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Clinical manifestations of mitral stenosis
Acute rheumatic fever usually has no symptoms (average 10 ~ 20 years) from the initial onset to MS symptoms. During this period, the patient feels good. At first, there was little or no pressure difference at rest, but with the increase of cardiac output, the left atrial pressure increased and fatigue dyspnea appeared. With the aggravation of mitral valve obstruction, patients engaged in lighter work will have difficulty breathing. The process of losing the ability to work is very long, and patients can gradually adapt by limiting their lifestyle.
Director Liu of Tianjin Outpatient Department introduced that with the aggravation of obstruction, when the patient was in supine position, sitting breathing and paroxysmal nocturnal breathing difficulties occurred due to the redistribution of blood to the chest. In patients with severe MS and increased pulmonary vascular resistance, fatigue rather than dyspnea may be the main symptom. Postural edema, nausea, anorexia and upper right body pain reflect systemic venous congestion caused by elevated systemic venous pressure and water and sodium retention.
MS patients often complain of palpitation, which is caused by frequent atrial premature beats or paroxysmal atrial fibrillation and atrial flutter. More than 50% patients with severe MS have persistent atrial fibrillation. In some MS patients, paroxysmal atrial fibrillation can lead to pulmonary edema. The shortening of diastolic interval and the loss of atrial transport function caused by the increase of heart rate can lead to the increase of acute left atrial pressure and pulmonary edema.
Systematic embolism is a common complication of MS, which can lead to stroke, arterial occlusion of limbs, arterial bifurcation occlusion and visceral or myocardial infarction. The left atrium of patients with atrial fibrillation increases with age, and the history of embolism is often accompanied by an increase in the incidence of systemic embolism.
There are many reasons for hemoptysis. Usually caused by elevated pulmonary vein pressure. Paroxysmal nocturnal dyspnea may be accompanied by blood in sputum; Pink foam-like sputum may be caused by pulmonary infarction with acute pulmonary edema or pulmonary embolism caused by alveolar capillary rupture, or severe hemoptysis (pulmonary hemorrhage). The latter is caused by the rupture of thin-walled dilated bronchial veins. Although it is usually not fatal, it may be life-threatening due to aspiration pneumonia or massive bleeding. Bronchial mucosal edema is more likely to be complicated with chronic bronchitis, especially in cold and humid climate, and it can also bring blood in sputum. In some severe MS patients, chronic stable chest pain and typical angina pectoris may occur even if the coronary artery is normal. Severe pulmonary hypertension is the basic condition leading to this symptom. Infectious endocarditis is not common in patients with simple MS.
Generally speaking, the progress of MS symptoms is slow and persistent. Therefore, sudden changes in symptoms rarely reflect changes in valve obstruction, usually due to sudden non-cardiac events or paroxysmal atrial fibrillation. Fever, pregnancy, hyperthyroidism and non-cardiac surgery can increase the cardiac output of patients with moderate and severe MS and promote decompensation.
In patients with fatigue dyspnea and fatigue, the valve orifice area has usually been reduced to 1/3 ~ 1/2 of the normal area. When the valve orifice area is further reduced, the blood flow is obviously blocked, even in the slightest activity, symptoms will appear. The time interval from the initial mild symptoms to disability may be 10 years. In the meantime, the patient is in danger of death. Persistent injury will produce atrial fibrillation and rapid ventricular rate, leading to pulmonary edema and systemic embolism. Unfortunately, it is impossible to predict who is at risk of embolism. When the symptoms of cardiac function grade ⅱ or ⅲ appear in the late stage, the valve orifice area often
Mitral regurgitation
Director Liu of Tianjin Clinic said that simple rheumatic mitral stenosis is rare, and in most cases it is combined with stenosis and junction. Severe rheumatic MR requiring surgical correction is common in developing countries, but rare in developed countries. The basic lesion is the retraction of lobules and chordae tendineae fibers, which leads to poor lobule closure. Secondary mitral annulus dilatation reduces interlobular contraction. Tendon elongation or rupture is rare.
The common causes of chronic mitral regurgitation are ischemic heart disease and valve mucinous degeneration, which leads to valve prolapse, chordae tendineae rupture or some flail-like changes. Patients with chronic severe degenerative MR and symptoms of heart failure and/or left ventricular dysfunction undoubtedly need mitral valve repair or replacement. However, the surgical indications for asymptomatic patients, especially those with normal left ventricular function, are still controversial, especially according to the data of structural and biochemical abnormalities of the valve itself, which improves the durability and life of valve repair. In addition, it is uncertain whether vasodilation therapy can avoid or delay the operation time of asymptomatic chronic mitral stenosis patients. It is a complex and controversial issue how to determine the best operation time to avoid the irreversible stage of left ventricular dysfunction.
Degenerative mitral regurgitation. Calcification of mitral annulus is very common in autopsy, especially in the elderly. Hypertension, aortic stenosis and diabetes will accelerate the calcification process. Connective tissue diseases are also related to it. There are usually no functional consequences; However, it may be a factor leading to severe MR. In some serious cases, the blood flow obstruction caused by it requires surgical treatment.
Degenerative MR is usually associated with valve prolapse. Valve prolapse is caused by improper chordae tendineae support (stretching or rupture) and long valve tissue, which leads to abnormal movement of valve leaflets and enters the left atrium during systole. In western countries, mitral valve prolapse is the most common cause of severe MR requiring surgery.
Ischemia and functional MR are caused by left ventricular wall dysfunction secondary to ischemia, scar, aneurysm, cardiomyopathy or myocarditis. The same mechanism of mitral regurgitation is incomplete closure of normal leaflets. However, regional left ventricular deformation is more likely to cause MR than systolic function.
Most patients need surgery, and the most common problem is the timing of surgery, which is influenced by the natural history of Mr. The results of surgical correction, Mr valve repair and/or valvuloplasty should be considered according to the different circumstances of each case.
Mitral valve repair and elimination of atrial fibrillation
The advantage of mitral valve repair is to avoid long-term use of anticoagulants, and the most important thing is to maintain the continuity between mitral annulus and papillary muscle. The continuity between mitral annulus and papillary muscle is helpful to maintain normal left ventricular geometry and systolic function. After mitral valve surgery, the ejection fraction remained stable or improved, while the destroyed ejection fraction decreased 10% on average. The average mortality of mitral valve repair is 1%-2%, and that of valve replacement is 5%- 10%. Age and coronary artery disease are important indicators of survival rate. According to the data published in recent 5 ~ 10 years, the reoperation rate of mitral valve repair is low because of MR recurrence, and the survival rate is 80% ~ 90%. However, due to the abnormal structure of the valve itself and the data of valve repair, the durability of successful mitral valve structure reconstruction in degenerative mitral valve disease is not constant. In asymptomatic patients, this problem should be considered in early valve repair.
Director Liu of Tianjin outpatient department said that unless the duration of atrial fibrillation before operation is short, postoperative atrial fibrillation will often persist. Although anticoagulant therapy is needed, the additional risk of this arrhythmia is not great. At present, for patients with MR complicated with atrial fibrillation, some hospitals now advocate the use of atrial parallel procedures to restore sinus rhythm and prevent the recurrence of atrial fibrillation. After mitral valve replacement, there is no difference in the risk of long-term thromboembolism compared with other mitral valve diseases. The risk of thrombosis is different between valve repair and replacement, but the estimated results are different, and the risk of valve repair seems to be smaller. In addition, after valve repair, if atrial fibrillation persists, it is suggested to treat it with Chinese medicine honey in Tianjin Xinyue Clinic, which has a high inhibition rate on atrial fibrillation.
Causes and symptoms of mitral valve prolapse
Mitral valve prolapse refers to the separation of one or two mitral valves from the left atrium during systole, with or without reflux. Clinically, mitral valve prolapse generally has no or only mild reflux. Compared with MR caused by other reasons, MR caused by mitral valve prolapse has unique clinical characteristics.
In primary mitral valve prolapse, because the rough and smooth parts of the involved leaflets are long, the height of intertendinous prolapse usually exceeds 4mm, involving at least the anterior lobe 1/2 or the posterior lobe 2/3.
Mitral valve prolapse can be seen in patients with hypertrophic cardiomyopathy, which is caused by asymmetric contraction of left ventricular cavity, change of papillary muscle position or both. Mitral valve leaflets are generally normal, but occasionally pathological changes of primary mitral valve prolapse can be seen. In some patients, the whole left ventricular function is sometimes reduced due to segmental motion disorder of left ventricular wall, and there can also be evidence of mitral valve prolapse and mitral regurgitation on echocardiography and auscultation, so non-hypertrophic cardiomyopathy is also listed as one of the causes of mitral valve prolapse.
40% patients with mitral valve prolapse can have tricuspid valve prolapse, and tricuspid valve prolapse will also have similar changes, such as chordae tendineae prolapse, mucopolysaccharide proliferation and collagen dissolution. 10% patients with mitral valve prolapse will have pulmonary valve prolapse and 2% patients will have aortic valve prolapse. Sternal anomalies are often found earlier than mitral valve prolapse. The incidence of secondary atrial septal defect (but not atrial septal tumor) in patients with mitral valve prolapse increased, and the incidence of mitral valve prolapse in patients with atrial septal defect increased. This phenomenon is not accidental, nor can it be explained only by the traction of patent foramen ovale. The incidence of left atrial ventricular passage and supraventricular tachycardia in patients with mitral valve prolapse also increased.
Director Liu of Tianjin Clinic said that the most common complaint of patients with mitral valve prolapse is palpitation, which is mainly caused by ventricular premature beats, but supraventricular tachycardia is also very common. The most common persistent supraventricular tachycardia is paroxysmal reentrant supraventricular tachycardia (see Chapter 28). Some patients may have ventricular tachycardia while others may have symptomatic bradycardia. Patients often complain of palpitation, but continuous ECG monitoring can not record any arrhythmia.
Patients with mitral valve prolapse often complain of chest pain. Most patients are not accompanied by ischemic heart disease, so the pain is atypical (it can occur during rest or activity, which is sharp and unsustainable pain), and there are few typical angina pectoris pains. Some patients have recurrent pain, which may be unbearable. The cause of the pain is unknown. In rare cases, it may be that the prolapsed mitral valve leaves make the papillary muscle and the left ventricular wall supporting it abnormal, leading to real myocardial ischemia. It has been reported that patients with mitral valve prolapse have coronary artery spasm, but this does not seem to be the cause of most atypical chest pain attacks, because st segment elevation is very small.
Patients with mitral valve prolapse, including many patients without severe mitral regurgitation, usually have symptoms of shortness of breath and fatigue. In the exercise test, the exercise endurance generally does not decrease, and some patients may have obvious hyperventilation. Some patients have neuropsychological complaints, some patients have panic symptoms and some patients have manic-depressive syndrome. The incidence of transient cerebral ischemia in patients with mitral valve prolapse is also increasing, and some patients may also develop stroke syndrome. A study shows that there is no correlation between mitral valve prolapse and stroke. Transient amaurosis, contralateral isotropic visual field loss and retinal artery embolism have been reported. Occasionally, the eyesight fails to recover. These diseases may be caused by the formation of emboli, platelets and cellulose deposits on the atrial side of mitral valve. It is worth noting that mitral valve prolapse and acute anxiety attacks are more common.
Director Liu of Tianjin Clinic introduced that patients with severe mitral regurgitation accompanied by symptoms and/or left ventricular systolic dysfunction should undergo cardiac catheterization to determine whether mitral valve surgery is needed. Thickened and redundant mitral valve can be repaired by surgery without replacement, with low mortality and good long-term prognosis. Follow-up showed that the incidence of prosthetic valve, thrombosis and endocarditis was lower than that of artificial valve.
Mitral valve repair and Chinese medicine self-healing repair
The treatment of patients with mitral valve prolapse may require valve surgery, especially when the chordae tendineae is broken or too long to form flail mitral leaflets. Most of these mitral leaflets can be successfully repaired by experienced surgeons, especially when the injury mainly involves the posterior leaflet.
Director Liu of Tianjin Clinic introduced that the surgical indications of patients with mitral valve prolapse and mitral regurgitation are the same as those of other patients with non-ischemic severe mitral regurgitation, including symptoms of grade II-IV, left ventricular ejection fraction < 60%, and/or left ventricular end-diastolic and end-systolic volume increased significantly. If surgical repair of mitral valve is expected to be successful, severe mitral regurgitation with mild symptoms or atrial fibrillation can also be considered.
Symptoms of heart failure, severity of mitral regurgitation, atrial fibrillation, left ventricular systolic function, left ventricular end-diastolic and end-systolic volume, and pulmonary artery pressure (during rest and activity) are all influencing factors in choosing surgical treatment. If you can't have surgery or don't consider surgery, you can choose the traditional Chinese medicine "self-healing repair" in Tianjin Xinyue Clinic.
Many people have had pets such as cats and dogs. When these animals are sick, they will lie there without eating or drinking. In fact, they are on a diet to treat themselves. There is a simple reason. Dieting is to reduce physical strength, because the body needs to consume its own physical strength when digesting food, and dieting can reduce physical consumption and treat diseases with limited physical strength. This is how animals treat themselves with self-healing power. In fact, people are born with this ability. When we are sick, we all feel that we don't want to eat, which is to treat ourselves with our self-healing power. Therefore, when encountering minor problems such as a cold and fever, try to eat less and drink more water and juice, which will help speed up the recovery of the body. Self-healing power is both innate and excitable. Reasonable compatibility of traditional Chinese medicine prescriptions can stimulate the self-healing ability of human body.
According to the German health magazine Vitality, researchers found that the human body has the ability to cure 60% to 70% of discomfort and diseases. It is said that scientists have solved some secrets of body self-healing at present. When people are unwell or sick, the body can find some "internal medicine" from its own "medicine field" to treat symptoms. The series of prescriptions for valvular heart disease in Tianjin Xinyue Clinic play a role by regulating the self-healing system of human body as a whole.
Director Liu of Tianjin Clinic introduced that the huge self-healing system in our body is related to the circulatory system, stress system, immune system and the function of bone marrow hematopoietic stem cells. Most people living in modern civilization have become accustomed to seeking medical advice to resist diseases, often ignoring the strength of the human body itself. In fact, the traditional Chinese medicine treatment of mitral valve disease is to adopt scientifically compatible Chinese medicine prescriptions, actively use the self-healing ability of the human body, eliminate the pathogenic factors in the body through the adjustment of the human body itself, partially repair the damaged mitral valve, and restore the patients with mitral valve disease to health. This method is called "self-healing repair" in Chinese medicine.
The ancient Greek doctor Hippocrates once said, "The best doctor for a patient is himself." This is to emphasize the power of self-healing. To some extent, Chinese medicine also stimulates and supports the self-healing ability of human body through drugs. Liu, director of Tianjin Clinic, said that Chinese medicine has the theory of "three-point treatment and seven-point support", and the treatment should rely on internal forces as much as possible. But it should be noted that self-healing is the premise. According to the differences of age, constitution, family history and immunity, consult relevant doctors for guidance and help when necessary.