What do degrees of regurgitation mean?
In conclusion, echocardiography usually describes regurgitation in degrees from one to four, or with the words “minor”, “moderate”, “severe”. The first degree in a person without complaints and with normal sizes of the heart chambers, as a rule, is not considered a defect and does not require treatment - this is a feature of the valve. Severe failure is considered clinically significant, especially if the left ventricle and atrium begin to dilate and cardiac function decreases. It is the dynamics of size and function, and not one degree number, that determines tactics, so it is important to repeat studies and compare protocols.
- The first degree is more often a variant of the norm
- The second is moderate, requires observation
- The third and fourth are pronounced, surgery is being discussed
- More important than degree: chamber sizes and ejection fraction
- Assess dynamics using repeated echocardiography
Reasons
Primary failure occurs when the valve itself is damaged. Its most common cause is mitral valve prolapse, in which the leaflets bend excessively into the atrium; This also includes chord rupture, the consequences of rheumatic fever and infective endocarditis, and calcification of the valve ring in the elderly. Secondary, or functional, failure occurs when the valve is unchanged: the left ventricle expands after a heart attack or during cardiomyopathy, the valve ring stretches, and the leaflets stop closing. The separation is important because the treatment for these options is different.
- Mitral valve prolapse
- Rupture or elongation of chordae
- Consequences of rheumatic fever
- Infective endocarditis
- Coronary heart disease and previous heart attack
- Dilated cardiomyopathy
- Mitral annulus calcification
Symptoms
The heart takes a long time to compensate for the reverse flow, so severe failure can proceed hidden for years. The first sign is usually shortness of breath on exertion, which is attributed to age or excess weight. Later, fatigue, decreased tolerance to usual activities, palpitations and interruptions due to atrial fibrillation appear. With increasing pressure in the pulmonary vessels, night attacks of shortness of breath, coughing in a lying position, and then swelling of the legs and heaviness in the right hypochondrium appear. Often the defect is first identified by a noise that the doctor hears during a routine examination.
- Shortness of breath on exertion, later at rest
- Fatigue and decreased endurance
- Palpitations and cardiac irregularities
- Night attacks of shortness of breath, cough while lying down
- Swelling of the legs, heaviness in the right hypochondrium
- Systolic murmur when listening to the heart
Diagnostics
The main method is transthoracic echocardiography: it shows the structure of the leaflets, the direction and volume of reverse flow, the size of the chambers and the ejection fraction, as well as the pressure in the pulmonary artery. If the picture is unclear or surgery is planned, a transesophageal examination is performed, which provides a more detailed image of the valve. ECG and 24-hour monitoring reveal atrial fibrillation, which often accompanies the defect. Exercise tests help to objectively assess exercise tolerance in patients who consider themselves healthy. Before the intervention, the condition of the coronary arteries is assessed.
- Examination by a cardiologist and listening to the murmur
- Transthoracic echocardiography
- Transesophageal echocardiography if necessary
- ECG and daily monitoring
- Load test
- MSCT of the heart and assessment of the coronary arteries before surgery
Treatment and observation
For minor and moderate regurgitation without complaints, treatment is not required - periodic echocardiography and pressure monitoring are needed, the timing of repeated studies is determined by a cardiologist. Medicines do not eliminate the reverse flow, but they help with heart failure and rhythm disturbances: they use drugs that reduce the load on the heart, diuretics, rhythm control agents, and for atrial fibrillation - anticoagulants to prevent stroke. In case of severe failure with symptoms or with dilatation and decrease in ventricular function, surgery is indicated. Plastic surgery of the patient's own valve is preferable; if this is not possible, prosthetics are performed.
- Regular echocardiography at the time prescribed by the doctor
- Blood pressure control
- Diuretics and drugs for heart failure
- Anticoagulants for atrial fibrillation
- Mitral valve repair
- Valve replacement if plastic surgery is not possible
- Prevention of infective endocarditis and dental sanitation
