Mitral insufficiency

The cause of mitral insufficiency (MI) is mitral regurgitation.

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[edit | edit source]

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[edit | edit source]

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

Therapy[edit | edit source]

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).