Choroba zastawki mitralnej
Etiologia i przyczyny
Choroba zastawki mitralnej obejmuje szeroki zakres patologii, od wrodzonych wad strukturalnych, takich jak zastawka mitralna z rozszczepem czy spadochronowa, po nabyte zmiany wynikające z gorączki reumatycznej, infekcyjnego zapalenia wsierdzia (IE), zwyrodnienia śluzakowatego (myxomatous degeneration) oraz powikłań choroby niedokrwiennej serca i kardiomiopatii. Gorączka reumatyczna pozostaje główną przyczyną stenozy mitralnej, odpowiadającą za około 85% przypadków, szczególnie w krajach rozwijających się. Zwyrodnienie zastawki mitralnej jest natomiast dominującą etiologią niedomykalności mitralnej w krajach rozwiniętych, często manifestującą się w postaci wypadania zastawki mitralnej (MVP). Warto podkreślić, że uszkodzenia zastawki mogą wynikać także z powikłań zawału serca, prowadząc do niedokrwiennej niedomykalności mitralnej, a także z chorób tkanki łącznej (np. zespół Marfana, Ehlersa-Danlosa) i chorób autoimmunologicznych (np. toczeń rumieniowaty układowy, reumatoidalne zapalenie stawów).
- Choroba zastawki mitralnej – Etiologia, przyczyny
- Wrodzone przyczyny choroby zastawki mitralnej
- Choroba reumatyczna serca
- Infekcyjne zapalenie wsierdzia
- Zwyrodnienie zastawki mitralnej
- Choroba niedokrwienna serca i zawał serca
- Kardiomiopatia i niewydolność serca
- Choroby tkanki łącznej i choroby autoimmunologiczne
- Zmiany związane z wiekiem i zwapnienie
- Inne przyczyny choroby zastawki mitralnej
- Podsumowanie etiologii choroby zastawki mitralnej
Choroba zastawki mitralnej – Etiologia, przyczyny
Choroba zastawki mitralnej to schorzenie obejmujące nieprawidłowości zastawki mitralnej, która reguluje przepływ krwi między lewym przedsionkiem a lewą komorą serca. Może być obecna od urodzenia lub rozwijać się w późniejszym okresie życia. Etiologia choroby zastawki mitralnej jest zróżnicowana i obejmuje wiele czynników, które mogą prowadzić do zaburzenia funkcji tej zastawki.123
Wrodzone przyczyny choroby zastawki mitralnej
Wrodzone wady zastawki mitralnej są obecne od urodzenia i stanowią jedną z możliwych przyczyn choroby zastawki mitralnej. Obejmują one różnorodne nieprawidłowości strukturalne, które mogą prowadzić do zaburzenia funkcji zastawki:134
- Wrodzone nieprawidłowości w budowie zastawki mitralnej, takie jak nieprawidłowy kształt lub rozmiar, lub niewłaściwe przyczepianie się płatków zastawki do ściany serca5
- Zastawka mitralna z rozszczepem (cleft mitral valve) – rzadka wada, w której jeden z płatków zastawki mitralnej ma szczelinę67
- Zastawka mitralna o podwójnym ujściu (double orifice mitral valve)7
- Zastawka mitralna spadochronowa (parachute mitral valve) – wrodzona anomalia zastawkowa, w której struny ścięgniste są przyczepione do pojedynczego mięśnia brodawkowatego7
Wrodzone wady zastawki mitralnej mogą być łagodne lub ciężkie. Noworodki z zagrażającymi życiu wadami wymagają natychmiastowej operacji.2 Wady wrodzone mogą również współistnieć z innymi wadami serca.5
Choroba reumatyczna serca
Gorączka reumatyczna i jej następstwo – choroba reumatyczna serca – stanowią jedną z najczęstszych przyczyn choroby zastawki mitralnej, szczególnie w przypadku stenozy mitralnej.18 Gorączka reumatyczna to powikłanie nieleczonego zakażenia paciorkowcowego (angina paciorkowcowa, płonica), które może wpływać na serce.94
Choroba reumatyczna serca rozwija się w różnym stopniu u nawet 50% pacjentów z gorączką reumatyczną, prowadząc do niedomykalności zastawki mitralnej we wczesnym lub późniejszym okresie życia.10 W przypadku stenozy mitralnej, gorączka reumatyczna jest przyczyną u około 85% pacjentów.11
Uszkodzenie zastawki mitralnej w przebiegu gorączki reumatycznej najprawdopodobniej wynika z reakcji immunologicznej organizmu na zakażenie paciorkowcowe. Reakcja ta może prowadzić do zapalenia i bliznowacenia zastawki, co powoduje jej dysfunkcję.912 Stenoza mitralna jest rozpoznawana jako przewlekła reumatyczna choroba serca, a więc jako następstwo ostrej gorączki reumatycznej, nawet gdy pacjent nie ma historii gorączki reumatycznej, prawdopodobnie z powodu przeoczonej diagnozy.11
Gorączka reumatyczna była kiedyś powszechną chorobą dziecięcą, ale częstość jej występowania znacznie spadła w krajach rozwiniętych dzięki powszechnemu stosowaniu antybiotyków w leczeniu zakażeń paciorkowcowych. Nadal jednak pozostaje istotnym problemem w krajach rozwijających się.213
Infekcyjne zapalenie wsierdzia
Infekcyjne zapalenie wsierdzia (IE) to zakażenie wyściółki serca i zastawek sercowych, które może prowadzić do uszkodzenia zastawki mitralnej.314 Jest to poważne schorzenie, które wymaga kilkutygodniowego leczenia antybiotykami.15
IE jest zazwyczaj spowodowane przez bakterie, które dostają się do krwiobiegu i przyczepiają do zastawek serca. Może to prowadzić do powstania wegetacji na płatkach zastawki mitralnej, co wpływa na jej funkcję.116 Zakażenie może zniszczyć zastawkę, prowadząc do ostrej niedomykalności mitralnej.17
Osoby z chorobą zastawki mitralnej są bardziej narażone na rozwój infekcyjnego zapalenia wsierdzia.5 Infekcyjne zapalenie wsierdzia może dotyczyć normalnych, nieprawidłowych lub sztucznych zastawek mitralnych.18
Zwyrodnienie zastawki mitralnej
Zwyrodnienie zastawki mitralnej, znane również jako zwyrodnienie śluzakowate (myxomatous degeneration), jest najczęstszą przyczyną niedomykalności mitralnej w krajach rozwiniętych.1016 Prowadzi ono do wypadania zastawki mitralnej (MVP), stanu, w którym płatki zastawki uwypuklają się (wypadają) do lewego przedsionka podczas skurczu serca.1813
W przypadku wypadania zastawki mitralnej, tkanka zastawki staje się nieprawidłowo elastyczna i wiotka, co powoduje, że nie zamyka się ona właściwie. MVP może być uwarunkowane genetycznie lub związane z chorobami tkanki łącznej.919 Często nie ma określonej lub znanej przyczyny wypadania zastawki mitralnej, ale ma tendencję do występowania rodzinnie lub u osób z innymi schorzeniami, takimi jak skolioza i problemy z tkanką łączną.9
Zwyrodnienie śluzakowate zastawki mitralnej może również prowadzić do rozciągnięcia lub zerwania strun ścięgnistych, które kotwiczą płatki zastawki do mięśnia sercowego, co powoduje niedomykalność zastawki.915
Choroba niedokrwienna serca i zawał serca
Choroba niedokrwienna serca i zawał serca mogą prowadzić do uszkodzenia mięśnia sercowego, które wspiera zastawkę mitralną, wpływając na jej funkcję.315 Zawał serca może uszkodzić obszar mięśnia sercowego, który wspiera zastawkę mitralną. Jeśli występuje duże uszkodzenie po zawale serca, może dojść do nagłej i ciężkiej niedomykalności zastawki mitralnej. Nieszczelna zastawka mitralna spowodowana zawałem serca nazywana jest niedokrwienną niedomykalnością mitralną.13
Zawał serca może również prowadzić do pęknięcia mięśnia brodawkowatego, co jest kolejną przyczyną ostrej niedomykalności mitralnej.10 Niedokrwienna niedomykalność mitralna jest wynikiem wcześniejszego zawału serca związanego z normalnymi płatkami zastawki mitralnej i strunami ścięgnistymi.7
Kardiomiopatia i niewydolność serca
Kardiomiopatia, czyli choroba mięśnia sercowego, może wpływać na funkcję zastawki mitralnej, powodując niedomykalność.1314 Rodzaje kardiomiopatii, które mogą powodować niedomykalność mitralną, obejmują:
- Kardiomiopatię niedokrwienną, w której mięsień sercowy ulega uszkodzeniu z powodu braku tlenu6
- Kardiomiopatię rozstrzeniową, w której dochodzi do powiększenia i osłabienia mięśnia sercowego6
- Kardiomiopatię przerostową zawężającą67
Niewydolność serca to stan, w którym serce nie jest w stanie pompować wystarczającej ilości krwi, aby zaspokoić potrzeby organizmu. Może to prowadzić do powiększenia (rozstrzeni) lewej komory, co wpływa na funkcję zastawki mitralnej. Rozstrzeń lewej komory z powodu kardiomiopatii niedokrwiennej lub nieniedokrwiennej może wtórnie upośledzać zwarcie płatków strukturalnie normalnej zastawki mitralnej, prowadząc do wtórnej niedomykalności mitralnej.7
Choroby tkanki łącznej i choroby autoimmunologiczne
Choroby tkanki łącznej i choroby autoimmunologiczne mogą wpływać na zastawkę mitralną, prowadząc do jej dysfunkcji.14 Choroby te obejmują:
- Zespół Marfana – genetyczne zaburzenie tkanki łącznej, które może prowadzić do wtórnego wypadania zastawki mitralnej, powodując niedomykalność720
- Zespół Ehlersa-Danlosa – grupa zaburzeń tkanki łącznej, które mogą wpływać na zastawkę mitralną721
- Fenotyp MASS – może prowadzić do wtórnego wypadania zastawki mitralnej7
- Toczeń rumieniowaty układowy (SLE) – choroba autoimmunologiczna, która może uszkodzić zastawkę mitralną17
- Reumatoidalne zapalenie stawów – choroba autoimmunologiczna, która może prowadzić do stenozy mitralnej8
Choroby autoimmunologiczne, takie jak toczeń, mogą powodować stan zapalny, który wpływa na zastawkę mitralną, prowadząc do jej dysfunkcji.14
Zmiany związane z wiekiem i zwapnienie
Wraz z wiekiem, zastawka mitralna może ulegać różnym zmianom, które mogą prowadzić do jej dysfunkcji.14 Główne zmiany związane z wiekiem to:
- Zwapnienie pierścienia mitralnego (mitral annular calcification, MAC) – odkładanie się wapnia wokół i na zastawce mitralnej, co może prowadzić do jej zwężenia lub niedomykalności2223
- Degeneracyjne zmiany zastawki – prowadzące do jej osłabienia i wiotkości17
Zwapnienie pierścienia mitralnego jest drugą przyczyną stenozy mitralnej u osób starszych. Obecnie ten stan anatomopatologiczny jest rzadko uważany za przyczynę przeszkody w odpływie z lewej komory i jest niedoszacowany. Zwapnienie pierścienia mitralnego polega na postępującym odkładaniu się wapnia nad i pod włóknistym pierścieniem zastawki, powodując zmniejszenie ruchomości płatków, a tym samym przeszkodę w fizjologicznym rozszerzaniu się pierścienia w czasie rozkurczu.11
Wśród czynników promujących rozwój zwapnienia pierścienia mitralnego kluczową rolę odgrywają zaburzenia mineralizacji tkanki, co jest szczególnie widoczne u starszych pacjentów z przewlekłą chorobą nerek, a jeszcze bardziej u osób dializowanych.11
Inne przyczyny choroby zastawki mitralnej
Istnieje kilka innych czynników, które mogą przyczyniać się do rozwoju choroby zastawki mitralnej:314
- Radioterapia – radioterapia klatki piersiowej, stosowana w leczeniu nowotworów, może prowadzić do uszkodzenia zastawki mitralnej w późniejszym okresie życia3524
- Zaburzenia rytmu serca – w tym migotanie przedsionków, które może powodować powiększenie przedsionka i pierścienia zastawki, prowadząc do czynnościowej niedomykalności mitralnej37
- Leki – niektóre leki mogą powodować niedomykalność zastawki mitralnej, np. zawierające ergotaminę (Cafergot, Migergot) stosowane w leczeniu migren i innych chorób1025
- Leki na odchudzanie – stosowanie pewnych leków na odchudzanie, takich jak „Fen-Phen” (fenfluramine i phentermine) lub dexfenfluramine, może prowadzić do uszkodzenia zastawki mitralnej. Lek ten został wycofany z rynku przez Amerykańską Agencję ds. Żywności i Leków (FDA) w 1997 roku ze względu na obawy dotyczące bezpieczeństwa2627
- Urazy klatki piersiowej – w rzadkich przypadkach, uraz klatki piersiowej w wypadku lub urazie może prowadzić do uszkodzenia zastawki mitralnej2425
- Choroby rzadkie – w tym zespół rakowiaka, choroba Fabry’ego, choroba Whipple’a i pseudoxanthoma elasticum87
Podsumowanie etiologii choroby zastawki mitralnej
Etiologia choroby zastawki mitralnej jest złożona i obejmuje wiele różnych czynników. Najczęstsze przyczyny to:1310
- Wrodzone wady zastawki mitralnej
- Choroba reumatyczna serca (po gorączce reumatycznej)
- Infekcyjne zapalenie wsierdzia
- Zwyrodnienie zastawki mitralnej (wypadanie zastawki mitralnej)
- Choroba niedokrwienna serca i zawał serca
- Kardiomiopatia i niewydolność serca
- Choroby tkanki łącznej i choroby autoimmunologiczne
- Zmiany związane z wiekiem i zwapnienie zastawki
- Inne czynniki, takie jak leki, radioterapia czy urazy
Warto zauważyć, że w krajach rozwiniętych najczęstszymi przyczynami choroby zastawki mitralnej są zabiegi degeneracyjne (wypadanie zastawki, wiotka zastawka), podczas gdy w krajach rozwijających się nadal dominuje choroba reumatyczna serca.1028 Zrozumienie etiologii choroby zastawki mitralnej jest kluczowe dla właściwego postępowania i leczenia, ponieważ różne przyczyny mogą wymagać różnych podejść terapeutycznych.10
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Materiały źródłowe
- #1 Mitral valve diseasehttps://johnsonmemorial.org/jmh-health/disease-conditions/con-20214385
Mitral valve disease has many causes. Some forms of mitral valve disease can be present at birth. A heart problem that you’re born with is called a congenital heart defect. […] Mitral valve disease also may develop later in life. This means it is acquired. For example, mitral valve stenosis is often caused by rheumatic fever. This fever is a complication of a strep infection that can affect the heart. When this happens, it’s called rheumatic mitral valve disease. […] Other causes of acquired mitral valve disease include: Other heart conditions. Infection. Age-related changes. Autoimmune disease, such as lupus.
- #2 Mitral Valve Disease: Types, Symptoms and Treatmenthttps://my.clevelandclinic.org/health/diseases/23235-mitral-valve-disease
Mitral valve disease can be acquired (it develops over time as you get older) or congenital (you were born with it). […] There are many possible causes for mitral valve disease. These include: […] Congenital heart defect. Some people are born with mitral valve disease. It may be mild or severe. Babies with life-threatening defects need surgery right away. […] Rheumatic fever is the most common cause of mitral valve stenosis, especially among people born before 1943. Modern use of antibiotics to treat bacterial infections has greatly reduced this problem in the U.S. and many other countries.
- #3 Mitral Valve Disease: Types, Causes, Signs, Treatments – UChicago Medicinehttps://www.uchicagomedicine.org/conditions-services/heart-vascular/valve-disease/mitral-valve-disease
Mitral valve disease can either be caused by a defect or abnormality in the mitral valve, or it can result from another disorder or condition, such as: […] Rheumatic fever […] Heart attack […] Endocarditis (infection of the heart valve) […] Infection or trauma […] Cardiomyopathy (abnormality of the heart muscle) […] Congenital heart defects […] Radiation therapy […] Heart rhythm disorders.
- #4 About Heart Valve Disease | Heart Disease | CDChttps://www.cdc.gov/heart-disease/about/heart-valve-disease.html
Congenital heart valve disease is malformations of the heart valves. The most commonly affected valve with a congenital defect is a bicuspid aortic valve. […] Other types of heart disease: Heart failure. Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body. […] A heart attack (also known as myocardial infarction or MI), which can damage the muscles that control the opening and closing of the valve. […] Other causes for heart valve disease: Autoimmune disease, such as lupus. […] The aging process, which can cause calcium deposits to develop on the heart valves, making them stiff or thickened and less efficient with age.
- #4 About Heart Valve Disease | Heart Disease | CDChttps://www.cdc.gov/heart-disease/about/heart-valve-disease.html
Heart valve disease is when any valve in the heart has damage or is diseased. There are several causes of valve disease. […] There are several causes of heart valve disease, including congenital conditions (being born with it), infections, degenerative conditions (wearing out with age), and conditions linked to other types of heart disease. […] Rheumatic disease can happen after an infection from the bacteria that causes strep throat is not treated with antibiotics. The infection can cause scarring of the heart valve. This is the most common cause of valve disease worldwide, but it is much less common in the United States, where most strep infections are treated early with antibiotics. It is, however, more common in the United States among people born before 1943. […] Endocarditis is an infection of the inner lining of the heart caused by a severe infection in the blood. The infection can damage the heart valve. Intravenous drug use can also lead to endocarditis and cause heart valve disease.
- #5 Valvular heart disease | Heart and Stroke Foundationhttps://www.heartandstroke.ca/heart-disease/conditions/valvular-heart-disease
Valvular heart disease can develop before or at birth (congenital causes) or normal valves may become damaged during ones lifetime (acquired causes). The cause of valvular heart disease is not always known. Support for more research into the causes of valvular heart disease is needed. […] Congenital valvular heart disease This is a birth defect that may involve a heart valve being the wrong size or the wrong shape, or its valve flaps (leaflets) not being properly attached to the heart. […] Bicuspid aortic valve disease A congenital defect that affects the aortic valve. Instead of the normal three leaflets, the bicuspid aortic valve has only two leaflets. Without the third leaflet, the valve is unable to open or close properly, is more prone to aortic valve stenosis, and may lead to regurgitation.
- #5 Valvular heart disease | Heart and Stroke Foundationhttps://www.heartandstroke.ca/heart-disease/conditions/valvular-heart-disease
Marfan syndrome This is a genetic disorder that affects the bodys connective tissue. Connective tissue holds all the bodys cells, organs and tissues together, including in the heart. People with Marfan syndrome may develop mitral valve prolapse and aortic valve regurgitation. […] Rheumatic fever This is an inflammatory disease that can affect the heart valves if it isnt treated properly. Rheumatic fever usually starts as strep throat or an infection involving strep (streptococcal bacteria). Heart valves may be damaged or scarred as the body fights the strep infection. […] Infective (bacterial) endocarditis Common germs can travel through the bloodstream to the heart and infect the surface of the heart, including the heart valves. People with valvular heart disease are at a higher risk of developing infective endocarditis.
- #5 Valvular heart disease | Heart and Stroke Foundationhttps://www.heartandstroke.ca/heart-disease/conditions/valvular-heart-disease
Radiation therapy People who had radiation therapy to the chest due to cancer are more likely to develop valvular heart disease. […] Age Heart valve problems may result from degenerative changes, or normal wear and tear of aging. […] Other causes include coronary artery disease, damage to the heart muscle from a heart attack, other diseases of the heart muscle (cardiomyopathy), metabolic disorders such as high blood cholesterol, tumour in the heart, and certain medications.
- #6 Mitral Valve Regurgitation: Symptoms, Causes, Diagnosis, Treatmenthttps://www.webmd.com/heart-disease/what-is-mitral-valve-regurgitation
Mitral Valve Regurgitation Causes […] Numerous health conditions can cause mitral valve regurgitation. They include: […] Mitral valve prolapse. Often harmless and requiring no treatment, this condition causes the leaflets to bulge, or prolapse, into your left atrium rather than closing properly. […] Rheumatic heart disease. This is caused by rheumatic fever, a condition that can develop if strep throat goes untreated. It causes inflammation that can damage your mitral valve. […] Heart attack. This can damage the heart muscles that control your mitral valve, leading to sudden and severe mitral valve regurgitation. […] Congenital heart defects. These are problems you’re born with, such as a cleft mitral valve, a rare condition in which one of your mitral valve leaflets has a split in it.
- #6 Mitral Valve Regurgitation: Symptoms, Causes, Diagnosis, Treatmenthttps://www.webmd.com/heart-disease/what-is-mitral-valve-regurgitation
Cardiomyopathy. These are diseases of the heart muscle. The most common is ischemic cardiomyopathy, in which your heart muscle gets damaged due to lack of oxygen. Others include dilated cardiomyopathy and hypertrophic obstructive cardiomyopathy. […] Damaged tissue cords. The tissue that holds the leaflets of your mitral valve in place can stretch and tear due to traumatic injury to your chest, as can mitral valve prolapse. […] Infective endocarditis. This is inflammation of the lining of your heart’s valves and chambers. It’s a type of bacterial infection that can damage your mitral valve.
- #7 Mitral Regurgitation – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK553135/
Conditions like isolated cleft of the mitral valve, double orifice mitral valve, and parachute mitral valve (PMV), which is a congenital valvular anomaly where the chordae tendineae are attached to a single papillary muscle, have been linked to causing MR. […] Chronic rheumatic heart disease is associated with pancarditis and has mitral valve involvement, causing regurgitation in almost 100% of cases due to scarring of the valve and valve apparatus. […] Left ventricular dilation due to ischemic or nonischemic cardiomyopathy secondarily impairs leaflet coaptation of a structurally normal MV, resulting in secondary MR. […] Papillary muscle rupture is a rare condition seen in 1% to 2% of patients after myocardial infarction (MI) or infective endocarditis that leads to severe mitral regurgitation due to dysfunction of the papillary muscles.
- #7 Mitral Regurgitation – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK553135/
Ischemic mitral regurgitation results from prior MI associated with normal mitral valve leaflets and chordae. […] Atrial fibrillation associated: Results from a retrospective cohort study found atrial fibrillation to cause increased atrial and valve annular size, resulting in functional MR. […] Hypertrophic cardiomyopathy (HCM) can also lead to MR.
- #7 Mitral Regurgitation – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK553135/
Mitral regurgitation is a heart condition characterized by the incomplete closure of the mitral valve, leading to the backflow of blood from the left ventricle into the left atrium during systole. […] This results in a systolic murmur heard at the apex of the heart, often radiating to the left axilla. […] With a global prevalence of over 2%, mitral regurgitation is a common valvular abnormality with various causes, including congenital conditions, rheumatic fever, and degenerative changes in the valve. […] The underlying pathophysiologic basis for degenerative mitral regurgitation is most commonly related to myxomatous degeneration of the mitral valve, resulting in mitral valve prolapse (MVP). […] Connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, MASS phenotype, systemic lupus erythematosus, osteogenesis imperfecta, and pseudoxanthoma elasticum lead to secondary MVP, causing MR.
- #8 Mitral Stenosis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK430742/
Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. The most common cause of mitral stenosis is rheumatic fever, though the stenosis typically does not become clinically relevant until several decades later. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The most common cause of mitral stenosis is rheumatic fever. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The number one cause for most cases of mitral stenosis is rheumatic fever.
- #9 Mitral Valve Disease: Types, Causes, and Symptomshttps://www.healthline.com/health/mitral-valve-disease
Mitral valve stenosis is typically caused by scarring from rheumatic fever. Usually a childhood disease, rheumatic fever results from the bodys immune response to a streptococcal bacterial infection. Rheumatic fever is a serious complication of strep throat or scarlet fever. […] If the mitral valve becomes inflamed or otherwise injured by these conditions, it can lead to the chronic heart condition called rheumatic heart disease. […] Mitral valve prolapse often has no specific or known cause. It tends to run in families or occur in those who have other conditions, such as scoliosis and connective tissue problems. […] A variety of heart problems can cause mitral valve regurgitation. You may develop mitral valve regurgitation if you’ve had: endocarditis, or inflammation of the hearts lining and valves, heart attack, rheumatic fever. […] Damage to your hearts tissue cords or wear and tear to your mitral valve can also lead to regurgitation. Mitral valve prolapse can sometimes cause regurgitation.
- #10 Mitral valve incompetence: epidemiology and causeshttps://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-incompetence-epidemiology-and-causes
Rheumatic heart disease is the most serious sequela of rheumatic fever, developing to a varying degree in up to 50% of patients with rheumatic fever, leading to mitral valve regurgitation early or later in life. […] Papillary muscle rupture is another cause of acute mitral regurgitation. […] Mitral incompetence may occur as congenital malformations of the mitral valve. […] Endocarditis is one of the causes of primary MR. […] Prolonged use of certain medications can cause mitral valve regurgitation, such as those containing ergotamine (Cafergot, Migergot) that are used to treat migraines and other conditions. […] The common causes of organic (primary) MR include prolapse syndrome, flail leaflet, rheumatic heart disease, CAD, infective endocarditis, certain drugs, and collagen vascular disease.
- #10 Mitral valve incompetence: epidemiology and causeshttps://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-incompetence-epidemiology-and-causes
Mitral regurgitation (MR) is the second most frequent indication for valve surgery. The common causes of organic (primary) MR include prolapse syndrome, flail leaflet, rheumatic heart disease, coronary artery disease (CAD), infective endocarditis, certain drugs (some anorectic drugs), and collagen vascular disease. […] In primary MR, one or several components of the mitral valve apparatus are directly affected. The common causes of organic (primary) MR include prolapse syndrome, flail leaflet, rheumatic heart disease, coronary artery disease (CAD), infective endocarditis, certain drugs (some anorectic drugs), and collagen vascular disease. […] It is important to know the causes of MR because the management and treatment differ according to the aetiology. […] The most frequent aetiology of mitral incompetence is degenerative (prolapse, flail leaflet).
- #11 Mitral valve stenosis: epidemiology and causes in elderly patientshttps://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis in the elderly is an evolving and complex pathological entity. The prevalence of rheumatic disease in developing countries is important and, due to migration, it continues to be seen as the first cause of mitral stenosis in developed countries. […] Nowadays, in this increasingly large section of the population, mitral valve stenosis is mainly due to sequelae of chronic rheumatic valvular disease and to calcific degeneration. […] Rheumatic disease and degenerative calcific aetiology are the main causes contributing to the prevalence of mitral stenosis. Rheumatic disease accounts for about 85% and degenerative causes for about 12%; in all other valvular diseases this relationship is reversed. […] The second cause of mitral stenosis in the elderly is mitral annular calcification. Currently, this anatomopathological condition is rarely considered a cause of left ventricular inflow obstruction and is underestimated. Mitral annular calcification consists in the progressive deposition of calcium above and below the valvular fibrous ring causing a reduction of leaflet mobility and therefore a hindrance to physiological diastolic annular dilation.
- #11 Mitral valve stenosis: epidemiology and causes in elderly patientshttps://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Another possible cause of valvular disease, and consequently also of stenosis, is exposure to cancer therapies. The cardiotoxicity of chemotherapy and radiation therapy is a complication of oncological treatments administered 10 to 20 years earlier. […] Mitral stenosis is recognised as a chronic rheumatic heart disease and therefore as a consequence of acute rheumatic fever even when the patient has no history of rheumatic fever, probably as a result of a missed diagnosis. […] The disease has a different rate of progression depending on the geographical area, which reflects the quality of care and the epidemiology of the country. […] Calcification at the level of the mitral annulus can determine haemodynamically significant obstruction due to the impairment of physiological diastolic annular dilatation and the reduction of leaflet motion.
- #11 Mitral valve stenosis: epidemiology and causes in elderly patientshttps://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Among the promoters of the development of mitral annular calcification, disorders of tissue mineralisation play a key role that is particularly evident in elderly patients with chronic kidney disease and even more in those on dialysis. […] The increase in the average age of the population with the majority represented by the elderly is also due to the improvement in the quality and possibility of treatment. This is particularly true in the cardiovascular and oncological fields, which are the main areas of disease prevalence in the elderly population. […] An active understanding of changes in population characteristics and their consequences on the aetiological evolution allows us to continue to improve and personalise the currently available therapies for complex pathologies.
- #12 Mitral Valve Diseasehttps://www.erlanger.org/medical-services/heart/heart-conditions/mitral-valve-disease
Mitral valve stenosis is usually the result of scarring caused by rheumatic fever. This condition, which primarily occurs in childhood, results from the bodys response to a strep infection. If the mitral valve becomes inflamed due to rheumatic fever, its known as rheumatic heart disease. As people age, the more common cause of mitral stenosis is calcium build up.
- #13 Mitral valve regurgitation – Symptoms and causes – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/symptoms-causes/syc-20350178
Mitral valve regurgitation is the most common type of heart valve disease. […] To understand the causes of mitral valve disease, it may be helpful to know how the heart works. […] Possible causes of mitral valve regurgitation include: Mitral valve prolapse. In this condition, the mitral valve’s flaps bulge back into the left upper heart chamber when the heart squeezes. This common heart problem can prevent the mitral valve from closing tightly and cause blood to flow backward. […] Rheumatic fever is a complication of untreated strep throat. Rheumatic fever can damage the mitral valve, leading to mitral valve regurgitation early or later in life. If rheumatic fever causes mitral valve disease, the condition is called rheumatic mitral valve disease. Rheumatic fever is rare in the United States.
- #13 Mitral valve regurgitation – Symptoms and causes – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/symptoms-causes/syc-20350178
A heart attack can damage the area of the heart muscle that supports the mitral valve. If there is a lot of heart attack damage, sudden and severe mitral valve regurgitation can occur. A leaky mitral valve caused by a heart attack is called ischemic mitral regurgitation. […] Some people are born with heart structure problems, including damaged heart valves. […] Cardiomyopathy makes it harder for the heart to pump blood to the rest of the body. The condition can affect how the mitral valve works, causing regurgitation. […] Over time, the pieces of tissue that hold the flaps of the mitral valve to the heart wall may stretch or tear. This is especially likely in people with mitral valve prolapse. […] Inflammation of the inner lining of the heart’s chambers and valves, called endocarditis. This condition is usually caused by an infection. […] Rarely, radiation therapy for cancer that is focused on the chest area can lead to mitral valve regurgitation.
- #14https://continentalhospitals.com/diseases/mitral-valve-disease/
Infective Endocarditis: This is an infection of the heart valves or inner lining of the heart, often caused by bacteria. It can damage the mitral valve, leading to regurgitation or, less commonly, stenosis. […] Congenital Heart Defects: Some people are born with abnormalities in the mitral valve that can lead to dysfunction later in life. […] Degenerative Valve Disease: Age-related changes can cause the mitral valve to become thickened and calcified, leading to stenosis or regurgitation. […] Cardiomyopathy: Diseases of the heart muscle, such as dilated cardiomyopathy, can affect the function of the mitral valve, often leading to regurgitation. […] Ischemic Heart Disease: Reduced blood flow to the heart, typically from coronary artery disease, can lead to damage or dysfunction of the mitral valve. […] Trauma: Rarely, physical injury to the chest can damage the mitral valve, causing regurgitation.
- #15 Mitral Valve Regurgitation: Symptoms & Causes | NewYork-Presbyterianhttps://www.nyp.org/heart/heart-valves/mitral-valve-regurgitation
Cardiomyopathy. A condition in which the heart muscle fails. Cardiomyopathy can result from conditions such as hypertension (high blood pressure), heart attack, or infection; in some patients, no clear cause is identified. […] Endocarditis. A very serious condition involving an infection of the heart valves that generally requires several weeks of antibiotics to treat […] Heart attack. Heart attacks can result in damage to the heart muscle that supports the mitral valve, possibly leading to mitral valve regurgitation […] Congenital heart defects. This includes any structural defects present from birth that prevent the mitral valve from closing properly […] Rheumatic fever. An inflammatory condition that results when strep throat or scarlet fever is not properly treated. It can damage the heart and its valves, resulting in mitral valve regurgitation.
- #15 Mitral Valve Regurgitation: Symptoms & Causes | NewYork-Presbyterianhttps://www.nyp.org/heart/heart-valves/mitral-valve-regurgitation
Damaged tissue cords. Small pieces of tissue anchor the flaps of the mitral valve to the wall of the heart. These tissues can tear or stretch over time, particularly in people with mitral valve prolapse. […] Radiation therapy that is used to treat cancer in the chest area can cause mitral valve regurgitation […] Calcium buildup. Calcium can accumulate on structures within the mitral valve, causing them to become less flexible and possibly preventing them from closing properly.
- #16 Mitral Valve Disorders | Conditions | UCSF Healthhttps://www.ucsfhealth.org/conditions/mitral-valve-disorders
Valves control blood flow through the heart. The mitral valve controls blood flow from the left atrium into the left ventricle. […] If left untreated, mitral valve disease may lead to more serious problems, such as heart dilation, in which the heart’s walls become stretched and weakened. […] Myxomatous degeneration of the valve, also known as „floppy valve” or mitral valve prolapse, is the most common condition that requires mitral valve repair. […] Mitral valve stenosis is a narrowing of the opening of the mitral valve, which can prevent the valve from opening and closing normally, reducing the amount of blood flow through the heart. […] Endocarditis typically occurs when bacteria or other germs in the mouth, intestinal tract or urinary tract travel to the heart via the bloodstream and lodge in the heart.
- #17 Heart Valve Disease Causes | National Jewish Healthhttps://www.nationaljewish.org/conditions/heart-valve-disease/causes
Rheumatic fever was the single biggest cause of valve disease before widespread availability of good antibiotics. […] Most valvular disease in the United States at the current time is due to: […] Myxomatous degeneration: Age-related degeneration – It happens most often in elderly patients and commonly affects the mitral valve. […] Calcific degeneration: A buildup of calcium on the aortic or mitral valves due to age or other reasons causes thickened valves which prevents them from closing well. […] Congenital (genetic) disease: Irregularly-shaped valves that people are born with. […] Weight loss medicines such as fen-phen and Redux: These can accelerate valvular damage. […] Endocarditis: An infection in the lining of the heart’s walls and valves. Sometimes infections can destroy the valves. […] Coronary artery disease: This can cause functional limitations in the parts of the heart muscle which support the heart valves. […] Hypertension: Can lead to degeneration (wear and tear injuries).
- #18 Mitral Regurgitation: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/155618-overview
Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle (LV) to the left atrium (LA). It is caused by disruption in any part of the mitral valve (MV) apparatus. The most common etiologies of MR include MV prolapse (MVP), rheumatic heart disease, infective endocarditis, annular calcification, cardiomyopathy, and ischemic heart disease. […] Causes of acute mitral regurgitation (MR) include coronary artery disease, infectious endocarditis, chordae tendineae rupture (as with myxomatous valve disease), valvular surgery, and other conditions. […] Causes of chronic MR include the following: rheumatic heart disease, systemic lupus erythematosus, scleroderma, myxomatous degeneration (mitral valve prolapse, Ehlers-Danlos syndrome, Marfan syndrome), calcification of mitral valve annulus, infective endocarditis (can affect normal, abnormal, or prosthetic mitral valves), ruptured chordae tendineae (trauma, mitral valve prolapse, endocarditis, spontaneous), functional MR (dilation of mitral valve annulus, abnormal tethering of leaflets due to enlargement of LV cavity and stretch of papillary muscles and chordae [dilated cardiomyopathies, aneurysmal dilation of the left ventricle]), hypertrophic cardiomyopathy, systolic anterior motion of the mitral valve, perivalvular prosthetic leak, congenital (mitral valve clefts, mitral valve fenestrations, parachute mitral valve abnormality), drug-related (ergotamine, methysergide, pergolide, anorexiant medications).
- #19 Pathophysiology and natural history of chronic mitral regurgitation – UpToDatehttps://www.uptodate.com/contents/pathophysiology-and-natural-history-of-chronic-mitral-regurgitation
Mitral valve prolapse (MVP) â This condition includes a range of disorders ranging from myxomatous mitral valve disease (also known as myxomatous degeneration, with redundancy of anterior and posterior mitral leaflets and the chordae), seen primarily in younger populations, and fibroelastic deficiency disease, seen primarily in older populations. […] It is not clear if these are two distinct disease processes or manifestations of a single disease. […] In mitral valve prolapse, what appears to be excessive mitral leaflet tissue and excessive surface area leads to redundancy, folding, and hooding affecting one or more segments of one or both leaflets. […] The alterations yield inadequate apposition of the rough zones of the mitral leaflets so they no longer support each other during systole and fall into the left atrium.
- #20 Diseases of the Mitral Valve | The Texas Heart Institute®https://www.texasheart.org/heart-health/heart-information-center/topics/diseases-of-the-mitral-valve/
The mitral valve regulates the flow of blood from the upper-left chamber (the left atrium) to the lower-left chamber (the left ventricle). […] Three diseases of the mitral valve are mitral valve prolapse, mitral regurgitation, and mitral stenosis. […] MVP is one of the most common forms of valve disease. It also runs in families. Some forms of MVP have been associated with Marfan syndrome, a connective tissue condition where patients have long bones and very flexible joints. […] Mitral regurgitation is usually caused by conditions that weaken or damage the valve. The most common causes of mitral regurgitation in adults are listed below. […] Mitral stenosis is usually caused by rheumatic fever, but it can be caused by any condition that causes narrowing of the mitral valve.
- #21 Mitral valve regurgitation | Radiology Reference Article | Radiopaedia.orghttps://radiopaedia.org/articles/mitral-valve-regurgitation?lang=us
Mitral regurgitation can be caused by damage to any of the mitral valve leaets, the annulus, the chordae tendineae, the papillary muscles, and the subjacent myocardium 2. Thus, the causes of mitral regurgitation are protean, and, as such, there is no single group of patients who are affected 1,2. […] Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2. Furthermore, causes and mechanisms can be divided into primary causes (i.e. degenerative) or secondary causes (i.e. functional) 1,2. […] Causes and mechanisms include 1,2: acute mitral regurgitation, myocardial infarction with a papillary muscle rupture, infective endocarditis, chordae tendinae rupture seen in myxomatous degeneration (e.g. due to mitral valve prolapse, Marfan syndrome, Ehlers-Danlos syndrome, etc.), prosthetic mitral valve dysfunction, trauma; chronic mitral regurgitation, annular calcification, myxomatous degeneration (same underlying causes as in acute mitral regurgitation), previous infective/inflammatory illness (rheumatic heart disease, infective endocarditis, connective tissue diseases), congenital valvular malformation (e.g. parachute mitral valve in the Shone complex), dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy.
- #22 Causes of Mitral Valve Stenosis/Regurgitation | Stanford Health Carehttps://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/mitral-valve-stenosis-regurgitation/causes.html
Mitral valve stenosis occurs when the mitral valve in your heart narrows, restricting blood flow into the main pumping chamber. […] Potential stenosis causes include: Calcium buildup: As we age, calcium in the blood can collect around the mitral valve and harden it. Calcium buildup is the most common cause of mitral stenosis. […] Rheumatic heart disease: Rheumatic fever was once a common and serious complication of strep throat, but the frequency has significantly declined with the use of antibiotics. Mitral valve complications can occur years after you have rheumatic fever. […] Potential regurgitation causes, as well as factors that can increase your risk, include: Mitral valve prolapse: Prolapse is the most common cause of mitral regurgitation, and features extra tissue in the valve that keeps it from closing. Certain inherited genes can increase your risk of developing prolapse.
- #23 Mitral Valve Disease Causes, Symptoms, and Treatmenthttps://www.upmc.com/services/heart-vascular/conditions/mitral-valve-disease
Mitral valve disease occurs when your mitral valve stops opening and closing properly. […] The cause of mitral valve disease depends on whether you have mitral stenosis or mitral regurgitation. […] Causes of mitral stenosis include: Blockage as you age, calcium can build up around and on your mitral valve. This is the most common form of mitral stenosis. […] Infection Rheumatic fever and scarlet fever in childhood may cause the leaflets of your valve to thicken or fuse over prolonged periods of time, preventing it from opening properly. This is the second most common cause of mitral stenosis. […] Causes of mitral regurgitation include: Infection A type of infection called endocarditis occurs when bacteria enter the blood stream and attach themselves to the mitral valve. […] Mitral valve prolapse This happens when you are born with excess leaflet tissue, known as a floppy mitral valve. This may cause your mitral valve to leak as you age. This is the most common cause of mitral regurgitation.
- #24 Mitral Valve Disease Symptoms, Causes, Types (Orange County)https://www.hoag.org/specialties-services/heart-vascular/specialty-programs/heart-valve-program/conditions/mitral-valve-disease/
Radiation therapy to the chest during cancer treatment, which can lead to heart valve damage later in life. […] Chest trauma from an accident or injury, though this is a very rare cause of mitral valve damage. […] Certain drugs or chemical agents, including ergot and the discontinued late-1990s weight loss drug Phen-Fen (fenfluramine/phentermine).
- #25 What Causes Mitral Regurgitation?http://www.cardiosmart.org/topics/mitral-regurgitation/what-causes-mitral-regurgitation
Endocarditis: This bacterial infection can attach to the heart valves and damage the valve itself. […] Trauma: For example, trauma to the chest in a car accident. […] Congenital heart defects: Some people are born with either leaky heart valves or enlarged hearts that make it hard for the valves to close. […] Drugs: The medications ergotamine and bromocriptine have been linked with mitral regurgitation. […] Age: Over time, your body can deposit calcium around the valves and make it hard for your valves to close tightly.
- #26 Mitral valve regurgitation: MedlinePlus Medical EncyclopediaLockhttps://medlineplus.gov/ency/article/000176.htm
Mitral regurgitation may begin suddenly. This often occurs after a heart attack. […] Many other diseases or problems can weaken or damage the valve or the heart tissue around the valve. You are at risk for mitral valve regurgitation if you have: […] Another important risk factor for mitral regurgitation is past use of a diet pill called „Fen-Phen” (fenfluramine and phentermine) or dexfenfluramine. The drug was removed from the market by the U.S. Food and Drug Administration (FDA) in 1997 because of safety concerns.
- #27 Mitral valve regurgitation – UF Healthhttps://ufhealth.org/conditions-and-treatments/mitral-valve-regurgitation
Mitral regurgitation may begin suddenly. This often occurs after a heart attack. When the regurgitation does not go away, it becomes long-term (chronic). […] Many other diseases or problems can weaken or damage the valve or the heart tissue around the valve. You are at risk for mitral valve regurgitation if you have: […] Another important risk factor for mitral regurgitation is past use of a diet pill called „Fen-Phen” (fenfluramine and phentermine) or dexfenfluramine. The drug was removed from the market by the U.S. Food and Drug Administration (FDA) in 1997 because of safety concerns.
- #28 Heart valve disease module 1: epidemiology – The British Journal of Cardiologyhttps://bjcardio.co.uk/2016/03/heart-valve-disease-module-1-epidemiology-2/5/
Rheumatic disease is the most common cause of valve disease in the young worldwide with an estimated prevalence of 15.619.6 million. […] In industrially developed regions diseases of old age predominate, particularly calcific aortic stenosis and functional mitral regurgitation. […] Drug-induced valve disease is increasing as a result of 5HT2b receptor agonists. […] Infective endocarditis is increasingly related to medical devices and intravenous drug use.