Mitral valve, mitral valve stenosis

Mitral valve, mitral valve stenosis

Anatomical image of the heart suffering from heart disease and rheumatoid appear hallmarks of the disease (increased thickness of the mitral valve tendon, ligaments and muscle of left ventricular hypertrophy).
Coronary stenosis or valve Almtra

Coronary stenosis or mitral valvular heart disease characterized by shortness of mitral valve opening is located in the heart.
Overview of the diseaseWhen the natural physiological heart function, the mitral valve opens during left ventricular diastole, so as to allow the flow of blood from the left atrium to left ventricle. And that blood can flow in the right direction because during this phase of the cardiac cycle is the pressure in the left ventricle is less than the pressure in the left atrium, where blood flows under the influence of the difference barotrauma. In the case of coronary stenosis, mitral valve does not open fully. In order to transfer the same amount of blood, it needs the left atrium to the pressure of higher than normal to overcome the increasing difference barotrauma.
Causes of the diseaseBack most of the cases of shortness of mitral valve injury to heart one of the diseases caused by rheumatic fever, and the consequent injury status of rheumatic heart disease. There are - well - less common reasons leading to coronary stenosis include: balconies mitral valve calcification. Also, it causes a congenital heart disease in the incidence of shortness of mitral valve. However, there are major causes of coronary stenosis, including the presence of a crack in the mitral valve. Among other reasons that are attributable to infection shortness of mitral valve inflammation of the lining the heart (endocarditis) bacterial; as (vegetations) may increase the risk of shortness of the valve.
Physiology of the diseaseRange space for natural mitral valve opening between 4 and 6 cm 2. In natural conditions, does not hinder the mitral valve in the normal flow of blood from the left atrium into the left ventricle during ventricular diastole, and the pressure in each of the left atrium and left ventricle during ventricular diastole equal. As a result, the left ventricle fills with blood at the beginning of ventricular diastole, as well as additional small amount of pumping blood through the contraction of the left atrium (in what is known as the "heart payment") at the end of ventricular diastole.
When the minimum area of ​​mitral valve opening to less than 2 cm 2, this valve causing obstruction of blood flow to the left ventricle - which result in the presence of compressive forces across the mitral valve. This could increase the difference in the case of increasing heart rate or the rate of the heart to pump blood. It is worth mentioning that the greater the pressure difference across the mitral valve, increased with the amount of time required for filling the left ventricle with blood. Thus, the need to push the left ventricle of the heart atrium until it is filled with blood. Also, when your heart rate, less the time that the development of ventricular diastole until it is filled with blood (called the diastolic filling period). Hand, if the heart rate for a certain extent, be a period of diastolic filling is then sufficient to fill the ventricle with blood, and gradually increase the pressure in the left atrium; resulting in injury to pulmonary congestion.
If I said mitral valve opening area of ​​1 cm 2, there will be an increase in pressure Baloven the left (and this works the pressure to push blood through the valve infected upset). Since the diastolic pressure normal in the left ventricle is 5 mm Hg almost, the existence of a difference in pressure across the mitral valve - which is estimated at 20 mm Hg as a result of his extremely upset - would increase the pressure in the left atrium for up to 25 mm Hg almost. This pressure is transmitted in the left atrium, in turn, to the pulmonary vasculature, causing pulmonary hypertension. Then, it causes the blood pressure in the pulmonary capillaries at this level in the imbalance between the hydrostatic pressure and oncotic pressure, leading to leakage of blood outside the vascular tree and Ansbabh in the lungs (causing disease, congestive heart failure, which causes pulmonary edema).
The continued increase in pregnancy barotrauma Baloven the left to increase its size. The greater the size of the left atrium, it becomes more susceptible to disease atrial flutter. If the injury occurred Ppalartjav atrial already, it is not the time to do the work of the batch cardiac atrium (since it only occurs with the natural contraction of the atrium).
Dependent left ventricular filling in people who suffer from severe coronary stenosis on the installment by the heart atrium. Thus, it can cause lack of payment as a result of cardiac injury Ppalartjav fibrillation in a sharp decline in the rate of pumping blood to the heart, and thus risk a sudden congestive heart failure.
Patients who suffer from coronary stenosis to a series of dynamic changes in the blood, which causes many cases, the deterioration of clinical condition of the patient. The decline in the rate of the heart to pump blood - associated with increased heart rate and short duration of diastole, resulting in many cases of injury to congestive heart failure. In addition - and as soon as a case of atrial flutter - Bansmam systemic infection becomes a real threat to the patient.
Clinical examination of the patientIf the examination on the patient Baltsama tight mitral valve, the doctor finds that the first heart sound is abnormally high, and may even be felt with the hand test (where the pulse of the summit of a heart sound foveal) due to make a larger force to close the mitral valve. The first heart sound is the sound output from the closure of mitral and tricuspid valve. And closes the two valves simultaneously, called the voice of mitral valve M1, while the voice of the so-called tricuspid valve T1. Of course, the sound becomes higher in the case of M1 injury shortness of mitral valve.
If the pulmonary hypertension caused by severe coronary stenosis, the P2 or the component (pulmonary) of the second heart sound (S2) will prevail.
This may hear the sound (opening snap) is the voice of another high-issued after the sound component (aortic) (A2) of the second heart sound (S2), which is linked to the strong open coronary valve. The mitral valve opens when the pressure in the left atrium is higher than the pressure in the left ventricle. This occurs during ventricular diastole (after aortic valve closure), if the sharp decline in ventricular pressure. Associated with the pressure in the left atrium in people who suffer from shortness of mitral valve stenosis strongly. The more narrow the intensity, the higher the pressure in the left atrium, and thus open mitral valve during early ventricular diastole.
In the middle of extraversion, will hear the heart murmur - an abnormal sound comes from the heart - after the bombing of openness. The summit area attacks are the best places to hear this voice then, the sound does not spread to other places. Since it is a low-class voice, it should be captured by the bell with a rubber frame in the stethoscope. In order for the doctor hear the heart murmur, should wrap the patient's body to the left, and exercises Alaizumtria also help in highlighting this sound clearly. The doctor finds voice growl when he put his hand over the area of ​​the summit attack in the area in front of the heart.
The signs include virtual coronary stenosis as follows:

    Flushing (redness) and reap - The pulmonary hypertension of the most prominent hallmarks of patients with coronary stenosis
    Edema sacrum / ankles (edema) at the incidence of failure, the right side of the heart
    Atrial flutter - disorder in the heart and the loss of the wave 'a' in the jugular venous pressure
    Upheaval epimere shear left - in the presence of right ventricular hypertrophy due to high blood pressure, pulmonary
    Issued by the cardiac pulse Summit Enkeria voice, a voice does not move away from its original position
Changes that occur when the evolution of the infection status Ppalartjav fibrillation:
Heart rate ranges between 100 to 150 beats / minutes. A non-standard, patients are exposed to a situation of irregular heartbeats with a lack of pulse (difference between my speed pulse and heart) is greater than 10. Varying the intensity of the first heart sound. Not hear the bombing of openness in some cases. The absence of waves, "a" in the neck veins. Fade Puff Extraversion previous contraction. The possible emergence of other embolic phenomena.
DiagnosisIn most cases, the diagnosis of coronary stenosis easier using Echocardiography (ECHO-rays), which shows decreased opening balconies mitral valve and increase the speed of blood flow during diastole the heart muscle. The pressure difference across the mitral valve, which is measured by Doppler echocardiography is the gold standard in assessing the severity of coronary stenosis.
There is another way to measure the severity of coronary stenosis which is the introduction of a catheter in the left ventricle of the heart and another catheter in the right side of the heart at the same time. The catheter on the right side of the heart (known as the Swan Ganz catheter) explaining to the doctor the average pulmonary capillary wedge pressure, a reflection of blood pressure in the left atrium. On the other hand, the left ventricular catheter makes the doctor knows the blood pressure in the left ventricle. And when you know the measurements of the pressure in the same time, it becomes possible to determine the pressure difference between the left atrium and left ventricle during ventricular diastole, which is a sign of the severity of coronary stenosis. However, the use of this method in assessing the extent of stenosis coronary tend the results to exaggerate a little, and this because of the time delay in the registration lines pressure revealed by the catheter on the right side of the heart and slow downs (in the form of a letter Y) that appears in the registration lines wedge pressure . Although, if the puncture during catheter through the barrier on the right side of the heart, can measure the severity of coronary stenosis accurately by calculating the difference in pressure between the right and the left ventricle.
The natural history of diseaseThe natural history of disease, coronary stenosis resulting from rheumatic fever (the most common cause of the disease) that this disease is asymptomatic phase latent track the initial phase of rheumatic fever. The average latent period was 5.2 ± 16.3 years. And when it began to show symptoms of coronary stenosis, the evolution of the situation in the direction of incidence of severe disability needs to be a period ranging between 4.3 ± 9.2 years.
For patients with tight mitral who refuse surgery mitral valve despite the advice of doctors have made, the rates of survival with the assistance of medical treatment alone is% 6 ± 44 in a period of five years and% 8 ± 32 in a period of ten years after the proposal surgery debug them.
Methods of TreatmentTreatment options include mitral valve to the lack of medical treatment and surgical valve replacement and coronary coronary balloon valvuloplasty through the skin.
Usually develops disease, narrow mitral valve slowly (over decades), starting with the appearance of initial signs of tight mitral valve and even the symptoms of functional classification of the Association of attacks in New York for people with heart disease (a category that is indicated for short letters NYHA) Class II, then infections Ppalartjav fibrillation followed by the emergence of symptoms classified NYHA functional class III or IV. And when it began to show symptoms classified NYHA class III or IV on the patient, increases the speed of disease progression and with the patient's condition deteriorate.
The arrival of the condition to the third or fourth category determined by the NYHA functional classification requires the use of treatment Albada (surgical intervention), which is the replacement of mitral valvuloplasty or another.
Another option for treatment, a balloon expansionTo identify patients who may benefit from coronary balloon valvuloplasty through the skin, has been developing a system assessment to determine the degree of it. The system is based on four criteria to be determined by echocardiography (ECHO-ray), namely: the movement of the valve and balconies balconies thickness and the thickness of an area under the mitral valve and the degree of calcification. And the patient who gets in this evaluation of eight degrees or more the result of this intervention is not good for him. And the results are fantastic with a few surgical mitral valve in the case of persons with bombed openness and clear voice, to be the result of the assessment were less than 8 degrees with the lack of calcium in the arterial links.

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