MANAGEMENT OF HEART DISEASE

It is a mitral or bicuspid valve disease, where the valve fails to close completely to recovered blood flow. It is also called mitral insufficiency or mitral incompetence. We know that heart has four chamber right atrium, right ventricle, left atrium and left ventricle. In between left atrium and left ventricle mitral valve is present. In mitral valve there are two flat cusp or leaflet are present. It prevents backward movement of blood. But if there mitral regurgitation is present, valve cannot close completely. When heart contraction or ventricular contraction occur, the left ventricular blood back into left atrium. If mitral regurgitation is mild there is no significance value. But in moderate or severe condition left ventricle work heard to pumped blood .Heart muscle also work overtime. If this condition continued heart failure occur.

CAUSES OF MITRAL REGURGITATION:

1. Rheumatic fever: It is the most common causes of mitral regurgitation .It causes an inflammation of heart valve include mitral valve. For this valve cannot close completely and mitral regurgitation occur.

2. Mitral valve prolapsed: In mitral valve prolapsed ,two cusp of mitral valve cannot come together normally and mitral regurgitation occur.

3. Infective endocarditis:In infective endocarditis infection of heart valve occurs by microorganism(Bacteria ,fungi).An abnormal mass formed in heart valve and valve cannot close properly.

4. Myocardial infarction

5. Myxomatous proliferation.

5. Dilation of left ventricle and mitral valve ring

SYMPTOMS:

§Dyspnoea or breathlessness

§Palpitation

§Orthopnea

§Chronic weakness

§Oedema or ascitis

SIGN:

§Pulse: Irregularly irregular

§Pansystolic murmur

§Soft first heart sound

§Present of third heart sound

§Pulmonary component of second heart sound is loud

§Crepitation is present

§Ankylosing spondylitis

INVESTIGATION:

1. ECG:

   §Left ventricular hypertrophy found

  § If there is no atrial fibrillation left atrial hypertrophy are present.

  §Atrial fibrillation

2. CHEST X-RAY

    §Size of the heart enlarges transversely.

3. ECHOCARDIOGRAM:

    Left ventricle are dilated and hyperdynamic

   Dilated left atrium present

4. CARDIAC CATHETERISATION:

    Pulmonary hypertension

   Coronary artery disease can be diagnosed.

TREATMENT:

A. In mild to moderate condition:

 1. Prophylactic drug can be used to prevent infective endocarditis and rheumatic fever.

2. Diuretics (Furosemide) can be used

3. Vasodialator (ACE inhibitor) may be used.

4. If atrial fibrillation present digitoxin can be used.

5. Follow up every six month by echocardiogram.

B. In severe condition, mitral valve replacement or repair is needed.