Symptoms of mitral valve prolapse

In most patients, the symptoms of mitral valve prolapse are absent, are asymptomatic. In the presence of complaints, the clinical picture of uncomplicated mitral valve prolapse is determined by symptoms of dysfunction of the autonomic nervous system accompanying syndromes of connective tissue dysplasia, cardialgia, palpitation, increased fatigue, weakness, orthostatic hypotension, syncopal and presyncopal condition, inadequate inspiration, panic attacks, neuropsychological syndromes (depression, mood imbalance, anxiety, etc.).

[1], [2], [3], [4], [5], [6]

Frequent symptoms of mitral valve prolapse

Among the numerous symptoms of mitral valve prolapse, mitral regurgitation occupies a special place, since it determines the severity of the course of the disease. In most cases, the severity of mitral regurgitation is mild or moderate, but severe pathology develops in 8-10% of men and in 4-5% of women with PMP. It is believed that the degree and rate of progression of mitral regurgitation are more pronounced with the prolapse of the posterior sash of the mitral valve. The incidence of severe mitral regurgitation increases with age, regardless of sex. The first symptoms of congestive heart failure occur on average 15-16 years from the onset of mitral regurgitation in patients with a prolapse of> 10 mm and severe regurgitation.

Due to the rupture of altered tendon chords, acute mitral regurgitation may develop with the formation of acute left ventricular failure. The auscultatory pattern is determined by the appearance of intense hysterostolic noise (may be accompanied by "squeak chords"). In connection with the eccentric arrangement of the regurgitation jet. Deflected by an unattached segment of the valve "with a ruptured chord of the posterior wing, systolic murmur is carried to the aortic zone and to the vessels of the neck, and when the anterior rupture is applied to the axillary region and back. Rupture of chords is more common in patients with prolapse of the posterior sash of the mitral valve.

Symptoms of complications of mitral valve prolapse

In the development of mitral valve prolapse complications, myxomatous degeneration of the valves is essential. Thickening of the valve> 5 mm appears to be a predictor of the development of complications such as sudden death, rhythm disturbances, infective endocarditis, thromboembolism in the vessels of the brain.

The characteristic clinical symptoms of complicated mitral valve prolapse are paroxysmal rhythm disturbances. The most common supraventricular and ventricular extrasystole, paroxysmal supraventricular tachyarrhythmias, unstable and sustained ventricular tachycardia. Factors contributing to the development of rhythm disturbances include excessive tension of the valves, tendon chords and papillary muscles during prolapse; dilation of the left atrium and / or left ventricle; fibrotic changes in papillary muscles, myocardium of the left atrium and left ventricle; dysplasia of the coronary artery, blood supplying the atrioventricular (AV) node, prolongation of the QT interval, the presence of AV shunt tracts. A major role in the origin of arrhythmias in young people is played by the imbalance of the autonomic nervous system with the predominance of sympathicotonia, which contributes to the occurrence of electrical instability of the myocardium.

In patients with PMP, thromboembolic complications can occur with damage to the vessels of the brain and retina. As possible pathophysiological factors conducive to their development, a violation of the integrity of the endocardium in the zones of myxomatous transformation with the formation of parietal thrombi and subsequent embolization, as well as paroxysmal supraventricular tachyarrhythmias are considered.

One of the complications of prolapse of the mitral valve is infective endocarditis. Its development is promoted by mitral regurgitation and the presence of thickened myxomatally altered valves in bacteremia.

One of the terrible but rare complications of mitral valve prolapse is the sudden death of arrhythmic genesis, registered in 2% of cases, the annual mortality rate is 0.5-1%. In the recommendations of the European Society of Cardiology on the prevention of sudden death (2001), the risk factors for the development of sudden cardiac death of arrhythmic genesis in PMC are:

• episodes of cardiac arrest or ventricular tachycardia in the anamnesis;
• myxomatous changes and redundance of the mitral valve flaps;
• sudden cardiac death of arrhythmic genesis in a family history;
• lengthening the QT interval or changing its variance;
• frequent and high-grade ventricular extrasystoles;
• severe mitral regurgitation.

Clinical observation

The patient S., 23, complained of aching pains in the region of the heart that were not associated with physical activity for up to 1 hour, stopped with sedation, palpitations, increased fatigue, arthralgias in the knee joints that occur in the afternoon, subsiding into mowing. These complaints have been troubling since the age of 20. It is observed out-patient with a diagnosis of "neurocirculatory asthenia."

At physical examination: asthenic physique, height 171 cm, weight 55 kg.

In the standing position, the curvature of the spine in the frontal plane is noticeable-the C-type deformation with the right-side arch in the thoracic region. The Adams test is positive. "Funnel" chest. Skin covers of normal color. The thickness of the skin fold above the outer ends of the clavicle is 4 cm. Hypermobility of the Joints in Beiton is 5 points. In the lungs - vesicular breathing, there is no rattling, Heart sounds are sonorous, the rhythm is correct. A systolic click and a short soft late systolic murmur without irradiation are heard above the tip. Heart rate - 72 per minute, blood pressure - 110/70 mm Hg, The abdomen is soft, painless, the liver and spleen are not enlarged. Stool and urination without features. Peripheral edema is absent.

The clinical blood test, hemoglobin - 128 g / l, leukocytes - 4,0х 10 ⁹ / l, the formula is not changed, ESR - 12 mm / m; urinalysis clinical - without pathology. In the immunological analysis of the blood: CRP - negative, ASL-O - 1: 200. Rheumatoid factor - negative.

With electrocardiography - the vertical position of the axis of the heart, rhythm sinus, single atrial extrasystoles, incomplete blockade of the right leg of the bundle. Heart rate - 78 per minute.

Holter daily monitoring: during the observation period, 54 atrial extrasystoles, 10 ventricular, QRST complex changes were not detected.

With DEHOKG: prolapse of the posterior sash of the mitral valve into the cavity of the left atrium - 7 mm, the thickness of the valve - 6 mm, mitral regurgitation I.

Given the presence of phenotypic markers of STD, a genetic study was conducted, during which the differentiated syndrome of STD is not confirmed.

[7], [8], [9]

Clinical diagnosis

Hypermobile syndrome: joint hypermobility (Beiton score - 5), arthralgia of the knee joints, FN 0; funnel-shaped chest; C-shaped right-sided thoracic scoliosis; hyper-stretchability of the skin; symptoms of prolapse of the mitral valve of the II degree (myxomatous degeneration - grade II), complicated by mitral regurgitation of mild degree. НК 0, ФК 0.

[10], [11]