Insufficienza mitralica, rischi e diagnosi

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L’insufficienza mitralica o rigurgito della valvola mitralica è una condizione in cui il sangue, anziché uscire dal cuore dal ventricolo sinistro, torna indietro nell’atrio, a causa di un errato funzionamento della valvola. Un’insufficienza mitralica lieve può non dare sintomi e neppure destare rischi di sorta, per tutta la vita. In altri casi invece può manifestarsi all’improvviso in forma severa. Ecco le complicanze più comuni e pericolose, oltre che una lista dei test per fare la diagnosi.

 

cuore ingrossato significa perché


Rischi e complicanze dell’insufficienza mitralica (moderata o severa)

  • Insufficienza cardiaca: è quella condizione che si sviluppa quando il cuore non riesce a pompare abbastanza sangue per soddisfare le esigenze dell’organismo. Un grave rigurgito della valvola mitrale provoca uno sforzo più intenso per il muscolo cardiaco ad ogni battito: il ventricolo sinistro allora comincia a dilatarsi, ad ingrossarsi e se non si cura il problema si arriva a insufficienza cardiaca grave. A questo si aggiunge che il tutto provoca una pressione maggiore sui polmoni, con conseguente accumulo di liquidi, che può arrivare a colpire anche il lato destro del cuore.
  • Fibrillazione atriale. L’allungamento e allargamento dell’atrio sinistro del cuore possono portare a questa irregolarità del ritmo cardiaco in cui le camere superiori del cuore battono caoticamente e rapidamente. La fibrillazione atriale può causare coaguli di sangue, che possono staccarsi e viaggiare in altre parti del corpo, causando seri problemi, come un ictus se un coagulo blocca un vaso sanguigno nel cervello.
  • Ipertensione polmonare. Sul lungo tempo un’ insufficienza mitralica non trattata o trattata in modo inadeguato, può sviluppare un tipo di pressione alta che colpisce le arterie dei polmoni (ipertensione polmonare). Anche tale condizione può compromettere il funzionamento del lato destro del cuore.

 

Come si fa la diagnosi

Se si pensa di avere un rigurgito della valvola mitrale, è importante fissare un appuntamento con il medico curante o meglio ancora con uno specialista in cardiologia. Il medico inizierà la sua valutazione con l’anamnesi dettagliata (storia clinica del paziente, familiarità con patologie cardiovascolari) ed una visita clinica (che comprenderà l’ascolto del cuore con lo stetoscopio- un’insufficienza della valvola mitrale spesso produce un soffio al cuore- e la misurazione della pressione). Potranno poi essere necessari altri test diagnostici. Tra i più comuni troviamo:

  • Ecocardiogramma: aiuta il medico a guardare da vicino il cuore e la valvola mitrale anche durante il battito, per valutarne, dimensioni e funzionamento
  • Elettrocardiogramma (ECG): registra gli impulsi elettrici del cuore fornendo informazioni sul ritmo cardiaco. Si può fare a riposo o sotto sforzo (camminando su tapis roulant o pedalando su una cyclette durante un ECG).
  • Radiografia del torace (RX): permette al medico di determinare se l’atrio sinistro o il ventricolo sinistro sono ingrossati – possibili indicatori di rigurgito della valvola mitrale – e la condizione dei polmoni
  • Ecocardiogramma transesofageo. Un piccolo trasduttore attaccato alla fine di un tubo viene inserito nell’ esofago, permettendo uno sguardo ancora più specifico e dettagliato della valvola mitrale rispetto ad un ecocardiogramma normale
  • Cateterismo cardiaco. Questa tecnica invasiva comporta l’inserimento di un tubo sottile (catetere) attraverso un vaso sanguigno nel braccio o inguine ad un’arteria nel cuore e l’iniezione di un colorante (mezzo di contrasto) attraverso il catetere per rendere l’arteria visibile su una radiografia. Ciò fornisce un quadro dettagliato delle arterie del cuore e della sua funzionalità. Può anche misurare la pressione all’interno delle camere cardiache.

Cure e farmaci

Stabilita una diagnosi di rigurgito della valvola mitralica si potrà procedere al trattamento: questo dipenderà dalla gravità della condizione e dallo stato generale di salute del cuore del paziente. L’obiettivo del trattamento è quello di migliorare la funzione del cuore, riducendo al minimo i segni ed i sintomi ed evitare complicazioni future. Per cui si potrà optare per una sorveglianza attiva (controlli regolari dal cardiologo), utilizzo di farmaci (per controllare i sintomi e prevenire i rischi: non esiste un medicinale che ripara la valvola), chirurgia di riparazione della valvola.

 

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Foto: Thinkstock

Fonte: Mayo clinic

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