In this chapter, we can not dwell on the genesis of the systolic noise in athletes. This matter is dealt fairly extensive literature.
Should focus only on one of the possible causes of systolic murmur at the apex, namely - the syndrome of mitral valve prolapse.
SPMK a retraction of one or both wings mitral valve into the cavity of the left atrium, which occurs at the left ventricular systole. This retraction creates the conditions for the occurrence of regurgitation (and hence the systolic murmur), the extent of which depends on the depth of retraction of the cusps. According to most authors Read more [...]
Patient M., 20, a soldier who went 10 / V 1977 , complaining of general weakness, unpleasant and inconsistent dull pain in the heart, pain in the knee and ankle joints.
20/IV 1977 was ill with acute epidemic angina (sore and the other soldiers of the unit), and 29 have appeared in large joints arthralgia, with 6 / V arthritis, ankle and knee joints, the body temperature rises above 38 ° C.
On admission objectively determined arthritis of knee and ankle joints, myocarditis, pulse 50 beats per minute, the heart sounds are muffled, clear systolic murmur at the apex in the left lateral position - Read more [...]
Patient P., aged 54, was admitted to the hospital 31 / I 1975 with complaints of shortness of breath with a little exertion, palpitations, fatigue, edema in the legs. Mitral heart disease diagnosed by age 22. Previous rheumatic fever does not remember, symptomatic recurrence of rheumatic fever was not. For many years there was a physician in the medical unit. In 1951, along with mitral identified aortic heart disease. Only in 1970 began to pay attention to the appearance of inadequate exercise dyspnea, and in the summer of 1972 - the occurrence of edema in the day. About the protracted return Read more [...]
Diagnosis and differential diagnosis. Diagnosis mitral stenosis in the early phases of its development is quite complex, especially as rheumatism often occurs in these patients without attacks. In severe cases, mitral stenosis, when there is an increase of the left atrium and right ventricle typical auscultatory findings, as well as the corresponding changes in the electrocardiogram, phonocardiogram, radiographs diagnosis mitral stenosis, no doubt.
Difficulties in diagnosis arise in differentiating current carditis with relative mitral stenosis Formed from blemish - venous stenosis of the left Read more [...]
Course and prognosis. There are different options for the development and course of evil. Pediatricians often watch such options stenosis, which is moderately expressed and well-compensated. Clinical signs of heart failure in these patients appear as an adult.
Some children with progressive course of rheumatic mitral stenosis is accompanied by a marked and early development of heart failure. If during this period the patient did not undergo surgery, it is usually a rapid increase in heart failure is fatal.
Unfavorable aspect in disease is the development of atrial fibrillation and thromboembolic Read more [...]
The clinical picture. Diagnosis of "pure" mitral stenosis in children, particularly in the early stages of its development, it is quite difficult. This is due to the fact that the formation of defect often occurs on the background of the current latent rheumatic process. Interpretation of clinical data is often quite difficult (AB Volovik, 1955, 3. J. Edelman, 1962 PG Kiss and D. Sutreli, 1962 W. Yonash, 1960 EN Maksakova etc. , 1967 T. P.Churakova, 3. A. Ta tochenko 1969 Makolkin VI, 1977).
However, early diagnosis of this defect is extremely important for the conservative and sometimes Read more [...]
Complication of mitral stenosis. Complications of mitral stenosis are: occurrence of acute pulmonary edema, hemoptysis, pulmonary hemorrhage, high pulmonary hypertension, disorders of cardiac rhythm and conduction, thromboembolic complications. These complications occur in children less often, so unfamiliar to pediatricians.
Acute pulmonary edema is due to sharply growing weakness of the left ventricle while maintaining sufficient contractile right ventricle. Often primary pathogenetic importance levopredserdnaya acute failure. Pulmonary edema is stepping transudate of pulmonary capillaries Read more [...]
Fluoroexam is extremely important in the diagnosis of mitral stenosis. Typical signs of mitral stenosis on X-ray is the presence of pulmonary hypertension, an increase in the left atrium and the right ventricle and the pulmonary artery bulging arc (Fig. 12. A, b, c). In this case, X-ray data depends on the stage of mitral stenosis. At stages I and II marked predominance of arterial pulmonary hypertension, with stages III and IV there is a pronounced stagnation in the pulmonary veins.
Important to the study of patients in the oblique (left and right) projections. In the study of patients in Read more [...]
Polikardiogramma allows us to determine the phase change of left ventricular systole. In mitral stenosis, there is an increase of load by reducing the induction phase (SB Feldman, 1962; Lenzi et al 1962; Holldack, 1964). Elongation phase transformation due not only to the restriction of the mitral orifice, but to a large extent and myocardial damage. This dramatically changed vnutrisistolicheskie indicators: coefficient decreases Blyumbergera increases vnutrisistolichesky index Exile (YG Joffe, 1963 N. Gvatua et al., 1966; Gibney et a]., 1961). Shortening of the period of exile due to a decrease Read more [...]
Electrocardiography. The earliest sign of mitral stenosis are changes of atrial P wave that occur earlier than with mitral valve insufficiency. Tooth P first be high, advanced, then reduced split (Fig. 11). These changes of P wave is usually expressed in standard I and II and in aVL and aVF leads. In the right precordial leads (V1 and V2) tooth P is often a two-phase (+ -), the first phase of its positive. It is noted to increase the time of internal displacement and increasing index Makruza.
According to Wood (1956), clearly mitral tooth P rather points to mitral stenosis, rather than valvular Read more [...]
Classification. The successful surgical treatment of patients with mitral stenosis to determine the timing of surgical intervention A. Bakulev and EA Damir (1955, 1958) proposed the following classification of mitral stenosis. The authors of the main indicators of violations hemodynamics pulmonary circulation found it possible to get short of breath as the most simple and easy to determine the rate.
I stage of mitral stenosis - is a complete compensation of vice. In this case, the presence of a typical clinical picture of the patient does not blemish dyspnea even during high physical stress.
Stage Read more [...]
Diagnosis and differential diagnosis. The diagnosis of mitral valve insufficiency with a history of rheumatic appropriate data, the typical hospital (blowing systolic murmur at the apex of the heart, traveling in the left armpit, reinforced, raised apex beat, shifted to the left and sometimes down, increasing the border of the heart, mainly the left and up) as well as these additional studies (X-ray, electrocardiography and fonokardiograficheskogo) is not too difficult for the doctor.
Difficulties in diagnosis arise when mitral insufficiency with I degree of compensation for the GF Lang appears Read more [...]
Course and prognosis. Course mitral insufficiency depends on the severity and progression of vice rheumatism. With frequent recurrences of the disease prognosis is much worse, as she progresses mitral failure and it is possible accession of other valve lesions. At the same time, with a moderate degree of mitral failure and lack of frequent recurrence of rheumatic fever can long remain a good state of compensation due to the large compensatory capacity of the left ventricle. Pronounced mitral failure often leads to early heart decompensation. Develops stagnation in small and large circulation, Read more [...]
Classification of degrees of compensation defect. Determining the degree of compensation of mitral insufficiency in a child is of great practical importance in the decision on the appointment of the regime, drug therapy, and the prognosis.
When mitral valve GF Lang (1958) identified three degrees of compensation.
I degree of compensation observed in patients with a small defect in the valve. At the same time, showed a slight systolic expansion of the left atrium and a small hypertrophy and expansion of the left ventricular cavity, almost captured in the study. Manifests a mitral failure only Read more [...]
Fonokardiograficheskoe study. When mitral valve insufficiency, a decrease of the amplitude I tone at the top until its complete disappearance, although in the initial period of one tone at the top may be in the normal range. Often the determination of the amplitude and tone I is difficult as it merges with the systolic murmur (IA Kassirskii, GI Kassirskii, 1964 LM Fitileva, 1962).
Interval Q - I tone is usually not changed. Amplitude II tone on the pulmonary artery is enlarged, sometimes there is a slight splitting II tone on the pulmonary artery and the pulmonary component of the delay.
In the Read more [...]
Electrocardiography. In the diagnosis of mitral insufficiency importance belongs electrocardiography. In the initial stage of defect in the electrocardiogram abnormalities do not. Further characteristic is the change in the P wave I, II standard leads in aVL, V1 and V2. In the early development of mitral insufficiency its value increases, but then it decreases, it becomes flat. In connection with the reduction of asynchrony right and left atria tooth P splits. Tooth R is low and wide due to the slowdown intraatrial conductivity due to the development of degenerative changes in the left atrium. Read more [...]
Children with heart defects, as in the sanatorium, and in outpatient advisable to carry out therapy to restore the metabolic processes in the heart muscle. To this end, it calls for vitamins - B1, B2, B6, B15, and if necessary - cocarboxylase and cardiac glycosides.
Of great importance for adolescents with rheumatic heart disease is the choice of profession. The doctor should help a young in this matter.
Jobs involving heavy physical exertion, stay at high temperatures, prolonged sitting, are not appropriate.
In recent years with the development of surgical treatment of acquired heart diseases, Read more [...]
Radiographic signs characterized mainly mitral stenosis, but notes and signs of increased left ventricular (Fig. 18a, b).
Fig. 18. Radiographs of the chest patient B. 13.
Clinical diagnosis: rheumatic fever, continuous-recurrent Combined mitral mink with a predominance of stenosis. Atrial fibrillation. HN2?.
and - the front projection. Heart mitral configuration, dramatically expanded across. Marked congestion of the lungs, and b - left lateral view. There is a significant increase in the right ventricle, left atrium. Increase Left ventricular moderate. Read more [...]
Forecast in this variant of the combined Mitral vice unfavorable, as compensation defect occurs due to the weak left atrium and right ventricle. Unfavorable point is the fact that the defect gradually progresses (stenosis). Also, perhaps, for this option more frequently than others, there are severe complications, such as the arteries of the brain embolism and atrial fibrillation.
Third option combined mitral defect characterized by the absence or deficiency prevalence of stenosis, and there is a combination of significant Mitral stenosis with significant mitral insufficiency. In these patients, Read more [...]
Polikardiograficheskie data correspond to changes in left ventricular systolic phases in pure mitral stenosis.
For hemodynamic mitral vice with a predominance of stenosis is a poor option: reduced cardiac output, revealed a sharp decline in the functional capacity of the heart even stihanii carditis, which leads to an early disruption of blood circulation in a small circle until the edema. Often develop atrial fibrillation (see Fig. 13).