mucous valve disease in the elderly
Introduction
Introduction to mucinous valvular disease in the elderly Mucinous valvular disease in the elderly refers to the mucosal degeneration of the heart valve causing the atrioventricular valve to sag into the atria during systole, and the semilunar valve is prolapsed into the ventricular outflow tract during diastole, with or without a degenerative valvular insufficiency. Non-specific non-inflammatory heart valve disease. This mucoid degeneration can lead to multiple valve prolapse, clinically the most common mitral valve prolapse, aortic valve prolapse and tricuspid prolapse second, pulmonary valve prolapse is rare, the disease and its complications ( The chordae rupture is a common cause of regurgitation of the valve, and severe surgery requires surgical intervention. basic knowledge The proportion of illness: 0.002% Susceptible people: the elderly Mode of infection: non-infectious Complications: Infective endocarditis Mitral annulus calcification Cerebral embolism Sudden death Syndrome
Cause
The cause of mucinous valvular disease in the elderly
(1) Causes of the disease
More and more young and middle-aged patients are secondary to Ma Fang syndrome, congenital heart disease (atrial septal defect, patent ductus arteriosus) and connective tissue disease. A group of 47 patients and 179 first-degree relatives have shown that the disease may be Autosomal dominant inheritance, age and gender are important factors affecting gene expression. Recently, musculoskeletal valvular heart disease is a kind of degenerative, non-specific, non-inflammatory lesions that occur with age. The cause of the change, the cause is still unclear, is the main cause of mitral valve prolapse in the elderly, most commonly seen in the elderly over 75 years old.
(two) pathogenesis
The basic pathological changes of the disease are mucoid degeneration of the valve and the chordae, mainly involving the posterior lobe of the mitral valve, followed by the anterior lobe of the tricuspid valve and the right coronary valve of the aortic valve. The parachute has a pearl-like white opacity on the surface, and the mucus-like degeneration can be seen in the incision of the valve leaf. The most obvious is the attachment of the leaf and the leaf. It is considered that the mucoid substance is hyaluronic acid, chondroitin sulfate and other acidic mucopolysaccharides. After the mucoid degeneration of the valve, the mucus-like substance of the sponge layer is obviously increased, so that the volume of the leaflet is increased, forming a large valve that is too long, too wide, and too thick, and sometimes the posterior lobe of the mitral valve can be increased to twice the anterior leaflet. The fibrous layer of the leaflets is atrophied and thinned, its continuity is interrupted, or it is replaced by mucoid substances. The entire leaflet is soft due to the loss of the scaffold, and is called the Floppy valve syndrome. The mucoid degeneration of the leaf extends downward to the chordae, which lengthens its length, weakens its strength, and is easily broken. The annulus also affects the normal contractile force due to the same lesion. When the ventricle contracts, under the pressure, the mitral valve is too large. or The tricuspid valve is bulging or inverting to the atrium. If the chordae tends to become longer, the pulling force is weakened, resulting in aggravation of the mitral or tricuspid prolapse. When the ventricle is dilated, the aortic valve is bulging or flipping to the left ventricular outflow tract. Aortic valve prolapse, 20% to 75% of patients with aortic regurgitation, mucoid degeneration of the valve leaflets can occur ulcers and non-infectious thrombotic endocarditis, easy to cause infective endocarditis The chordae rupture can cause acute valvular insufficiency, leading to refractory heart failure and death. The valvular degeneration of the heart valve is absent due to vascular and inflammatory cells, and there is no calcification, which is different from rheumatic valvular heart disease.
Prevention
Prevention of mucinous valvular disease in the elderly
Long-term use of -blockers can induce coronary spasm and should be used with caution.
Complication
Complications of mucinous valvular disease in the elderly Complications Infective endocarditis mitral annulus calcification cerebral embolism sudden death syncope
The common complications of this disease are as follows:
1 Infective endocarditis: the incidence rate is 5% to 10%, more common in men, the common pathogens are staphylococcus and streptococcus, 95% have murmurs or murmurs with clicks, but only few clicks This complication occurred.
2 chordae rupture: due to mucoid degeneration, the chordae tendon is weak and the valve regurgitation increases the tension of the chordae tendine, leading to chordae rupture; clinical manifestations of acute refractory heart failure and syncope.
3 non-infectious thrombotic endocarditis: the atrial surface of the mitral valve is damaged due to traction, and the endocardial tissue is exposed to form a thrombus, which can cause cerebral embolism.
4 mitral annular calcification: the mitral valve has a large amplitude and high tension due to relaxation. About 14% of patients have mitral annular calcification, which can cause conduction system disorders and atrial fibrillation, etc., aggravating mitral regurgitation flow.
5 death: This disease can cause sudden death, but rare, may be related to malignant arrhythmia.
Symptom
Symptoms of mucinous valvular disease in the elderly Common symptoms Arrhythmia mitral valve prolapse systolic murmur angina pectoris combined with valve prolapse diastolic qi-like murmur anxiety sigh-like breathing tricuspid prolapse
Mitral valve prolapse
(1) Symptoms: Symptoms vary in severity, and quite a few patients are asymptomatic. Symptoms often have the following manifestations:
1 chest tightness, pain in the anterior region: can be expressed as typical angina, but most of them are atypical angina, which is related to the sudden tension of the prolapsed leaflets causing increased myocardial tension in the papillary muscles and underneath.
2 palpitations, shortness of breath and fatigue: palpitations may be related to arrhythmia, but the time of palpitations and arrhythmia is not the same, shortness of breath is mainly because the patient feels insufficient gas and poor breathing, often sigh breathing or excessive ventilation, and Unlike organic diseases, patients feel weak in exercise and at rest. In short, these symptoms are not related to objective examination.
3 autonomic dysfunction: many patients have both vagal tone and sympathetic excitation, showing dual autonomic dysfunction, these various symptoms may also be related to this, in addition, patients are often in anxiety, irritability and emotions Tension.
(2) Signs: The most important specific signs of this disease are the apical apical and systolic non-ejection snaps (the sudden stop of the avalvular lobes and the tension of the chordae) and subsequent systolic The murmur, the left lateral position is clearer, only the click sound, indicating that only the mitral valve prolapse, if accompanied by systolic murmur, indicating mitral valve prolapse with mitral regurgitation, the characteristics of the auscultation of this disease are different The patient's snoring and murmur are different. The same patient has different auscultation at different times. This is because the disease is caused by the dysfunction of the mitral valve and the left ventricle. Any increase in left ventricular volume (such as , -blocker) When the booster is applied, the click sound is enhanced and moved back to the second heart sound; when the left ventricular volume (such as erect, inhalation, and nitrate) is reduced, the chord is relatively long, and the click sound appears in advance. The murmur is prolonged and strengthened. The severe ones (10%) only hear the full systolic murmur, while the squeaky sound is covered by the murmur. A few patients have neither clicks nor murmurs, but the ultrasound has mitral valve prolapse. Clinically, it is called For dumb mitral valve prolapse, another specific sign is apex palpation can be found in double Heart beats, the left lateral position accessible, because while Kara appears sound, the heart suddenly back in the mid-contraction, the normal heart beat out of a sudden interruption due.
2. Aortic valve prolapse
(1) Symptoms and signs: The clinical manifestations of aortic valve prolapse depend on the presence or absence of aortic regurgitation, degree of cardiac function compensation and degree of mucoidosis, and aortic regurgitation is often asymptomatic and murmur. The incidence of aortic regurgitation is 20% to 75%. Symptoms of angina pectoris and cardiac insufficiency can occur gradually. Typical cases can be seen in the aortic valve auscultation area and diastolic phase gas-like murmurs. In severe cases, there may be peripheral blood vessels. Sign.
(2) Ultrasound: The aortic valve is hammock-like, with a change of axillary and aortic systolic oscillating or diastolic flutter, indicating aortic valve prolapse, aortic valve closure is double-line, left ventricle and aortic diameter Increased, ventricular septum and left ventricular posterior wall beat increased, mitral valve activity is small, mitral anterior diastolic flap or mitral valve closed early, indicating the presence of aortic regurgitation.
3. Tricuspid prolapse: no tricuspid regurgitation usually asymptomatic and murmur, tricuspid regurgitation may have a feeling of head and neck pulsation, late appearance of right heart failure, typical signs are on the left sternal border or Under the xiphoid, the systolic murmur of the systolic period is enhanced, the inhalation is enhanced, the exhalation or the Valsalva action is weakened, the M-mode ultrasound shows the right ventricular right ventricular enlargement, and the ventricular septum is contradictory; the two-dimensional ultrasound shows the tricuspid regurgitation Flow, Doppler ultrasound can evaluate the degree of reflux and right ventricular pressure.
Examine
Examination of mucinous valvular disease in the elderly
When complicated with infective endocarditis, white blood cells can be elevated.
Mitral valve prolapse:
Electrocardiogram
Half of the patients had II, III, avF lead ST-T changes, aggravated when erect, and -blockers were alleviated, which may be related to the pulling of the papillary muscles. The prolongation of QT interval is related to the level of catecholamines. A variety of arrhythmia, but pre-systolic contraction is the most common, atrial fibrillation will aggravate mitral and tricuspid prolapse, resulting in hemodynamic deterioration, 1/3 of patients with positive exercise test, usually in the early and middle stages of exercise ST The segment moves down, and the ST segment tends to recover at the peak of exercise, and the -blocker can correct this abnormality.
2. Ultrasound
This is an important means of diagnosing this disease. The mitral valve is displaced in the middle and late stage of contraction and is a hammock-like change. It can be characterized as late systolic prolapse or full systolic prolapse. Two-dimensional real-time echocardiography is a mitral valve. The posterior displacement is closed, and the one or two lobe of the systolic mitral valve moves upward beyond the level of the mitral annulus.
Diagnosis
Diagnosis and diagnosis of mucinous valvular disease in the elderly
Diagnostic criteria
There is no clear diagnostic criteria for senile mucoid degeneration valvular disease. This disease is most common with mitral valve involvement. Therefore, for the elderly, especially the elderly, the apical region can smell and systolic click and/or systole. Noise, and susceptible to certain actions and drugs, if you can rule out mitral annulus calcification, papillary muscle dysfunction, hypertrophic cardiomyopathy and rheumatic heart disease (Table 1) and other diseases, should consider the mucus-like degeneration Apical valve prolapse, ultrasound examination is very helpful for diagnosis; valve biopsy has diagnostic value, but it is almost impossible, unless valve replacement, in mitral mucoid degeneration, 22% of patients with three Mucus degeneration of the cusp or aortic valve is called combined valve prolapse.
Differential diagnosis
Clinical needs are differentiated from mitral annulus calcification, papillary muscle dysfunction, hypertrophic cardiomyopathy and rheumatic heart disease.
