat can become completely unusable.

At the initial stage, any signs will be absent, because in this case, blood circulation is not disturbed, regurgitation is completely absent. But, with the transition of the disease to a more serious stage, a person will feel the following symptoms:

1. decreased performance, general weakness, fatigue, even with minimal loads;
2. shortness of breath, appearing with minimal physical or emotional stress, a feeling of shortness of breath;
3. pain in the heart, which most often manifests itself in the form of tingling. Occur periodically, are short-lived;
4. dizziness, accompanied by arrhythmia, often leading a person to a light-headed state;
5. cough, it should be considered as an additional symptom that may not appear. At first it is dry, then it is accompanied by the secretion of sputum, which may contain streaks of blood.

When visiting a doctor, signs of a malfunction of the heart system will first of all be noticed when listening to the heart. The doctor will hear murmurs that accompany the return of blood to the ventricle. Already this can become a reason for a more detailed examination, including anamnesis, laboratory tests, electrocardiography, echocardiography.

If electrocardiography shows only the presence of a violation, its stage, then ultrasound of the heart will be able to give more complete information, because it will allow determining the size of the valves, the features of their deformation, in other words, all the pathological changes that take place in this case.

One of the abnormalities of cardiac development is mitral valve prolapse (MVP). It is characterized by the fact that its valves are pressed into the left atrial cavity at the moment when the left ventricle contracts (systole). This pathology has another name - Barlow syndrome, after the name of the doctor who was the first to determine the cause of the late systolic apical murmur that accompanies MVP.

The significance of this heart defect is still not well understood. But most medical luminaries believe that he does not pose a particular threat to human life. Usually this pathology does not have pronounced clinical manifestations. It does not require drug therapy. The need for treatment arises when, as a result of MVP, a violation of cardiac activity (for example, arrhythmia) develops, which is accompanied by certain clinical manifestations.

To understand this, it is necessary to imagine how the heart works. The oxygen-enriched blood from the lung enters the left atrial cavity, which serves as a kind of storage (reservoir) for it. From there, it enters the left ventricle. Its purpose is to forcefully push out all the incoming blood into the aortic orifice, for distribution to the organs located in the zone of the main circulation (large circle).

The blood flow again rushes to the heart, but this time into the right atrium, and then into the cavity of the right ventricle. In this case, oxygen is consumed, and the blood is saturated with carbon dioxide. The pancreas (right ventricle) throws it out into the pulmonary circulation (pulmonary artery), where it is re-enriched with oxygen.

With normal cardiac activity at the time of the onset of systole, the atria are completely freed from the blood, and the mitral valve closes the entrance to the atria, there is no backflow of blood. The prolapse prevents the sagging, stretched flaps from closing completely. Therefore, not all blood enters the aortic orifice during cardiac output. Part of it returns back to the left atrial cavity.

The process of retrograde blood flow is called regurgitation. Prolapse, accompanied by a deflection of less than 3 mm, develops without regurgitation.

PMK classification

Diagnostics and treatment methods

Mitral myxomatosis is determined by the results of several studies:

• assessment of patient complaints;
• history data;
• objective examination;
• additional survey methods.

During the examination, the characteristic auscultatory signs of pathology are:

• systolic click;
• average systolic murmur;
• holosystolic murmur.

A distinctive feature of the auscultatory picture in myxomatous degeneration is its variability (the ability to change from visit to visit).

From an additional examination, the doctor prescribes:

• holter monitoring;
• Ultrasound of the heart (transthoracic, transesophageal) is the only method to visualize pathological changes;
• samples with dosed physical activity;
• radiography of the lungs;
• MSCT;
• electrophysiological research.

Such an extensive diagnostics is necessary to determine the further tactics of patient management and control over the ongoing therapy.

Diagnostics of the myxomatous degeneration of the mitral valve

Pathology is determined while listening to the heart. The doctor hears a systolic murmur in the mitral valve.

For the final diagnosis, the physiological state of the person is examined and an EchoCG (ultrasound diagnosis of the heart) is prescribed. Echocardiogram allows you to determine the tacking of the valves, their structure and the possibility of the functioning of the heart muscle. For examination, one-dimensional and two-dimensional modes are used. This research method allows you to determine the following pathological factors:

• the anterior, posterior, or both flaps thicken by more than five millimeters in relation to the mitral ring;
• enlarged left atrium and ventricle;
• contraction of the left ventricle is accompanied by sagging of the valve cusps to the atrium;
• the mitral ring expands;
• tendon filaments are lengthened.

An electrocardiogram is mandatory. The ECG records all kinds of heart rhythm disturbances.

Additional diagnostic methods include chest x-ray.

The presence of pathology is indicated by systolic murmurs in the heart, which the doctor can hear during auscultation (listening). To confirm the diagnosis, appoint:

• electrocardiogram;
• echocardiography (a type of ultrasound of the heart);
• chest X-ray.

At the initial stage, when myxomatous degeneration of the mitral valve leaflets does not interfere with the work of the heart and does not affect the general condition of the body, active treatment, and even more so, surgical intervention, is not required. However, the patient must be registered with a cardiologist and undergo regular examinations.

To date, there are no effective drugs that could completely stop and eliminate this pathological disease. Therefore, with the progression of the pathology, those medications are prescribed that help eliminate the symptoms and significantly slow down the dangerous process. These drugs include those that remove excess fluid from the body, are aimed at maintaining the performance of the heart muscle and at improving blood circulation, at regulating the heart rate.

In the case when the pathology has led to mitral insufficiency and blood regurgitation, surgery may be indicated (you can watch the video on the Internet resource), in which it is possible:

• preservation of the valve with plastic leaflets or their replacement;
• prosthetics (the affected mitral valve is removed, and a biological or artificial prosthesis is placed instead).

Mitral valve prolapse is the deflection of the mitral valve leaflets into the left atrium during systole. The most common cause is idiopathic myxomatous degeneration. Mitral valve prolapse is usually benign, but complications include mitral regurgitation, endocarditis, valve rupture, and possible thromboembolism.

Mitral valve prolapse is usually asymptomatic, although some patients experience chest pain, shortness of breath, and manifestations of sympathicotonia (eg, palpitations, dizziness, pre-syncope, migraines, anxiety). Symptoms include a clear mid-systole click followed by a systolic murmur in the presence of regurgitation.

Mitral valve prolapse is a common condition. The prevalence is 1-5% among healthy people. Women and men suffer equally often. Mitral valve prolapse usually follows a youthful growth spurt.

A presumptive diagnosis is made clinically and confirmed by two-dimensional echocardiography. Holosystolic displacement of 3 mm or late systolic displacement

Myxomatous degeneration of the mitral valve is a gradually progressive condition that affects the anatomy and performance of the valve leaflets in middle-aged and old people.

The exact causes of the disease have not been determined, but it is known that a similar problem is associated with heredity.

As a rule, in the early or middle stages of the disease, a heart murmur is determined that does not show symptoms for several years or a lifetime.

In the later stages of the disease, complications are possible, manifested in arrhythmias, heart failure, sudden death in severe cases.

Drug therapy is aimed at slowing the course of degeneration, eliminating possible symptoms and improving the quality of life.

Features of myxomatous degeneration

Myxomatous degeneration of the mitral valve is a common heart condition. This disease has many names (degeneration, endocardiosis, or valve prolapse). This disease is associated with the mitral valve, which separates the left atrium and the left ventricle. All names are descriptions of age-related degeneration of the structural parts of the heart valves, which is manifested by stretching and thickening of the valve leaflets. In this case, the closure of the leaflets is disrupted and regurgitation (reverse blood flow) through one or a pair of valves with audible heart murmurs manifests itself. Subsequently, degenerative changes and an increase in the return blood flow intensify, the parts of the heart expand. Other complications (cardiac arrhythmias, insufficiency and other dangerous conditions) may also appear.

Symptoms of the disease

Symptoms of mitral degeneration vary based on the stage of the valve leaflet degeneration. At an early stage of development, systolic murmurs are determined in the heart. According to the degree of increase in changes, an increase in the heart and blood circulation, other symptoms arise, consisting of a decrease in physical activity, shortness of breath, a deterioration in appetite, fainting, and coughing. In some cases, in the late stages of the disease, death is possible (the reason for this is rupture of the hypertrophied left atrium or rupture of the valve leaflets).

Causes of the disease

Regardless of the fact that myxomatous degeneration is a very common disease, to date, no definite causes of its occurrence have been identified. In some people, the predisposition to this disease may be associated with hereditary or genetic nature.

Often myxomatous degeneration is observed in people who have problems with growth, as well as the formation of cartilage tissue. This indicates a connection between the disease and abnormal development, degeneration of connective tissues in the valve leaflets.

Now experts are conducting research based on determining the influence of hormonal factors in the development of such a pathology.

Diagnosis of mitral degeneration

Myxomatous valve degeneration can be determined in any person by detecting systolic murmurs in the mitral valve. To confirm the diagnosis, a physical examination of the patient is usually done, as well as an ultrasound examination of the heart (echocardiogram).

Experts recommend taking a chest x-ray if symptoms appear. When determining arrhythmia, an electrocardiogram is required. Currently, there are no genetic tests or tests aimed at detecting the presence of pathology based on blood tests.

Myxomatous degeneration therapy

Currently, there are no effective preventive drugs that can stop the development of this disease. If systolic murmurs and minimal changes in the structure of the heart are detected, a regular examination can be carried out without prescribing specific drug treatment.

In the later stages of the disease, specialists prescribe treatment aimed at reducing the manifestation of unwanted symptoms caused by hypertrophy and structural changes in the heart.

When heart failure occurs, the patient is prescribed additional medications that remove accumulated excess fluid from the human body, helping to maintain the efficiency of the heart muscle, antiarrhythmics that increase blood circulation.

A combination drug combination is often needed. This helps to maintain the quality of life. Treatment of myxomatous degeneration depends on the presence of concomitant diseases (especially from liver and kidney diseases) and individual intolerance to drugs.

Forecasting

Prediction of mitral valve myxomatous degeneration is associated with the stage of the disease at the time of diagnosis, including the rate of development of the disease. This pathology manifests itself in some patients of an early age, in some patients a rapid course of the disease is noted. Mostly, the development of myxomatous degeneration of the valve occurs very slowly and calmly, over several years, which is why some patients may be asymptomatic for a long period after the detection of systolic murmurs. With the development of heart failure, the average life expectancy with optimal treatment is 6-18 months.

Conducted research

This is a set of morphological changes occurring in the leaflets of the mitral valve. They correspond to the weakening of the connective tissue and are described by morphologists during examination of materials acquired during cardiac surgery (in people with mitral valve prolapse and severe, mitral hemodynamically significant regurgitation). In the early 1990s, Japanese authors generated echocardiographic indicators of myxomatous degeneration, the specificity and sensitivity of which is approximately 75 percent.

They include thickening of the sash over 4 mm and reduced echogenicity. The identification of patients with myxomatous degeneration of the leaflets is very important, since all complications from mitral valve prolapse (strokes, bacterial endocarditis, severe valve insufficiency requiring surgical treatment or sudden death) in 95-100 percent of situations were observed in the presence of myxomatous degeneration.

Some experts believe that such patients should undergo antibiotic prophylaxis for bacterial endocarditis (for example, when removing teeth).

Mitral valve prolapse together with myxomatous degeneration is also considered to be the cause of stroke in young patients with the absence of generally established risk factors for stroke development (primarily arterial hypertension).

The frequency of transient ischemic attacks and ischemic strokes in people under the age of 40 was studied on the basis of archival data from 4 metropolitan hospitals over a five-year period. The volume of such conditions in people under the age of 40 was equal to about 1.4%. Hypertensive disease (20% of situations) should be attributed to the causes of strokes in young patients, but 2/3 of young patients did not have any established risk factors for the development of ischemic damage in the brain.

Some of these patients underwent echocardiography, and in 93 percent of situations, mitral valve prolapse was found together with myxomatous leaflet degeneration.

Myxomatically modified leaflets in the mitral valve can become the basis for the development of macro and microthrombi, so the loss of the endothelial layer with the appearance of small ulcerations due to increased mechanical stress is associated with the deposition of platelets and fibrin on them. As a result, strokes in these people have a thromboembolic origin. Therefore, for people with myxomatous degeneration and mitral valve prolapse, some experts recommend taking small doses of acetylsalicylic acid every day.

Kazan State

University of Technology

abstract

"Myxomatosis of the mitral valve"

Completed:

student gr. 41-91-42

Khismiev Rishat

Checked:

senior Lecturer

Khusnutdinova R.G.

Kazan 2009

myxomatosis mitral valve

1. Foreword

2. Etiology and pathogenesis

3. Classification

4. Clinical picture

5. Treatment

6. Prevention

7. Forecast

References

1. Foreword

Mitral valve prolapse is the deflection of one or both leaflets of the mitral valve into the left atrial cavity during left ventricular systole. This is one of the most common forms of dysfunction of the valve apparatus of the heart. Mitral valve prolapse may be accompanied by prolapse of other valves or be combined with other minor anomalies in the development of the heart.

2. Etiology and pathogenesis

By origin, primary (idiopathic) and secondary mitral valve prolapse are distinguished. Primary mitral valve prolapse is associated with connective tissue dysplasia, which is also manifested by other microanomalies of the structure of the valve apparatus (changes in the structure of the valve and papillary muscles, impaired distribution, improper attachment, shortening or lengthening of chords, the appearance of additional chords, etc.). Connective tissue dysplasia is formed under the influence of various pathological factors affecting the fetus during its intrauterine development (gestosis, ARVI and occupational hazards in the mother, unfavorable environmental conditions, etc.). In 10-20% of cases of mitral valve prolapse is inherited maternally. At the same time, in 1/3 of families of probands, relatives with signs of connective tissue dysplasia and / or psychosomatic diseases are identified. Dysplasia of connective tissue can also be manifested by myxomatous transformation of the valve leaflets associated with a hereditary disorder of the structure of collagen, especially type III. At the same time, due to the excessive accumulation of acidic mucopolysaccharides, the leaflet tissue (sometimes also of the valve ring and chordae) proliferates, which causes the prolapse effect.

Secondary mitral valve prolapse accompanies or complicates various diseases. With secondary prolapse of the mitral valve, as with primary, the initial inferiority of the connective tissue is of great importance. So, it often accompanies some hereditary syndromes (Marfan syndrome, Ehlers-Danlo-Chernogubov syndrome, congenital contracture arachnodactyly, osteogenesis imperfecta, elastic pseudoxanthoma), as well as congenital heart defects, rheumatism and other rheumatic diseases, non-rheumatic carditis, some forms of cardiomyopathy , syndrome of vegetative dystonia, endocrine pathology (hyperthyroidism), etc. Mitral valve prolapse can be a consequence of acquired myxomatosis, inflammatory damage to valve structures, impaired contractility of the myocardium and papillary muscles, valve-ventricular imbalance, asynchronous activity of various parts of the heart, which is often observed in congenital and acquired diseases of the latter. Dysfunction of the autonomic nervous system is undoubtedly involved in the formation of the clinical picture of mitral valve prolapse. In addition, metabolic disorders and micronutrient deficiencies, in particular magnesium ions, are important.

Structural and functional inferiority of the valvular apparatus of the heart leads to the fact that during the period of systole of the left ventricle, sagging of the leaflets of the mitral valve into the cavity of the left atrium occurs. When the free part of the valves prolapses, accompanied by their incomplete closure in systole, isolated mesosystolic clicks associated with excessive tension of the chords are recorded auscultatory. Loose contact of the valve leaflets or their divergence in systole determines the appearance of systolic murmur of varying intensity, indicating the development of mitral regurgitation. Changes in the subvalvular apparatus (lengthening of the chords, a decrease in the contractile ability of the papillary muscles) also create conditions for the onset or intensification of mitral regurgitation.

3. Classification

There is no generally accepted classification of mitral valve prolapse. In addition to differentiating mitral valve prolapse by origin (primary or secondary), it is customary to distinguish auscultatory and "mute" forms, indicate the localization of prolapse (anterior, posterior, both leaflets), the degree of its severity (I degree - from 3 to 6 mm, II degree - from 6 to 9 mm, III degree - more than 9 mm), time of onset in relation to systole (early, late, holosystolic), the presence and severity of mitral regurgitation. The state of the autonomic nervous system is also assessed, the type of mitral valve prolapse is determined, and possible complications and outcomes are taken into account.

4. Clinical picture

Mitral valve prolapse is characterized by a variety of symptoms, depending primarily on the severity of connective tissue dysplasia and autonomic shifts.

Complaints in children with mitral valve prolapse are very diverse: increased fatigue, headaches, dizziness, fainting, shortness of breath, pain in the heart, palpitations, a feeling of interruption in the work of the heart. Characterized by decreased physical performance, psychoemotional lability, increased excitability, irritability, anxiety, depressive and hypochondriac reactions.

In most cases, with mitral valve prolapse, various manifestations of connective tissue dysplasia are found: asthenic physique, high growth, reduced body weight, increased skin elasticity, poor muscular development, joint hypermobility, poor posture, scoliosis, chest deformity, pterygoid scapula, flat feet, myopia ... You can find hypertelorism of the eyes and nipples, a peculiar structure of the auricles, a Gothic palate, a sandal fissure and other small developmental anomalies. Visceral manifestations of connective tissue dysplasia include nephroptosis, anomalies in the structure of the gallbladder, etc.

Often, with mitral valve prolapse, changes in heart rate and blood pressure are observed, mainly due to hypersympathicotonia. The borders of the heart are usually not expanded. Auscultatory data are most informative: more often isolated clicks or their combination with late systolic murmur are heard, less often - isolated late systolic or holosystolic murmur. Clicks are recorded in the middle or end of systole, usually at the apex or at the fifth point of auscultation of the heart. They are not carried out outside the region of the heart and do not exceed tone II in volume, they can be transient or permanent, appear or increase in intensity in an upright position and during physical exertion. An isolated late systolic murmur (rough, "scraping") is heard at the apex of the heart (preferably in the position on the left side); it is carried out into the armpit and is strengthened in an upright position. Holosystolic murmur, reflecting the presence of mitral regurgitation, occupies the entire systole, is stable. In some patients, the "squeak" of chords is heard associated with vibration of the valve structures. In some cases (with a "silent" variant of mitral valve prolapse), auscultatory symptoms are absent. The symptomatology of secondary mitral valve prolapse is similar to that of the primary one and is combined with manifestations characteristic of a concomitant disease (Marfan syndrome, congenital heart defects, rheumatic heart disease, etc.). Mitral valve prolapse must be differentiated primarily from congenital or acquired mitral valve insufficiency, systolic murmurs caused by other variants of minor cardiac anomalies or dysfunction of the valve apparatus. The most informative is EchoCG, which contributes to the correct assessment of the revealed cardiac changes.

5. Treatment

Treatment for mitral valve prolapse depends on its shape, the severity of clinical symptoms, including the nature of cardiovascular and autonomic changes, as well as on the characteristics of the underlying disease.

With the "mute" form, treatment is limited to general measures aimed at normalizing the autonomic and psychoemotional status of children, without reducing physical activity.

With the auscultatory variant, children who tolerate physical activity satisfactorily and do not have noticeable abnormalities according to ECG data, can exercise in a general group... Exclude only exercises associated with sudden movements, running, jumping... In some cases, an exemption from participation in competitions is necessary.

When mitral regurgitation, pronounced violations of the processes of repolarization on the ECG, and distinct arrhythmias are detected, a significant limitation of physical activity with an individual selection of the exercise therapy complex is necessary.

In the treatment of children with mitral valve prolapse, the correction of autonomic disorders, both non-drug and drug, is of great importance. In violation of ventricular repolarization (according to ECG data), drugs are used that improve myocardial metabolism [potassium orotate, inosine (for example, riboxin), vitamins B5, B15, levocarnitine, etc.]. Drugs that correct magnesium metabolism are effective, in particular orotic acid, magnesium salt (magnerot). In some cases (with persistent tachycardia, frequent ventricular extrasystoles, the presence of an extended Q-T interval, persistent violations of the repolarization processes), the appointment of I-blockers (propranolol) is justified, if necessary, antiarrhythmic drugs of other classes. With pronounced changes in the valve apparatus, prophylactic courses of antibiotic therapy are indicated (especially in connection with surgical intervention) in order to prevent the development of infective endocarditis. Necessarily conservative or surgical treatment of foci of chronic infection.

With mitral insufficiency, accompanied by severe, resistant to treatment, cardiac decompensation, as well as with the addition of infective endocarditis and other serious complications (pronounced arrhythmias), it is possible to perform surgical correction of mitral valve prolapse (reconstructive surgery or mitral valve replacement).

6. Prevention

Prevention is mainly aimed at preventing the progression of existing valvular disease and the occurrence of complications. For this purpose, an individual selection of physical activity and the necessary therapeutic and recreational measures, adequate treatment of other existing pathologies (with secondary mitral valve prolapse) are carried out. Children with mitral valve prolapse are subject to dispensary observation with regular examination (ECG, EchoCG, etc.).

7. Forecast

The prognosis for mitral valve prolapse in children depends on its origin, the severity of morphological changes in the mitral valve, the degree of regurgitation, the presence or absence of complications. In childhood, mitral valve prolapse, as a rule, proceeds favorably. Complications of mitral valve prolapse in children are rare. The development of acute (due to chordal separation, with pulmonary venous hypertension) or chronic mitral insufficiency, infective endocarditis, severe arrhythmias, thromboembolism, sudden death syndrome, most often of an arrhythmogenic nature, is possible. The development of complications, the progression of valvular disorders and mitral regurgitation adversely affect the prognosis. Mitral valve prolapse that occurs in a child can lead to difficult-to-correct disorders in a more mature age. In this regard, we need timely diagnostics, accurate implementation of the necessary therapeutic and preventive measures in childhood.

References

1. Childhood diseases. A. A. Baranov // 2002.

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