Mitral valve prolapse 1st, 2nd, 3rd degree

The essence of pathology

Mitral valve prolapse (MVP) is a lesion of the heart muscle of various origins or a pathology of the connective tissue formations of the heart. Leads to a change in the structure and shape of the mitral valve leaflets (at the moment of systole, they bend into the cavity of the left atrium, allowing some of the blood to flow back).

This pathology in cardiological practice is detected in 15% of children under fifteen years of age. At the same time, cardiac anomalies give rise to MVP in 40% of cases, rheumatism - in more than half of the children examined. Hereditary predisposition guarantees pathology in 100% of cases. Mitral valve prolapse is the main symptom of several congenital syndromes: Ehlers-Danlos, Marfan, contractural arachnodactyly, osteogenesis imperfecta, elastic pseudoxanthoma.

Adults suffer from MVP in 10%. The disease has a gender connotation: women over 40 years of age are more often affected.

Improving the characteristics and survivability of secondary guns

The effectiveness of guns of this class can be increased:

• ship commander skills:

1. "Desperate" ;
2. "Basic fire training";
3. "Enhanced fire training";
4. "Manual fire control of secondary guns".

• upgrades:

1. "PMK Modification 2";
2. "PMK Modification 3".

• signal Mike Yankee Soxisix. Although you can also increase the likelihood of a fire on an enemy ship by using Victor Lima and India X-Ray signals.

The survivability of secondary battery installations can be increased by 100% using the “Auxiliary Weapons Modification 1” upgrade.

Unique upgrades of some Tier X ships can also affect the characteristics of the secondary battery.

Classification of PMC

There is a division of the disease into primary and secondary pathology, as well as according to the severity of prolapse, the degree of reverse blood flow - regurgitation. In practice, both of these classifications are considered together. Mitral valve prolapse can be:

1. Primary, genetically determined, with congenital weakness of connective tissue structures. In this case, the mitral valve leaflets are stretched, and the chords that hold them lengthen. As a result, the doors cannot close and a gap remains between them. Congenital pathology does not have a significant effect on the functioning of the circulatory system, but is often accompanied by VSD, arrhythmia, and chest discomfort. Primary prolapse, according to the nature of the heart murmur, is divided into a latent, silent form, which is diagnosed on an echocardiogram, and an auscultatory form with typical noises distinguishable by the ear.
2. Secondary or acquired, which develops against the background of somatic diseases, rheumatic, cardiac pathologies. In this case, pain and interruptions in the heart are relieved with medications (Nitroglycerin, Betaloc). If prolapse is caused by injury, chord rupture, emergency medical care is necessary.

Depending on the severity, leaflet prolapse can be:

• first degree – deflection up to 6 mm, with complete closure, so the patient has no symptoms;
• the second – up to 8-9 mm, the leaflets do not fit tightly, regurgitation of varying degrees is observed (backflow of blood into the atrium);
• the third – everything that goes beyond this: the leaflets do not touch, the chords may be torn off, which worsens the patient’s condition, and acute left ventricular failure is formed, requiring emergency intervention.

Moreover, each degree has its own severity of regurgitation - reverse blood flow inside the chambers of the heart (according to Doppler ultrasound):

1. first degree - a slight mitral wave of reverse blood flow, which reaches the level of the leaflets;
2. the second is moderate regurgitation with a wave rising to the middle of the left atrium;
3. the third is a pronounced wave of reverse blood flow, which reaches the opposite end of the left atrium;
4. the fourth is severe (described only clinically).

The diagnosis indicates the degree of prolapse and the degree of regurgitation.

“Under the President’s control”: revival of the PMK

PMK - this abbreviation is well known in the post-Soviet space. A mobile mechanized column is a maneuverable contracting construction and installation organization created to perform construction, installation and repair work on dispersed and linear objects. The next issue of a special project of the Television News Agency, aired on the Belarus 1 channel, is dedicated to the revival of the PMC system in Belarus.

Gorodoksky district.
4th grade cook Alexander Voronov
begins his working day with a conversation with a colleague on a bench. They don’t know how long they will sit idle today. For them, there has been no work in their specialty in their native PMK-51 for several years now. Recently, men were sent to mix concrete, but is this work for a welder with forty years of experience, Alexander asks:

— While the funding was normal, we built so many houses near the hospital! It was only because of this that they held on. Then it ended, people’s wages fell. 290 rubles in hand - is it really possible to live like that?!

Problems in the Gorodok mobile mechanized column began after the organization began to change leaders one by one. Orders decreased and people began to quit. As a result, the once famous construction organization throughout the Vitebsk region fell into oblivion. The fate of this PMC was shared by dozens of others across the country. Head
of the Department of the SGC of Belarus Alexander Yakimov
states:

— In recent years, there has been a steady downward trend in the number of PMCs. By the end of last year, 122 mobile mechanized columns were operating in the republic. At the same time, several PMCs worked in certain regions, while in 28 districts of the country PMCs were not created.

In the Soviet Union, mobile mechanical columns were created in order to solve construction problems on site. If necessary, the equipment moved to a given area. A kind of construction landing, hence the name. In the 90s and 2000s, PMKs still performed the functions assigned to them, but after 2010, these large-scale organizations began to turn into piles of rusty construction equipment. Experienced managers retired, and the new school chose a different path of development, which, however, never justified itself...

The fact that the PMK needs to be revived has been said more than once at the highest level. For several years, the President demanded that strict order be established in the industry, but due to the connivance of local authorities, the order of the Head of State was not carried out. As a result, Alexander Lukashenko returned to this issue once again in 2016 during a working visit to the Rayagropromtekhnika enterprise:

— Recreate mobile mechanized columns. They should be! What kind of chairman of the district executive committee is he if he doesn’t have a construction organization? He cannot simply lay asphalt, repair or build a house. Therefore, you cannot destroy that infrastructure!

Carpenter-concrete worker Dmitry Palatinsky from Slutsk PMK

After this order, the business, or rather, the mobile column, moved from a dead point. In some areas, the PMK got its second wind. Around the same time, the ambitious manager Alexey Krivko took the helm of Shumilinskaya PMK-70. And the average construction business has become a leader in terms of the volume of square meters built. Today, the director has at his disposal more than 50 pieces of equipment and three hundred employees who work at ten sites. The order portfolio has been formed by the end of the year. PMK-70 closes all construction sites in its area and works in neighboring ones.

The director explains:

— Over these years of work, we have proven ourselves on the positive side; most customers want to work with us. When we come to the auction, we reduce the time required for the work and ensure its quality, which is required by the customer.

Having conquered the construction market, Shumilinskaya PMK decided to expand its horizons. We didn’t think for a long time about what else to do, because we had our own sawmill at our disposal. As a result, they began not only to saw the board, but also to chop firewood. Sales also go to the foreign market. Last year alone, woodworking earned $380,000. The main thing is a good plan and competent management decisions, the director of PMK-70 is sure:

— We try to put our risks into different baskets. To rely not only on the construction market, which is quite delicate and subtly reacts to the economic situation. I want a more or less stable income.

But Shumilinskaya PMK is rather a good exception to the rule. In most cases, the Vitebsk region cannot boast of such examples. At the end of last year in the northern region, there were mobile mechanized columns in only 12 out of 21 districts. By this time, the situation had changed for the better, but not significantly, notes the head of
the KGC department for the Vitebsk region Vadim Volovich
:

- PMKs have been revived in two districts - Tolochinsky and Lioznensky. Work is underway to revive mobile mechanized columns in the Verkhnedvinsky, Dubrovensky, Sennensky and Rossony districts.

A similar picture—only 12 PMCs in 21 districts—is in the Gomel region. In total, there were no mobile mechanized columns in 28 districts across the country last year. And of the 122 existing ones, only a few could boast of successful work. And this despite the fact that these organizations employ about 15 thousand people.

The critical state of affairs in the industry required radical changes. And the catalyst for such changes was given at the end of last year during a large construction seminar with the participation of the President. The head of state once again outlined the range of existing problems and gave clear instructions to correct them. The PMC began to be revived, but another problem arose. The construction army in the hands of local authorities, which the Head of State spoke about, turned out to be unarmed in the face of the problems that had accumulated over the years of inactivity. It turned out that construction organizations appeared, but they had nothing to build, and there was no reason for it. Thus, since 2013, PMK clients in the Mstislavsky district stopped paying their bills. As a result, accounts receivable began to grow with mathematical progression and over the years bankrupted the organization. Today the debt is more than a million rubles. Because of this, the company became insolvent with creditors and was mired in debts of 2 million. Moreover, most of this amount is accumulated interest for late payments.

Today, in each region, repayment schedules for receivables for mobile mechanical columns have been drawn up. Their implementation will be supervised not only by local authorities, but also by inspectors, says Alexander Yakimov:

— The regional executive committees have been tasked with reviving the PMCs in each district during 2021 and ensuring their efficient and profitable operation. KGC will continue to monitor the implementation of this instruction of the Head of State.

In Slutsk, the local PMK works at two sites at once. The director of the organization, Andrei Yanovich, says that they also have problems with orders. But high-quality work at one site automatically provides the PMK-225 with the following:

“We acted as the general contractor for a 40-apartment building, and we will manage it from scratch to roofing. Deadlines and quality! The times are such that these criteria must be observed and fulfilled impeccably.

The creation of inter-district PMCs can become insurance for the conditional execution of the President’s instructions. Renaming another construction organization to a familiar abbreviation is not a problem, nor is fictitiously creating a new enterprise. But the revival of mobile mechanized columns was intended to be something more.

But it turns out that the high-quality work of the Slutsk PMK is a headache for neighboring mobile mechanized columns. After all, it is always difficult to compete with leaders. Everything seems logical: the law of economics is that the strongest wins. But where then can weaker players in the construction market find work? After all, today everything is decided by tenders, and no one will make concessions for the middle peasants. And without orders, the revived columns will again go into oblivion.

I would like to hope that this will not be a nominal revival, but an effective and efficient one. And perhaps then in his native PMK there will be a job for 4th category welder Alexander - and he will no longer have to mix concrete for pennies.

Causes of the disease

In fact, mitral valve prolapse is not an independent disease. This is a clinical and anatomical syndrome that occurs in various somatic pathologies. Triggers of MVP can be both congenital anomalies and acquired diseases.

In modern cardiology, the main cause of mitral valve prolapse is considered to be a congenital pathology, which is based on myxomatous degeneration of valve structures and intracardiac nerve fibers. This prolapse is also called idiopathic, since the exact etiology of this process has not been established. Most scientists suggest that it is genetic.

Pathological destruction concerns, first of all, the fibrous layer of connective tissue, collagen and elastin, with the accumulation of polysaccharides in the intercellular substance. The connective tissue frame becomes loose, the mitral valve leaflets prolapse at the time of systole. Most often, this affects patients with autoimmune disorders, dysplasia of cartilage, ligaments, congenital defects of joint capsules, arthritis, and arthrosis.

Recent scientific research associates valve prolapse with hormonal disorders of various origins, viral diseases, and streptococcal infections, which cause direct destruction of not only the valves, but also the endocardium of the heart.

Among the secondary (acquired) causes:

• first place is given to rheumatic diseases (up to 80%) - an autoimmune pathology with combined damage to the mitral (prolapse) and aortic (stenosis) valves;
• on the second there is arterial hypertension with left ventricular hypertrophy (up to 10%);
• in the third – infective endocarditis (up to 10%).

Chest injuries, AMI, chord avulsions of various origins occupy an insignificant place (within 2%).

With age, connective tissue and autoimmune degeneration increases, so the risk of deformation of the mitral valve leaflets and damage to the chordae gradually increases and reaches its peak after 40. In adolescence, the cause of pathology is a violation of intracardiac blood flow due to dysplasia and anatomical abnormalities of the coronaries.

Improving the characteristics and survivability of secondary guns

The effectiveness of guns of this class can be increased:

• ship commander skills:

1. "Desperate" ;
2. "Basic fire training";
3. "Enhanced fire training";
4. "Manual fire control of secondary guns".

• upgrades:

1. "PMK Modification 2";
2. "PMK Modification 3".

• signal Mike Yankee Soxisix. Although you can also increase the likelihood of a fire on an enemy ship by using Victor Lima and India X-Ray signals.

The survivability of secondary battery installations can be increased by 100% using the “Auxiliary Weapons Modification 1” upgrade.

Unique upgrades of some Tier X ships can also affect the characteristics of the secondary battery.

What is the danger of PMK

Grade 1 MVP is practically asymptomatic, does not affect the general condition of a person, and does not require any adjustment. But from 5 to 10% of patients face the risk of complications that manifest themselves as the disease progresses, exacerbation of somatic pathologies, and with age. The most dangerous are the following:

• Acute mitral valve insufficiency, which is usually associated with chest trauma, chordae rupture: the patient is diagnosed with acute heart failure, pulmonary edema, and respiratory arrest. The chronic version of mitral regurgitation is mild: weakness, fatigue, shortness of breath.
• Infectious endocarditis of various origins is manifested by increased thrombus formation in the vessels of the brain, internal organs, and great vessels with impaired left ventricular function. Risks stroke, heart attack, cardiac arrest, pulmonary embolism.
• Prolapse of the anterior leaflet most often provokes an attack of angina: impaired myocardial contractility increases the load on the left half of the heart, leading to its hypertrophy, hypoxia of the brain, all internal organs and tissues.
• Cardiac fibrillation, MVP with pulmonary congestion, mitral insufficiency can lead to death (ECG shows prolongation of the QT interval).

Description and purpose

The PMK can be deciphered as “full face mask box”. It refers to military filter devices to protect the respiratory system, eyes and skin from harmful chemicals and other impurities. In this case, the oxygen content in the atmosphere should not be less than 18%, since the gas mask does not have its own independent oxygen supply system, as in PPE (personal protective equipment) and hose respirators.

PMK gas masks are quite reliable and versatile, providing good audibility for negotiations. The large filter reserve allows you to stay in it around the clock.

However, the shelf life and storage conditions of the filter box are the most important, since it has a limited time of use.

Today, there are many different types of gas masks and brands of filters designed for certain substances that cannot exceed 82% of the total air volume. These products are effective against radiation, vapors, most toxins, gases and airborne aerosols, including viruses and bacteria.

In accordance with the scope of application, in addition to military, there are models:

• civilian (adults or children);
• industrial.

The first ones do not require additional skills when using , but every simple person hopes that they will never be useful. The latter are an important tool for the survival of intelligence officers when performing dangerous work.

Deciphering the PMK gas mask makes it clear that it is much more effective compared to a simple respirator for the mouth and nose.

When it comes to performance and protection, the PMC is truly the best option. Serves as a rescue from quickly and slowly acting chemical warfare agents (chemical warfare agents):

• biological and chemical weapons - dangerous pathogens that cause epidemics, non-lethal and lethal toxic substances, tear and irritant, nerve-paralytic, psychogenic and asphyxiating substances;
• aerodispersed cloud of radioactive substances;
• To protect the organs of vision from nuclear and thermonuclear light radiation, special films (PSZG-2) are used.

Symptoms

Clinical manifestations of mitral valve prolapse depend on the degree of dysplasia of the connective tissue of the heart, the presence of vegetative-vascular, and neurological disorders. Signs of the disease that you should pay attention to in newborns include:

• asthenic body type;
• hip dysplasia;
• umbilical, inguinal hernias;
• malnutrition;
• the ability of joints to bend in all directions, including those that are anatomically unusual for them;
• varicocele;
• chest deformity.

Later, MVP manifests itself as flat feet, myopia, strabismus, nephroptosis, incorrect posture, frequent acute respiratory viral infections or acute respiratory infections, and sore throats. In adolescents, MVP is associated with vegetative-vascular dystonia.

The main clinical symptoms of mitral valve prolapse in adults are:

Vegetative-cardiac syndrome: pain behind the sternum due to emotional or physical stress, hypothermia, reminiscent of angina pectoris. Sometimes heart pain is spontaneous and can be relieved with nitrates (up to 98% of all cases).

• Arrhythmia, tachycardia (up to 80% of cases), associated with excitement, drinking strong tea, coffee, and lifting weights. They do not pose a threat to life.
• Hyperventilation syndrome resulting from dysregulation of breathing. Headache, often of the migraine type (more than half of the cases).
• Panic attacks of a non-epileptic nature occur spontaneously and do not have an exact cause.
• Depression.
• Asthenia.
• Syncope (short-term loss of consciousness) with muscle atony.
• Impaired thermoregulation.
• Dyspnea that does not correlate with heart failure.

Auscultation with MVP determines:

• isolated clicks in the left ventricle during mid or late systole (single or multiple);
• late systolic, glosystolic murmurs due to a large difference in pressure in the atrium and ventricle;
• a combination of clicks and noises.

With instrumental and laboratory examination, mitral valve prolapse gives:

• asymptomatic prolongation of the QT interval on the ECG is a marker of the development of life-threatening arrhythmia;
• high excretion of catecholamines (peak during the day, decrease at night).

Diagnostics

Diagnosis of mitral valve prolapse is subject to the standard algorithm for examining a heart patient:

• medical history, physical examination with stress tests (squats, holding your breath, walking in place);
• OBC, OAM, biochemistry – screening of the patient’s general condition.
• ECG, EchoCG - detect arrhythmia, the presence of regurgitation, determine the degree of MVP;
• Holter;
• radiography - determines mitral insufficiency by regurgitation;
• phonocardiography – confirms auscultatory murmurs;
• Dopplerography.

Sometimes consultation with specialists may be required. In children, MVP can be heard as a third tone, but this has no diagnostic significance. Mitral valve prolapse detected in a child may disappear on its own with age.

Features of treatment

Treatment of MVP depends on the severity of the pathology. Grade 1 mitral valve prolapse does not require any special treatment. There are no restrictions on physical activity. Any kind of sport is possible, with the exception of weightlifting and strength training equipment. The patient is not even exempt from the army.

The main treatment for stage 1 MVP is a healthy lifestyle, infection prevention, medical examination. But sometimes doctors decide to replace the mitral valve already at this stage of the disease. This happens if the cause of the pathology is autoimmune processes in the body, which will certainly progress and create a risk of fatal complications. The satisfactory condition of the patient at a given period of time allows us to predict a good effect from the operation and the absence of negative consequences. Delaying surgical intervention can lead to the impossibility of performing it even for health reasons.

Grade 2 MVP is accompanied by negative symptoms and requires not only constant monitoring of the patient, but also symptomatic drug treatment: the presence of signs of circulatory failure, arrhythmias, and syncope. The treatment regimen is strictly individual and is the exclusive prerogative of the doctor. Physical activity is not prohibited, but the type and dosage is selected by the doctor. There is no exemption from the army, with the exception of grade 2 MV prolapse with regurgitation above grade 2 or in the presence of arrhythmia, cardiac conduction disturbance. You can play sports if you lack:

• syncopation;
• no arrhythmia (24-hour monitoring);
• there is no regurgitation (Doppler sonography);
• the contractility of the heart is preserved (EchoCG);
• there was no history of thromboembolism. all indicators of the coagulation system are normal;
• no one in the family died from sudden cardiac arrest due to MVP.

To prevent the progression of pathology, it is recommended:

• sedatives: tincture of motherwort, valerian, hawthorn, Novopassit, Persen;
• mitral insufficiency or arrhythmia suggest the prescription of beta-blockers (Diltiazem, Sotahexal, Bisoprolol, Adenosine, Propanorm, Allapinin, Amiodarone), anticoagulants (Cardiomagnyl, Warfarin, Finilin, Girygen, Girylog, Argatroban), which relieve chest discomfort, rapid heartbeat, and anxiety.

Physiotherapeutic procedures (electrophoresis with bromine, magnesium on the collar area), massage, balneotherapy, hirudotherapy, acupuncture, acupuncture are indicated for MVP. Surgical intervention is used for the same indications to correct the valve or replace it. When planning minor surgical interventions, preventive antibiotic therapy is mandatory (tooth extraction, polyps in the maxillary sinuses, tonsils); courses of preventive antibiotic therapy are indicated.

Grade 3 MVP is characterized by serious structural disorders in the heart, which cause MV failure, persistent arrhythmia: expansion of the left atrium cavity, thickening of the walls of the ventricle, disturbances in the functioning of the circulatory system. This degree of pathology requires surgical correction of the valve, its suturing or prosthetics. Instead of physical education and sports, special gymnastic exercises and exercise therapy are recommended, and healthy, sound sleep is necessary.

Symptomatic treatment consists of using:

• vitamins of group B, PP, E, C;
• tachycardia is stopped by Betalok, Atenolol, Propranolol, which improve the nutrition of collagen fibers;
• vegetative-vascular dystonia is treated with adaptogens (Eleutherococcus, Schisandra, ginseng), vitamin and mineral complexes (Magne B6, Magnelis B6, Vitrum, DoppelHertz, Pikovit).

They use psychotherapy sessions (group and individual) to relieve emotional stress. Tobacco, alcohol, heavy lifting, and strength training are prohibited.

Mitral valve prolapse: treatment.

Treatment for MVP can only be prescribed by a cardiologist; it is required if a person has pain in the heart and there is an abnormal heart rhythm.

Factors influencing the need for treatment:

• degree of “fallout” of the valve leaflet;
• presence of returgitation;
• presence of complications.

In case of grade I MVP and the person does not have any complications, pain, or discomfort, treatment is not required. However, it is necessary to quit smoking and consume large quantities of coffee; It is important to constantly visit a doctor and get examined.

For grade I MVP with grade I regurgitation and degree II and III MVP (especially if cardiac arrhythmias and/or circulatory failure are detected), drug therapy is prescribed. In addition, in difficult cases, surgical treatment is prescribed.

It is also recommended for patients diagnosed with MVP:

• avoid excessive physical activity, avoid overwork; physical activity should be moderate;
• give up smoking, alcohol, coffee and strong tea;
• maintain a sleep schedule;
• eat a balanced diet.

Prolapse in pregnant women

Quite often, mitral valve prolapse is diagnosed in pregnant women during a complete mandatory examination. The first degree is usually not a concern. The pregnancy is proceeding normally, there are no negative consequences for the fetus. Moreover, prolapse can decrease during pregnancy: cardiac output increases, capillary resistance in the periphery decreases. Arrhythmias are possible, but childbirth occurs naturally and normally.

The addition of regurgitation or the transition of pathology to the second degree requires constant monitoring of the expectant mother by a cardiologist. Medicines are used only for health reasons (serious hemodynamic disturbances).

The rules of behavior for a pregnant woman with mitral valve prolapse are simple:

• avoid hypothermia and sudden temperature changes;
• move more to prevent congestion in the pelvic organs;
• rest in a reclining position.

Forecast

How MVP will behave during life depends on the reason that caused it:

• hypertensive prolapse depends on the degree of heart failure, the risk of AMI, stroke;
• rheumatic MVP can exist asymptomatically for decades, requiring preventive courses of drug therapy, and sometimes surgery;
• infective endocarditis is completely cured if the pathogen is accurately identified, treatment is long-term, and the prognosis is favorable (with the exception of drug addicts).

Uncomplicated mitral valve prolapse has a good prognosis.

Literature

1. A.I. Abdrakhmanova, I.V. Abdulyanov. Mitral valve prolapse in a doctor’s practice. // Kazan State Medical Academy, 2015.
2. Kuzhel D.A., Matyushin G.V., Savchenko E.A. Diagnosis and treatment of mitral valve prolapse // Rational Pharmacotherapy in Cardiology, 2010.
3. Amelina T.N., Tashchuk V.K., Turubarova-Leunova N.A. Current aspects of mitral valve prolapse in athletes // Scientific notes of the University named after P.F. Lesgafta, 2013.
4. Dzemeshkevich S.L., Stevenson L.W. Mitral valve diseases. Function, diagnosis, treatment. - M.: GEOTAR Medicine, 2000.
5. Movshovich B.L., Lisitsa D.N. Management of patients with mitral valve prolapse in the clinic // Attending physician, No. 5, 2001.