bubble_chart Overview

Rheumatic mitral insufficiency is one of the earliest clinical manifestations of acute rheumatic carditis. A systolic murmur at the apex indicates the presence of mitral regurgitation. If rheumatic fever is promptly controlled in the early stages and does not recur, the murmur may completely disappear. However, approximately two-thirds of affected children may later develop organic mitral insufficiency. Pathologically, the valve leaflets, papillary muscles, and chordae tendineae become shortened and adherent, preventing the leaflets from closing properly during systole. Hemodynamically, this results in partial backflow of blood from the left ventricle into the left atrium, leading to left atrial enlargement and volume overload in the left ventricle. In severe or advanced cases, pulmonary hypertension may develop, causing right ventricular hypertrophy and failure.

bubble_chart Diagnosis

(1) Symptoms and Signs

1. Symptoms: Mild cases often present with no symptoms. Those with significant regurgitation may exhibit palpitations, lack of strength, and shortness of breath due to reduced cardiac output.
2. Signs: The precordial area appears full, with an active and widely displaced apical impulse shifting downward and to the left. A high-pitched, holosystolic regurgitant murmur of grade ! or higher may be heard at the apex, radiating to the axilla. Severe cases may be accompanied by an early diastolic murmur in the precordial area (relative mitral stenosis or high flow across the mitral valve).

(2) Electrocardiogram Severe cases may show left axis deviation, left ventricular hypertrophy, and left atrial enlargement.

(3) X-ray Examination Severe cases may demonstrate cardiomegaly, predominantly left atrial enlargement, left ventricular hypertrophy, a smaller aortic knob, pulmonary congestion, or signs of pulmonary edema.

(4) Echocardiography Two-dimensional long-axis views of the left ventricle reveal incomplete mitral valve closure during systole. Short-axis views of the mitral valve show pathological changes in the valve membrane. Indirect signs such as left ventricular and left atrial enlargement may also be observed. Pulsed Doppler detects a turbulent flow spectrum on the left atrial side of the mitral valve during systole.

bubble_chart Treatment Measures

﹝Treatment﹞

(1) Since early-stage wind-dampness carditis is almost always accompanied by mitral regurgitation, although clinical signs of mitral insufficiency are present, they are actually one of the manifestations of early active wind-dampness. Therefore, the treatment plan should strictly follow the protocol for acute wind-dampness fever (refer to the wind-dampness fever section).

(2) For cases where organic sexually transmitted disease changes have already formed in the mitral valve, if there are no obvious clinical symptoms, excessive restriction of activity is generally unnecessary. However, attention must still be paid to preventing and treating wind-dampness recurrence. If tooth extraction or surgical procedures are required, penicillin should be administered in advance to prevent sepsis or infective endomembraneitis.

(3) Digitalis preparations can exert a positive inotropic effect on those with excessive left ventricular load, making them more effective in controlling the symptoms of cardiac insufficiency caused by this condition compared to mitral stenosis.

(4) Most cases of moderate and grade III wind-dampness mitral insufficiency are combined with mitral stenosis and often involve left heart failure. Conservative medical treatment alone is often ineffective, and surgical intervention should be considered for eligible patients.