Mitral insufficiency

The cause of mitral insufficiency (MI) is mitral regurgitation. náhled|Schéma mitrální regurgitace: červená šipka ukazuje směr toku krve v době, kdy má být mitrální chlopeň uzavřena The causes of MI include:


 * abnormalities of flaps (prolapse of mitral valve, infectious endocarditis),
 * abnormalities of mitral ring (dilation, calcification),
 * abnormalities of tendons (degeneration, ruptures),
 * abnormalities of papillary muscles (ruptures).

Mitral regurgitation is also accompanied by  mitral prolapse (can be inborne – Barlow syndrome, in Marfan syndrome, Ehlers-Danlos syndrome or acquired secondarily), the cause of acute insufficiency is usually a rupture of the papillary muscle in heart attack or valve damage infectious endocarditis.

Patophysiology of MI
náhled|Echo + doppler: mitrální regurgitace


 * LV pumps the blood to LA (regurgitation fraction), which decreases the systolic otput of the LV - LV must hypetrophy to stabilise (excentric hypertrophy) –systolic dysfunction occurs in LV and heart failure. As a result of pulmonary venostasis, exertional dyspnea to cardiac pulmonary edema occurs.

Diagnostics MI

 * 1) Physical findings:
 * 2) *dilation of a heart shadow (LV to the left, apex down and laterally),
 * 3) *congestion on the lungs (crackles),
 * 4) *auscultation: holosystolic murmur in apex with pormotion into the armpit, hearable on the left side, S3 gallop, gallopezosystolic click,
 * 5) *marks of the R heart failure: edema, elevated JVP, hepato- a splenomegaly, nocturia, flatulence, anorexia,ascites at a late stage,
 * 6) RTG – cardiomegaly,
 * 7) echocardiography – regurgitation from LV to LA in systole.

Therapy

 * Surgical:
 * effort to surgically save the valve– anuloplasty, valvuloplasty mitral valve,
 * valve replacement with preserved hanging apparatus,
 * every symptomaic patien is indicated to (if the ejection fraction doesn´t go below 30 %), we an only observe patients who:
 * have ejection fraction over 60 %,
 * don´t have dilation of the LA,
 * don´t have fibrilation of the LA,
 * don´t have pulmonary hypertension.


 * Drug therapy – prevention of injection endocarditis, therapy of the atrium fibrilation, therapy of he heart failure (ACEI, sartans, diuretics),
 * in acute MS is acute surgery indicated, nitrates, kardiotonics, IABP (intra-aortic balloon pump).

Video of mitral inssufficiencies
náhled|střed|upright=1.8|Video v angličtině, definice, patogeneze, příznaky, komplikace, léčba.

Auscultation
https://www.youtube.com/watch?v=9bjWdJ-dfg0