Mitral valve insufficiency – causes, symptoms & therapy

One speaks of “mitral valve insufficiency” when the heart valve between the left atrium and the left ventricle no longer closes properly. Normally, the oxygenated blood is pumped from the lungs to the left ventricle via the left atrium. The heart valve between the atrium and the ventricle, the mitral valve, then closes again in order to pump blood from the ventricle through the aorta into the body. When the mitral valve does not close properly, blood flows back into the atria, resulting in a permanently increased volume of blood that increases the workload on the heart.

causes

Inherited mitral valve regurgitation is rare. One of the main causes is rheumatic fever caused by streptococcal infection of the upper respiratory tract. In most cases, mitral valve insufficiency does not appear until old age due to wear and/or calcification of the mitral valve.Rarer causes are Marfan syndrome, a genetic connective tissue disease, or Ehlers-Danlos syndrome, a connective tissue disorder in which collagen synthesis is disrupted, which means that the skin can then be easily overstretched or injured, and organs and skin can become damaged as a result Vessels can rupture.

The cause can also be a heart attack in the case of an underlying coronary disease or an inflammation of the heart valves ( endocarditis ). If the causes are not treated or not treated in time, the heart muscle can be damaged due to constant overload.

symptoms and course

Typical symptoms of mitral valve insufficiency:

• tachycardia

• shortness of breath

• Cough

• exhaustion

Mitral valve insufficiency can go a long time without symptoms. It can first become noticeable through severe heart palpitations in the left lateral position. In the advanced stage there are more severe symptoms, initially shortness of breath during physical exertion, later also at rest and at night. Nocturnal coughing attacks can occur because the heart is overwhelmed with the increased blood volume.

This backs up to the lungs and is pressed against the air-filled area of ​​the lungs, triggering fits of coughing. Persistent overload can lead to cardiac arrhythmia with atrial fibrillation in the left atrium. This weakens the heart and increases the risk of blood clots forming if blood pools in the atria for too long. If these become loose and get into the bloodstream, they can clog small blood vessels and e.g. B. cause a stroke in a brain vessel. Symptoms of progressive mitral valve insufficiency can include a general feeling of weakness and fluid retention in the lungs.

Diagnose

The doctor can usually hear the characteristic sounds of mitral valve insufficiency with a stethoscope. However, an EKG is usually also carried out. The next step is an echocardiography , an ultrasound examination of the heart (usually with Doppler ultrasound) carried out in order to be able to better assess the non-closing heart valve and the blood volume flowing back. This method can also be used to detect blood clots that have already formed.

An X-ray of the upper body can also provide information as to whether the left atrium and left ventricle are enlarged. This recording also shows whether changes have already occurred in the pulmonary vessels due to the backlog of blood.

treatment and therapy

A mild mitral valve insufficiency does not necessarily have to be treated, but moderate to severe forms must be treated in any case. In moderate forms, 3 types of medication are mainly used: ACE inhibitors are prescribed to reduce the vascular resistance in the body and thus facilitate blood transport to the aorta. They inhibit the hormones that promote vasoconstriction.

Diuretic drugs ensure that excess water that has accumulated in the tissue is excreted again, so that the volume of fluid in the vessels is reduced and the heart is relieved. Cardiac glycosides strengthen the heart muscle for better pumping capacity of the heart. In addition, platelet aggression inhibitors such as For example, aspirin may be prescribed to prevent blood from clotting in atrial fibrillation and thereby reduce the risk of blood clots.

Anticoagulants such as heparin also prevent blood from clotting by blocking vitamin K , which is necessary for blood clotting and thus prevent blood from clotting. People who suffer from mitral valve insufficiency must take an antibiotic to prevent the risk of bacterial infections in the previously damaged heart valve before medical or dental procedures .Severe mitral valve regurgitation often requires surgical intervention. In Germany, mitral valve reconstruction is used most frequently. If this is no longer possible, e.g. B. because the heart valve is heavily calcified, it must be replaced by a valve prosthesis made of synthetic or biological material.

prevention

Since bacterial infections can also damage the heart valves of healthy people, it is important to treat these infections conscientiously. People with heart valve defects should be under regular medical supervision to determine when surgery is indicated. If the heart is weakened by the valve defect, this damage is permanent and also increases the risk of surgery.