The mitral valve separates between the left atrium and ventricle. It consists of 2 cusps anchored by papillary muscles and chordae tendinae.<\/p>\n\n\n\n
The diseases progress slowly, with symptoms appearing relatively late without correlation to the severity.<\/p>\n\n\n\n
Mitral stenosis<\/h3>\n<\/span>\n\n\n
During mitral stenosis, the leaflets of the mitral valve fail to open completely, decreasing blood flow capacity. The cusps are hardened, commissures are fused and the orifice is narrowed.<\/p>\n\n\n\n
Most commonly caused due to rheumatic fever<\/strong>. Other causes include calcification (rare, seen in older patients), and radiation therapy.<\/li>
F>M<\/li>
Mitral stenosis increases left atrial pressure leading to its enlargement, followed by AF, pulmonary HTN and edema, and eventually right heart failure<\/strong>.<\/li><\/ul>\n\n\n<\/span>\n
Rheumatic fever<\/h4>\n<\/span>\n\n\n
Rheumatic fever (RF) occurs after group A streptococcal infection, due to immune activity against M protein and molecular mimicry, leading to arthritis, cardiac and valvular disease, glomerulonephritis, skin, and neurologic disorders.<\/p>\n\n\n\n
The mitral valve is affected in most cases, resulting in either stenosis or regurgitation.<\/li>
The cardiac manifestations are evident many years after the episode of the RF.<\/li>
Diagnosis based on serology along with Jones criteria<\/strong> (presence of 2 out of 5 specific symptoms).<\/li><\/ul>\n\n\n<\/span>\n
Diagnosis<\/h4>\n<\/span>\n\n\n
Physical examination<\/strong>. During auscultation, diastolic murmur can be heard (S2-S1).
Opening snap after S2, during early diastole<\/li>
Low-pitched mid-diastolic murmur, loudest at the apex<\/li>
Loud S1<\/li><\/ul><\/li>
ECG<\/strong>. In late mitral stenosis, P-mitrale (prolonged P-wave) due to LA enlargement.<\/li>
Cardiac catheterization<\/li>
Echocardiography<\/li><\/ul>\n\n\n<\/span>\n
Treatment<\/h4>\n<\/span>\n\n\n
Mitral valve repair or replacement in severe cases
During mitral regurgitation (mitral insufficiency) the leaflets of the mitral valve fail to close fully, allowing backflow of blood back into the left atrium during ventricular systole.<\/p>\n\n\n\n
Mitral regurgitation is the most common valvulopathy.<\/li>
The most common cause is myxematous degeneration<\/strong> (mitral prolapse).<\/li>
Based on the etiology and duration, it can be acute<\/strong> or chronic<\/strong>, and primary<\/strong> or secondary<\/strong>.<\/li>
In acute MR, the symptoms are rapid, and are similar to those of acute heart failure and cardiogenic shock.<\/li>
MR causes volume overload in the LA and LV leading to their dilation (eccentric hypertrophy), and may eventually lead to LV heart failure<\/strong>. Other consequences include AF and infective endocarditis.<\/li><\/ul>\n\n\n<\/span>\n
Etiology<\/h4>\n<\/span>\n\n\n
Myxematous degeneration.<\/strong> A disorder of the connective tissue of the mitral valve that leads to mitral valve prolapse<\/strong>.
The most common cause of mitral regurgitation.<\/li>
One or both cusps become “floppy” and prolapse into the left atrium at every ventricular systole.<\/li><\/ul>
A characteristic mid-systolic “click” can be heard due to the prolapse.<\/li>
In case of standing (or Valsava maneuver), the click “shift” closer to S1, and during squatting it shifts closer to S2; this is due to changes in the venous return and venticular filling.<\/li>
The click can be confused with congenital aortic stenosis; however, it lacks the characteristing “shifting” described above.<\/li><\/ul><\/li>
Papillary muscle\/chordae tendinae rupture.<\/strong> In case of infective endocarditis, or MI leadding to papillary muscle necrosis. <\/li>
Rheumatic fever<\/strong> (explained above)<\/li>
Left ventricular enlargement<\/strong>. Due to aortic stenosis, myocarditis, ischemia, or dilated cardiomyopathy. The cusps separate from one another, increasing the diameter of the orifice.<\/li>
Failure of a prosthetic valve<\/strong><\/li><\/ul>\n\n\n<\/span>\n
Diagnosis<\/h4>\n<\/span>\n\n\n
Physical examination<\/strong>. During auscultation, a holosystolic<\/strong> (pansystolic) murmur can be heard (S1-S2).<\/li>
ECG (may display LV and LA dilation, ischemia, AF)<\/li>
Echocardiography<\/li>
Cardiac catheterization<\/li>
Stress-testing<\/li><\/ul>\n\n\n<\/span>\n
Treatment<\/h4>\n<\/span>\n\n\n
Mitral valve repair or replacement for severe cases
Mitral valve clipping<\/li>
Biosynthetic valve replacement<\/li><\/ul><\/li>
ACEi\/ARBs, BB ,CCB, and diuretics in HF<\/li>
Anticoagulants in AF<\/li><\/ul>\n\n\n\n<\/figure>\n<\/span>
The mitral valve separates between the left atrium and ventricle. It consists of 2 cusps anchored by papillary muscles and chordae tendinae. The diseases progress slowly, with symptoms appearing relatively late without correlation to the severity. Mitral stenosis During mitral stenosis, the leaflets of the mitral valve fail to open completely, decreasing blood flow capacity. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9513","page","type-page","status-publish","hentry"],"yoast_head":"\n
![\"HEART](\"https:\/\/okean.rs\/wp-content\/uploads\/2019\/05\/Screenshot-2019-05-05-at-10.12.19.png\")
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