Diagnosis of autonomic dysfunction of the heart. Heart diseases that cause disability Diastolic dysfunction of the left ventricle risk 4
In order for every cell of the human body to receive blood with vital oxygen, the heart must work correctly. The pumping function of the heart is carried out through alternate relaxation and contraction of the heart muscle - the myocardium. If any of these processes are disrupted, dysfunction of the ventricles of the heart develops, and the ability of the heart to push blood into the aorta gradually decreases, which affects the blood supply to vital organs. Myocardial dysfunction or dysfunction develops.
Ventricular dysfunction is a violation of the ability of the heart muscle to contract during systolic contraction to expel blood into the vessels and relax during diastolic contraction to accept blood from the atria. In any case, these processes cause disruption of normal intracardiac hemodynamics (blood movement through the heart chambers) and stagnation of blood in the lungs and other organs.
Both types of dysfunction have a relationship with - the more impaired ventricular function, the higher the severity of heart failure. If CHF can occur without cardiac dysfunction, then dysfunction, on the contrary, does not occur without CHF, that is, every patient with ventricular dysfunction has chronic heart failure of the initial or severe stage, depending on the symptoms. This is important for the patient to take into account if he believes that taking medication is not necessary. You also need to understand that if a patient is diagnosed with myocardial dysfunction, this is the first signal that some processes are occurring in the heart that need to be identified and treated.
Left ventricular dysfunction
Diastolic dysfunction
Diastolic dysfunction of the left ventricle of the heart is characterized by a violation of the ability of the left ventricular myocardium to relax to fully fill with blood. The ejection fraction is normal or slightly higher (50% or more). In its pure form, diastolic dysfunction occurs in less than 20% of all cases. The following types of diastolic dysfunction are distinguished: impaired relaxation, pseudonormal and restrictive type. The first two may not be accompanied by symptoms, while the last type corresponds to severe CHF with severe symptoms.
Reasons
- with myocardial remodeling,
- – increase in the mass of the ventricles due to thickening of their walls,
- Arterial hypertension,
- – inflammation of the outer lining of the heart, the heart “bag”,
- Restrictive myocardial lesions (endomyocardial Loeffler's disease and endomyocardial fibrosis of Davis) are compactions of the normal structure of the muscular and inner lining of the heart, which can limit the process of relaxation, or diastole.
Signs
An asymptomatic course is observed in 45% of cases of diastolic dysfunction.
Clinical manifestations are caused by increased pressure in the left atrium due to the fact that blood cannot flow into the left ventricle in sufficient volume due to its constant state of tension. Blood also stagnates in the pulmonary arteries, which is manifested by the following symptoms:
- , at first slight when walking or climbing stairs, then pronounced at rest,
- Dry nasal pain, worsening when lying down and at night,
- Feelings of interruptions in the work of the heart, chest pain, most often accompanying atrial fibrillation,
- Fatigue and inability to perform previously well-tolerated physical activities.
Systolic dysfunction
Left ventricular systolic dysfunction characterized by decreased contractility of the heart muscle and a reduced volume of blood ejected into the aorta. Approximately 45% of people with CHF have this type of dysfunction (in other cases, the function of myocardial contractility is not impaired). The main criterion is that the left ventricle is less than 45% according to cardiac ultrasound results.
Reasons
- (in 78% of patients with a heart attack, left ventricular dysfunction develops on the first day),
- – expansion of the cavities of the heart due to inflammatory, dyshormonal or metabolic disorders in the body,
- viral or bacterial nature,
- Mitral valve insufficiency (acquired heart disease),
- in later stages.
Symptoms
The patient may note both the presence of characteristic symptoms and their complete absence. In the latter case, they speak of asymptomatic dysfunction.
Symptoms of systolic dysfunction are caused by a decrease in blood ejection into the aorta, and, consequently, depletion of blood flow in the internal organs and skeletal muscles. The most characteristic signs:
- Paleness, bluish discoloration and coldness of the skin, swelling of the lower extremities,
- Fatigue, causeless muscle weakness,
- Changes in the psycho-emotional sphere due to depletion of cerebral blood flow - insomnia, irritability, memory impairment, etc.
- Impaired kidney function, and resulting changes in blood and urine tests, increased blood pressure due to activation of the renal mechanisms of hypertension, swelling on the face.
Right ventricular dysfunction
Reasons
The above diseases remain relevant as causes of right ventricular dysfunction. In addition to them, isolated right ventricular failure can be caused by diseases of the bronchopulmonary system (severe bronchial asthma, emphysema, etc.), congenital and defects of the tricuspid valve and pulmonary valve.
Symptoms
Right ventricular dysfunction is characterized by symptoms that accompany blood stagnation in the organs of the systemic circulation (liver, skin and muscles, kidneys, brain):
- Pronounced skin of the nose, lips, nail phalanges of the fingers, tips of the ears, and in severe cases the entire face, hands and feet,
- Edema of the lower extremities, appearing in the evening and disappearing in the morning, in severe cases - edema of the whole body (anasarca),
- Liver dysfunction, up to cardiac cirrhosis in the later stages, and the resulting enlargement of the liver, pain in the right hypochondrium, abdominal enlargement, yellowness of the skin and sclera, changes in blood tests.
Diastolic dysfunction of both ventricles of the heart plays a decisive role in the development of chronic heart failure, and disorders of systole and diastole are parts of one process.
What examination is needed?
If a patient experiences symptoms similar to signs of dysfunction of the ventricular myocardium, he should consult a cardiologist or therapist. The doctor will conduct an examination and prescribe any of the additional examination methods:
When to start treatment?
Both the patient and the doctor must be clearly aware that even asymptomatic dysfunction of the ventricular myocardium requires the prescription of medications. Simple rules for taking at least one tablet a day can prevent the onset of symptoms for a long time and prolong life in the event of severe chronic circulatory failure. Of course, at the stage of severe symptoms, one tablet cannot improve the patient’s well-being, but the most appropriately selected combination of drugs can significantly slow down the progression of the process and improve the quality of life.
So, at an early, asymptomatic stage of the course of dysfunction, it is imperative to prescribe or, if intolerable, angiotensin II receptor antagonists (ARA II). These drugs have organoprotective properties, that is, they protect the organs that are most vulnerable to the adverse effects of persistently high blood pressure, for example. These organs include the kidneys, brain, heart, blood vessels and retina. Daily intake of the drug in the dose prescribed by the doctor significantly reduces the risk of complications in these structures. In addition, ACE inhibitors prevent further myocardial remodeling, slowing the development of CHF. Among the drugs prescribed are enalapril, perindopril, lisinopril, quadripril, from ARA II losartan, valsartan and many others. In addition to them, treatment is prescribed for the underlying disease that caused the dysfunction of the ventricles.
At the stage of pronounced symptoms, for example, with frequent shortness of breath, nocturnal attacks of suffocation, swelling of the extremities, all main groups of drugs are prescribed. These include:
- – veroshpiron, diuver, hydrochlorothiazide, indapamide, lasix, furosemide, torasemide eliminate blood stagnation in the organs and lungs,
- (metoprolol, bisoprolol, etc.) reduce the heart rate, relax peripheral blood vessels, helping to reduce the load on the heart,
- You should limit the intake of table salt from food (no more than 1 gram per day) and control the amount of liquid you drink (no more than 1.5 liters per day) to reduce the load on the circulatory system. Nutrition should be rational, according to the eating regimen with a frequency of 4 - 6 times a day. Fatty, fried, spicy and salty foods are excluded. It is necessary to expand the consumption of vegetables, fruits, fermented milk, cereals and grain products.
The second point of non-drug treatment is lifestyle correction. It is necessary to give up all bad habits, observe a work-rest schedule and devote sufficient time to sleep at night.
The third point is sufficient physical activity. Physical activity must correspond to the general capabilities of the body. It is quite enough to take walks in the evening or sometimes go out to pick mushrooms or go fishing. In addition to positive emotions, this type of rest contributes to the good functioning of neurohumoral structures that regulate the activity of the heart. Of course, during the period of decompensation, or worsening of the disease, all stress should be excluded for a period determined by the doctor.
What is the danger of pathology?
If a patient with an established diagnosis neglects the doctor’s recommendations and does not consider it necessary to take prescribed medications, this contributes to the progression of myocardial dysfunction and the appearance of symptoms of chronic heart failure. For everyone, this progression occurs differently - for some, slowly, over decades. And for some it happens quickly, within the first year from diagnosis. This is the danger of dysfunction - the development of severe CHF.
In addition, complications may develop, especially in cases of severe dysfunction with an ejection fraction of less than 30%. These include acute heart failure, including left ventricular failure (pulmonary edema), fatal arrhythmias (), etc.
Forecast
In the absence of treatment, as well as in the case of significant dysfunction accompanied by severe CHF, the prognosis is poor, since progression of the process without treatment invariably ends in death.
The human heart is represented by four chambers, the work of which does not stop for a minute. For rest, the organ uses the intervals between contractions - diastole. At these moments, the cardiac sections relax as much as possible, preparing for a new compression. In order for the body to be fully supplied with blood, clear, coordinated activity of the ventricles and atria is necessary. If the relaxation phase is disrupted, the quality of cardiac output accordingly deteriorates, and the heart, without sufficient rest, is more likely to wear out. One of the common pathologies associated with a disorder of the relaxation function is called “left ventricular diastolic dysfunction” (LVDD).
The diastolic function of the left ventricle is as follows: relaxing, this section is filled with blood in order to further transfer it to its destination, according to the continuous cardiac cycle. From the atria, blood moves to the ventricles, and from there to organs and tissues. The right half of the heart is responsible for the pulmonary circulation, and the left half is responsible for the large circle. The left ventricle pumps blood into the aorta, supplying oxygen to the entire body. Waste blood returns to the heart from the right atrium. It is then sent through the right ventricle to the lungs to be replenished with oxygen. The enriched blood flow again goes to the heart, heading to the left atrium, which pushes it into the left ventricle.
Thus, a huge load falls on the left ventricle. If dysfunction of this chamber develops, then all organs and systems will suffer from a lack of oxygen and nutrients. Diastolic left ventricular pathology is associated with the inability of this section to fully absorb blood: the cardiac cavity is either not completely filled, or this process is very slow.
Development mechanism
Left ventricular diastolic dysfunction develops when at least one of the successive stages of enrichment of the cardiac chamber with blood during diastole is disrupted.
- Myocardial tissue enters a relaxation phase.
- A passive flow of blood occurs from the atrium into the ventricular cavity due to the pressure difference in the chambers.
- The atrium makes a contractile movement, freeing itself from the rest of the blood, pushing it into the left ventricle.
As a result of abnormal relaxation of the left ventricle, blood circulation worsens, and the myocardium experiences negative structural changes. Hypertrophy of the muscle walls develops as the heart tries to compensate for the lack of cardiac output with more intense activity.Classification of violation
In its development, left ventricular diastole dysfunction goes through several stages. Each of them has its own distinctive features and is characterized by varying degrees of danger.
- Mild stage (type 1).
This is the initial stage of the pathology. Type 1 diastolic dysfunction of the left ventricular chamber correlates with a slightly delayed relaxation phase. Most of the blood enters the cavity during the process of relaxation during contraction of the left atrium. A person does not feel the manifestation of violations; obvious signs can only be detected by echocardiography. This stage is also called hypertrophic, since it occurs against the background of myocardial hypertrophy.
- Moderate pseudonormal stage (type 2).
The ability of the left ventricle to relax is further impaired. This is reflected in cardiac output. To compensate for the lack of blood flow, the left atrium works in an enhanced mode. This phenomenon is accompanied by increased pressure in this cavity and an increase in the size of the muscle wall. Now the saturation of the left ventricle with blood is ensured by the pressure difference inside the chambers. A person experiences symptoms that indicate pulmonary congestion and heart failure.
- The stage is restrictive, with a severe degree of impairment (type 3).
The pressure in the atrium, located on the left, increases significantly, the walls of the left ventricle thicken and lose flexibility. The disorders are accompanied by severe symptoms of a life-threatening condition (congestive heart failure). Pulmonary edema and an attack of cardiac asthma are possible.
Dysfunction or failure?
The concepts of “diastolic dysfunction of the left ventricle” and “left ventricular failure” should be distinguished. In the first case, there is no obvious threat to the patient’s life if the pathology is at the first stage. Worsening of the condition can be avoided with adequate treatment of type 1 left ventricular diastolic dysfunction. The heart continues to work practically unchanged, systolic function is not impaired.
Heart failure arises as a complication from diastolic disorders.
This is a more serious disease, it cannot be cured, the changes are irreversible, and the consequences are deadly. In other words, these two terms relate to each other as follows: dysfunction is primary, and failure is secondary.
Symptoms
Signs of left ventricular diastolic dysfunction make themselves felt when serious changes have already begun in the body. List of characteristic symptoms:
- Heartbeats become rapid both in an active state and in a calm state.
- The person cannot take a deep breath, as if the chest is being compressed.
- Attacks of dry cough indicate the appearance of congestion in the lungs.
- Any slight effort is difficult.
- Shortness of breath occurs both during movement and at rest.
- Increased frequency of sleep apnea attacks is also an indicator of problems in the left ventricle.
- Another sign is swelling of the legs.
Reasons
The main reasons for the deterioration of relaxation of the left ventricle are hypertrophy of its walls and loss of elasticity. Various factors lead to this condition:
- arterial hypertension;
- aortic stenosis;
- cardiomyopathy;
- heart rhythm disturbances;
- myocardial ischemia;
- age-related changes;
- gender factor (women are more susceptible);
- abnormal condition of the coronary arteries;
- inflammation of the pericardium of the constrictive type;
- overweight;
- diabetes mellitus;
- heart defects;
- heart attack
Treatment
The essence of treatment for diastolic dysfunction of the left ventricular wall is to restore blood circulation. To do this you need:
- eliminate tachycardia;
- keep blood pressure normal;
- normalize metabolism in the myocardium;
- minimize hypertrophic changes.-
List of main drugs used for medicinal purposes:
Among the most commonly used medications are: Carvedilol, Digoxin, Enalapril, Diltiazem.
Diastolic dysfunction can be diagnosed mainly using echocardiography, echocardiography supplemented by Doppler study, ECG, and laboratory tests.
Left ventricular diastolic dysfunction is a pathology that requires careful attention. Failure to see a doctor in a timely manner can result in an unfavorable prognosis for a person: disability or death. People with a history of cardiovascular disease should especially carefully monitor their health. Along with basic drug therapy, it is recommended to treat myocardial dysfunction with home remedies. Traditional medicine recipes can be found in large quantities on the Internet.
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Myxoma of the heart: symptoms and dangers 
Type 1 - what is this disease and how should it be treated? We will give the answer to the question asked in the materials of the presented article. In addition, you will learn about why such a pathological condition occurs and by what obvious signs it can be identified.
General information
Before answering the question of why type 1 left ventricular diastolic dysfunction occurs, you should find out what this organ is.
The left ventricle is called one of the 4 people. It is where it originates that ensures a continuous flow of blood in the body.
What kind of disease?
Diastolic dysfunction of this part of the heart is a significant decrease in its ability to drive blood into its cavity from the pulmonary artery. In other words, such a pathological condition leads to the inability to ensure normal blood circulation.
Thus, type 1 left ventricular diastolic dysfunction is a serious heart disease, which is characterized by the insufficient ability of the mentioned part of the organ to relax during diastole. It should be especially noted that it can take approximately 0.4 seconds. This time is quite enough to completely restore the tone and energy content of the heart muscle.
How dangerous is the disease?
Type 1 left ventricular diastolic dysfunction is caused by a fall in ejection fraction, which subsequently leads to a marked decrease in stroke volume. To prevent stagnation of blood in the lungs and compensate for dilatation, the ventricle begins to enlarge. If such a protective reaction of the body does not follow, then there is a clear threat of pulmonary hypertension (repeated), and the load on the other ventricle (right) also increases significantly, which subsequently leads to a decrease in its volume. As a result, venous hyperemia may occur in it. If acute dysfunction occurs, pulmonary edema easily develops.
Probable causes
Why can type 1 left ventricular diastolic dysfunction develop? The reasons for this phenomenon lie in the following:
- hypertensive pathologies;
- hypertrophic cardiomyopathy;
- infiltrative (periodic) heart lesions (that is, heart attacks, ischemic heart disease, chronic hypertension (arterial), as well as hypertrophy of individual cardiac segments that are outside the zone of dilatation and thinning).
Signs of deviation
This condition very often leads to the development of secondary pulmonary arterial and venous hypertension. This pathological condition can manifest itself in the following:
- persistent cough (often paroxysmal);
- nocturnal dyspnea (paroxysmal);
- dyspnea.
What other signs are used to determine type 1? Symptoms of such a deviation may not manifest themselves for a long time. However, as the disease progresses, patients begin to experience symptoms such as:
- regular pain in the heart, which is paroxysmal in nature (as with coronary artery disease);
- swelling of the lower extremities;
- shortness of breath (can be observed even at rest);
- spastic phenomena;
- feeling of lack of air.
If these symptoms occur, you should definitely consult your doctor. After all, the sooner this pathological condition is identified, the easier it is to take control. If the presented disease is detected too late, then its treatment will last a very long time, with the use of a large number of medications and all the necessary procedures.
How to cure?
Currently, there is no single treatment regimen that would be recognized by most specialists. This is partly due to the fact that this disease is rather difficult to diagnose. As mentioned above, such a deviation occurs asymptomatically for a very long time, as a result of which the patient seeks medical help too late.
So what should you do if you have type 1 left ventricular diastolic dysfunction? Treatment of such a disease comes down to eliminating the causes that provoke negative tendencies. Thus, patients need:
- cure existing ischemia;
- normalize heart rate;
- lower blood pressure.
Among other things, if such a pathological condition is detected, the patient is prescribed drugs from the ACE blocker group. Most often, the choice of specialists falls on Lizonopril. It is prescribed in the form of tablets of 20-40 milligrams per day (in two doses).
Good results in the treatment of this deviation can be achieved by using calcium blockers. Thus, both drug groups lower blood pressure, significantly reduce the oxygen demand of cardiac tissues, and also stop and reduce. By the way, as a result of taking these drugs, the functioning of heart diastole improves, which subsequently leads to normalization of hemodynamics.
The best results in the treatment of this disease were observed when potassium-sparing diuretics were combined with cardiac drugs. If urgently needed, other antihypertensive medications can be used.
Left ventricular diastolic dysfunction is a violation of natural processes when blood fills the area of the ventricle itself, and the heart at this time is in a relaxed state.
This pathology must be treated as early as possible and not ignored, since it is considered a phenomenon that precedes the development of heart failure with the left ventricular type.
Subsequently, the patient develops pulmonary edema and cardiac asthma.Causes and symptoms
Ventricular dysfunction is a pathology in which normal processes are disrupted when blood fully fills part of the heart during the period of its relaxation, which is called diastole. According to statistics, this problem most often occurs in women. The same applies to older people.
In a normal state, blood fills the organ in stages:
- first the myocardium relaxes;
- then a difference in pressure occurs, so that there is a passive flow of blood fluid into the ventricle from the atrium;
- further the atrium contracts, so there will be fullness.
Various reasons lead to the fact that one of these three phases is disrupted. In the future, this will lead to the fact that an insufficient volume of blood enters the ventricle, and this cannot ensure normal ejection. As a result, the person gradually develops an insufficient left ventricular type.
The factors that cause diastolic dysfunction of the left ventricle lead to the fact that relaxation gradually worsens, the walls of the ventricle become less elastic. As a rule, this is due to the fact that the myocardium becomes denser. This is affected by the following diseases:
- hypertrophic type cardiomyopathy;
- aortic stenosis (the mouth of the aorta gradually narrows);
- hypertensive disease.
In addition, hemodynamic processes may be disrupted for other reasons:
- Constrictive type pericarditis. The pericardium thickens, and because of this, the heart chambers are gradually compressed.
- Primary amyloidosis. Amyloid is deposited, which causes muscle fiber atrophy. Because of this, the walls of the myocardium become less elastic.
- Pathologies of the coronary blood vessels, which lead to cardiac ischemia and the development of myocardial stiffness due to the formation of scars.
Risk factors include diseases of the endocrine system, such as diabetes and obesity.
Signs of the disease may not appear at first, but then they will gradually begin to interfere with the patient’s normal life. The symptoms are:
- Dyspnea. At first it occurs only during intense physical activity, but then it will begin to appear spontaneously, even when the patient is at rest.
- Cough. Its intensity increases when a person is lying down, so it is better to sit down or stand up when the next coughing attack begins.
- Fatigue. It is difficult for the patient to bear any load, even the smallest. He gets tired quickly.
- Heartbeat quickens.
- Nocturnal dyspnea of paroxysmal type.
- Heart rhythm disturbances. This symptom occurs quite often. The patient complains of atrial fibrillation.
Types and treatment
Patients may have different types of this disease. Disturbances in the left ventricle develop gradually. Depending on their degree, the following forms of the disease are distinguished:
- Left ventricular dysfunction type 1. In this case, there are problems with relaxation of this part of the organ. This stage of pathology development is considered initial. The ventricle does not relax enough. The bulk of blood enters the ventricle when the atrium contracts.
- Second type. It is also called pseudonormal. At this phase, the pressure indicator in the atrium cavity increases, and completely reflexively. And the ventricle fills due to the presence of a difference in pressure.
- Third type. Also known as restrictive. This stage is considered terminal. It is associated with the fact that the pressure in the atrium cavity increases. The elasticity of the walls of the ventricle gradually decreases, which is due to severe rigidity.
Before starting treatment, a diagnosis is required. It includes procedures such as:
- echocardiography and Dopplerography of both chambers;
- radionuclide ventriculography;
- electrocardiography;
- X-ray examination.
These techniques help prevent irreversible changes in the early stages of the disease.
Therapy must be comprehensive.
To correct hemodynamic processes, a number of measures are required. First, you should always monitor your blood pressure. Secondly, you need to reduce your heart rate. Thirdly, you always need to maintain water and salt metabolism. This will reduce preload. In addition, remodeling of left ventricular hypertrophy is required.
Drug therapy
Drug therapy includes taking the following drugs:
- Adrenergic blockers. The drugs help slow down the rhythm of the heart, lower blood pressure, and improve nutrition of the myocardium at the cellular level.
- Angiotensin receptor antagonists and angiotensin-converting enzyme inhibitors. These are two different types of drugs, but they have similar effects. Such drugs have a beneficial effect on myocardial remodeling, increase the elasticity of its tissues, and lower blood pressure.
- Diuretics. Such products are designed to remove excess fluid reserves in the body, which will reduce shortness of breath.
- Calcium antagonists. When the amount of this compound in myocardiocytes decreases, the myocardium can relax normally.
- Nitrates. They are auxiliary means that are used if signs of ischemia appear.
All these activities and medications will help eliminate the heart problem. But such a pathology is serious and entails serious consequences, so the symptoms cannot be ignored, but self-treatment is also prohibited.
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Causes of left ventricular hypertrophy
Persistent hypertension
The most likely cause of thickening of the left ventricular muscle of the heart is hypertension, which does not stabilize for many years. When the heart has to pump blood against a high pressure gradient, pressure overload occurs and the myocardium is trained and thickened. Approximately 90% of left ventricular hypertrophies occur for this reason.
Cardiomegaly
This is a congenital hereditary or individual feature of the heart. A large heart in a large person may initially have wider chambers and thicker walls.
Athletes
The heart of athletes hypertrophies due to physical exertion at the limit of what is possible. Exercising muscles constantly release additional volumes of blood into the general bloodstream, which the heart has to pump additionally. This is hypertrophy due to volume overload.
Heart valve defects
Heart valve defects (acquired or congenital) that impair blood flow in the systemic circulation (supravalvular, valvular or subvalvular stenosis of the aortic mouth, aortic stenosis with insufficiency, mitral insufficiency, ventricular septal defect) create conditions for volume overload.
Coronary heart disease
With coronary heart disease, hypertrophy of the walls of the left ventricle occurs with diastolic dysfunction (impaired myocardial relaxation).
Cardiomyopathy
This is a group of diseases in which, against the background of sclerotic or dystrophic post-inflammatory changes, an increase or thickening of the parts of the heart is noted.
About cardiomyopathies
Pathological processes in myocardial cells are based on hereditary predisposition (idiopathic cardiopathy) or dystrophy and sclerosis. The latter are caused by myocarditis, allergies and toxic damage to heart cells, endocrine pathologies (excess catecholamines and somatotropic hormone), and immune disorders.
Types of cardiomyopathies occurring with LVH:
Hypertrophic form
It may produce diffuse or limited symmetrical or asymmetrical thickening of the muscle layer of the left ventricle. At the same time, the volume of the heart chambers decreases. The disease most often affects men and is inherited.
Clinical manifestations depend on the severity of obstruction of the heart chambers. The obstructive variant gives the clinical picture of aortic stenosis: heart pain, dizziness, fainting, weakness, pallor, shortness of breath. Arrhythmias may be detected. As the disease progresses, signs of heart failure develop.
The boundaries of the heart expand (mainly due to the left sections). There is a downward displacement of the apical impulse and dullness of heart sounds. A functional systolic murmur is characteristic, heard after the first heart sound.
Dilated form
It is manifested by expansion of the chambers of the heart and hypertrophy of the myocardium of all its parts. At the same time, the contractile capabilities of the myocardium decrease. Only 10% of all cases of this cardiomyopathy occur in hereditary forms. In other cases, inflammatory and toxic factors are to blame. Dilated cardiopathy often manifests itself at a young age (30-35 years).
The most typical manifestation is the clinical picture of left ventricular failure: bluish lips, shortness of breath, cardiac asthma or pulmonary edema. The right ventricle also suffers, which is expressed in cyanosis of the hands, enlarged liver, accumulation of fluid in the abdominal cavity, peripheral edema, and swelling of the neck veins. Severe rhythm disorders are also observed: paroxysms of tachycardia, atrial fibrillation. Patients may die due to ventricular fibrillation or asystole.
Hypertrophy of the left ventricular myocardium is diffuse. The expansion of the cardiac cavities prevails over the thickening of the myocardium. Learn more about the symptoms and treatment of cardiomyopathy.
Types of LVH
- Concentric hypertrophy results in a reduction in the cavities of the heart and thickening of the myocardium. This type of hypertrophy is characteristic of arterial hypertension.
- The eccentric version is characterized by expansion of the cavities with simultaneous thickening of the walls. This occurs when there is pressure overload, such as heart defects.
Differences between different types of LVH
Cardiomyopathy
Arterial hypertension
Sports heart
Age under 35 over 35 from 30 Floor both sexes both sexes more often men Heredity burdened with hypertension burdened with cardiomyopathy not burdened Complaints dizziness, shortness of breath, fainting, heart pain, rhythm disturbances headaches, less often shortness of breath stabbing pain in the heart, bradycardia Type of LVH asymmetrical uniform symmetrical Myocardial thickness more than 1.5 cm less than 1.5 cm decreases when the load stops LV dilatation rarely, more often a decrease Maybe more than 5.5 cm Complications of LVH
Moderate left ventricular hypertrophy is usually harmless. This is a compensatory reaction of the body designed to improve blood supply to organs and tissues. For a long time, a person may not notice hypertrophy, since it does not manifest itself in any way. As it progresses, the following may develop:
- myocardial ischemia, acute myocardial infarction,
- chronic cerebrovascular accidents, strokes,
- severe arrhythmias and sudden cardiac arrest.
Thus, left ventricular hypertrophy is a marker of cardiac overload and indicates the potential risks of cardiovascular accidents. Its combination with coronary heart disease is most unfavorable in the elderly and smokers with concomitant diabetes mellitus and metabolic syndrome (overweight and lipid metabolism disorders).
Diagnosis of LVH
Inspection
Left ventricular hypertrophy can be suspected already during the initial examination of the patient. Upon examination, the bluish color of the nasolabial triangle or hands, increased breathing, and swelling are alarming. When tapping, there are expansions of the boundaries of the heart. When listening - noise, dullness of tones, accent of the second tone. The survey may reveal complaints about:
- shortness of breath
- interruptions in heart function
- dizziness
- fainting
- weakness.
ECG
Left ventricular hypertrophy on the ECG shows a characteristic change in the voltage of the R waves in the chest leads on the left.
- In V6 the tooth is larger than in V. It is asymmetrical.
- The ST interval in V6 rises above the isoline, in V4 it falls below.
- In V1, the T wave becomes positive, and the S wave is higher than normal in V1.2.
- In V6, the Q wave is larger than normal and this is where the S wave appears.
- T negative in V5,6.
ECG may cause errors in assessing hypertrophy. For example, an incorrectly placed chest electrode will give an incorrect idea of the state of the myocardium.
Ultrasound of the heart
With ECHO-CS (ultrasound of the heart), hypertrophy is already confirmed or refuted based on visualization of the heart chambers, septa and walls. All cavity volumes and myocardial thickness are expressed in numbers that can be compared with the norm. ECHO-CS can establish a diagnosis of left ventricular hypertrophy, clarify its type and suggest the cause. The following criteria are used:
- The thickness of the myocardial walls is equal to or greater than 1 cm for women and 1.1 cm for men.
- The myocardial asymmetry coefficient (more than 1.3) indicates an asymmetric type of hypertrophy.
- Relative wall thickness index (norm less than 0.42).
- The ratio of myocardial mass to body weight (myocardial index). Normally, for men it is equal to or exceeds 125 grams per square centimeter, for women – 95 grams.
An increase in the last two indicators indicates concentric hypertrophy. If the myocardial index exceeds the norm, there is eccentric LVH.
Other methods
- Doppler echocardioscopy - additional capabilities are provided by Doppler echocardioscopy, in which coronary blood flow can be assessed in more detail.
- MRI - Magnetic resonance imaging is also used to visualize the heart, which fully reveals the anatomical features of the heart and allows you to scan it layer by layer, as if making slices in the longitudinal or transverse direction. Thus, areas of damage, dystrophy or sclerosis of the myocardium become better visible.
Treatment of left ventricular hypertrophy
Left ventricular hypertrophy, treatment of which always requires normalization of lifestyle, is often a reversible condition. It is important to give up smoking and other intoxications, lose weight, correct hormonal imbalances and dyslipidemia, and optimize physical activity. There are two directions in the treatment of left ventricular hypertrophy:
- Prevent progression of LVH
- An attempt to remodel the myocardium with a return to the normal size of the cavities and the thickness of the heart muscle.
- Beta-blockers can reduce volume and pressure load, reduce myocardial oxygen demand, solve some problems with rhythm disturbances and reduce the risks of cardiac accidents - Atenolol, Metoprolol, Betolok-Zok, Nadolol.
- Calcium channel blockers are becoming the drugs of choice for severe atherosclerosis. Verapamil, Diltiazem.
- ACE inhibitors are drugs that lower blood pressure and significantly inhibit the progression of myocardial hypertrophy. Enalapril, Lisinopril, Diroton are effective for hypertension and heart failure.
- Sartans (Candesartan, Losartan, Valsartan) very actively reduce the load on the heart and remodel the myocardium, reducing the mass of hypertrophied muscle.
- Antiarrhythmic drugs are prescribed in the presence of complications such as heart rhythm disorders. Disapyramide, Quinidine.
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Diastolic dysfunction: new diagnosis or difficult to diagnose disease
Recently, cardiologists and therapists are increasingly giving their patients a “new” diagnosis - diastolic dysfunction. In severe cases, diastolic heart failure (HF) may occur.
Nowadays, diastolic dysfunction is found quite often, especially in older women, most of whom are surprised to learn that they have heart problems.
Neither diastolic dysfunction nor diastolic heart failure are actually “new” diseases - they have always affected the human cardiovascular system. But only in recent decades have these two diseases become frequently identified. This is due to the widespread use of ultrasound methods (echocardiography) in diagnosing cardiac problems.
It is believed that nearly half of patients presenting to emergency departments with acute heart failure actually have diastolic HF. But making the correct diagnosis can be difficult because once the patient's condition has been stabilized, the heart may appear completely normal on echocardiography unless the specialist specifically looks for signs of diastolic dysfunction. Therefore, inattentive and unwary doctors often miss this disease.
Characteristics of the disease
The cardiac cycle is divided into two phases - systole and diastole. During the first, the ventricles (the main chambers of the heart) contract, pushing blood out of the heart into the arteries, and then relax. When they relax, they refill with blood to prepare for the next contraction. This relaxation phase is called diastole.
However, sometimes due to various diseases the ventricles become relatively “hard”. In this case, they cannot relax completely during diastole. As a result, the ventricles are not completely filled with blood, and it stagnates in other parts of the body (in the lungs).
Pathological hardening of the walls of the ventricles and the resulting insufficient filling of them with blood during diastole is called diastolic dysfunction. When diastolic dysfunction is so severe that it causes congestion in the lungs (that is, accumulation of blood in them), it is considered to be diastolic heart failure.
Signs of heart failure - video
Reasons
The most common cause of diastolic dysfunction is the natural effect of aging on the heart. With increasing age, the heart muscle becomes stiffer, impairing the filling of the left ventricle with blood. In addition, there are many diseases that can lead to this pathology.
Diseases that provoke diastolic dysfunction - table
Classification
Based on echocardiography data, the following degrees of diastolic dysfunction are distinguished:
- I degree (impaired relaxation) - can be observed in many people, is not accompanied by any symptoms of heart failure;
- Grade II (pseudonormal cardiac filling) is diastolic dysfunction of moderate severity, in which patients often have symptoms of heart failure, and there is an increase in the left atrium in size;
- III (reversible restrictive cardiac filling) and IV (irreversible restrictive cardiac filling) are severe forms of diastolic dysfunction that are accompanied by severe symptoms of HF.
Based on the symptoms, the functional class (type) of heart failure can be determined according to the New York Heart Association (NYHA) classification.
- FC I - no symptoms of HF;
- FC II - symptoms of heart failure during moderate physical activity (for example, when climbing to the 2nd floor);
- FC III - symptoms of HF with minimal physical activity (for example, when climbing 1 floor);
- FC IV - symptoms of heart failure at rest.
Symptoms
The symptoms that bother people with diastolic dysfunction are the same as those experienced in patients with any form of heart failure.
With diastolic heart failure, signs of pulmonary congestion come to the fore:
- dyspnea;
- cough;
- rapid breathing.
Patients with this diagnosis often suffer from these symptoms in the form of sudden attacks that appear without any warning. This distinguishes diastolic heart failure from other forms of heart failure, in which shortness of breath usually develops gradually over several hours or days.
The sudden and severe difficulty breathing that often occurs in diastolic heart failure is called a “pulmonary edema flare” episode.
Although the hallmark of diastolic HF is bursts of pulmonary edema, patients with this disease may also experience less severe episodes of difficulty breathing that develop more gradually.
Diagnostics
The presence of diastolic dysfunction can be detected using cardiac ultrasound - echocardiography. This examination method allows you to evaluate the characteristics of myocardial relaxation during diastole and the degree of stiffness of the walls of the left ventricle. Echocardiography can also sometimes help detect the cause of diastolic dysfunction. For example, it can be used to identify:
- thickening of the walls of the left ventricle in hypertension and hypertrophic cardiomyopathy;
- aortic stenosis;
- some types of restrictive cardiomyopathies.
However, many patients with evidence of diastolic dysfunction on echocardiography do not have other pathologies that could explain its presence. In such people it is impossible to determine the specific cause of the disease.
It should be noted that for each degree of diastolic dysfunction there are specific criteria for echocardiography, so they can only be determined using this study.
Treatment
The best treatment strategy for diastolic dysfunction and diastolic HF is to attempt to identify and treat the cause. Thus, the following problems need to be overcome:
- Arterial hypertension. People with diastolic dysfunction often have elevated blood pressure that is difficult to detect. Moreover, very often such hypertension is treated inadequately. However, it is very important for patients with diastolic dysfunction to control their blood pressure within normal limits.
- Coronary heart disease. People with diastolic dysfunction should be evaluated for coronary artery disease. This disease is a common cause of diastolic dysfunction.
- Atrial fibrillation. The rapid heartbeat caused by this rhythm disorder can cause significant deterioration in heart function in people with diastolic dysfunction. Therefore, rhythm control is a very important aspect in the treatment of a patient with atrial fibrillation and diastolic dysfunction.
- Diabetes mellitus and overweight. Weight loss and glucose control help stop the worsening of diastolic dysfunction.
- Sedentary lifestyle. Many people with diastolic dysfunction lead a predominantly sedentary lifestyle. An aerobic exercise program can improve diastolic heart function.
In addition to measures aimed at identifying and treating the causes of diastolic dysfunction, the doctor may prescribe medications that affect its symptoms. For this purpose, diuretics (Furosemide) are most often used, which remove excess water and sodium from the body, reducing the severity of symptoms of pulmonary congestion.
Prevention
The development of diastolic dysfunction can be prevented through measures aimed at preventing cardiovascular diseases:
- rational and balanced diet low in fat and salt;
- regular exercise;
- control of diabetes and blood pressure;
- maintaining normal weight;
- minimizing stress.
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Structure and structure of the left ventricle
Being one of the chambers of the heart, the left ventricle in relation to other parts of the heart is located posteriorly, to the left and downward. Its outer edge is rounded and is called the pulmonary surface. The volume of the left ventricle during life increases from 5.5-10 cm3 (in newborns) to 130-210 cm3 (by 18-25 years).
Compared to the right ventricle, the left one has a more pronounced oblong-oval shape and is somewhat longer and more muscular.
There are two sections in the structure of the left ventricle:
- The posterior section, which is the cavity of the ventricle and, through the left venous opening, communicates with the cavity of the corresponding atrium;
- The anterior section - the arterial cone (in the form of an excretory canal) communicates with the arterial foramen with the aorta.
Due to the myocardium, the wall of the left ventricle reaches 11-14 mm in thickness.
The inner surface of the wall of the left ventricle is covered with fleshy trabeculae (in the form of small protrusions), which form a network, intertwining with each other. Trabeculae are less pronounced than in the right ventricle.
Left ventricular functions
The aorta of the left ventricle of the heart begins a large circle of blood circulation, which includes all branches, the capillary network, as well as veins of tissues and organs of the whole body and serves to deliver nutrients and oxygen.
Left Ventricular Dysfunction and Treatment
Systolic dysfunction of the left ventricle is a decrease in its ability to eject blood into the aorta from its cavity. This is the most common cause of heart failure. Systolic dysfunction is usually caused by a decrease in contractility, leading to a decrease in stroke volume.
Diastolic dysfunction of the left ventricle is a decrease in its ability to pump blood into its cavity from the pulmonary artery system (in other words, to ensure diastolic filling). Diastolic dysfunction can lead to the development of pulmonary secondary venous and arterial hypertension, which manifests itself as:
- Cough;
- Dyspnea;
- Paroxysmal nocturnal dyspnea.
Pathological changes and treatment of the left ventricle
One of the typical heart lesions in hypertension is left ventricular hypertrophy (otherwise known as cardiomyopathy). The development of hypertrophy is provoked by changes in the left ventricle, which leads to modification of the septum between the left and right ventricles and loss of its elasticity.
Moreover, such changes in the left ventricle are not a disease, but represent one of the possible symptoms of the development of any type of heart disease.
The cause of the development of left ventricular hypertrophy can be both hypertension and other factors, for example, heart defects or significant and frequent exercise. The development of changes in the left ventricle is sometimes observed over many years.
Hypertrophy can provoke significant changes that occur in the area of the walls of the left ventricle. Along with the thickening of the wall, there is a thickening of the septum located between the ventricles.
Angina pectoris is one of the most common signs of left ventricular hypertrophy. As a result of the development of pathology, the muscle increases in size, atrial fibrillation occurs, and the following are observed:
- Pain in the chest area;
- High blood pressure;
- Headaches;
- Pressure instability;
- Sleep disorders;
- Arrhythmia;
- Pain in the heart area;
- Poor health and general weakness.
In addition, such changes in the left ventricle can be symptoms of diseases such as:
- Pulmonary edema;
- Congenital heart defect;
- Myocardial infarction;
- Atherosclerosis;
- Heart failure;
- Acute glomerulonephritis.
Treatment of left ventricle is most often medicinal in nature along with diet and abandonment of existing bad habits. In some cases, surgical intervention may be required to remove a section of the heart muscle that has become hypertrophied.
Minor anomalies of the heart, manifested by the presence of cords (additional connective tissue muscle formations) in the cavity of the ventricles, include the false chord of the left ventricle.
Unlike normal chords, false chords of the left ventricle have an atypical attachment to the interventricular septum and the free walls of the ventricles.
Most often, the presence of a false chord of the left ventricle does not affect the quality of life, but in the case of their multiplicity, as well as in an unfavorable location, they can cause:
- Serious rhythm disturbances;
- Decreased exercise tolerance;
- Relaxation disorders of the left ventricle.
In most cases, treatment of the left ventricle is not required, but you should be regularly monitored by a cardiologist and prevent infective endocarditis.
Another common pathology is left ventricular failure of the heart, which is observed with diffuse glomerulonephritis and aortic defects, as well as against the background of the following diseases:
- Hypertension;
- Atherosclerotic cardiosclerosis;
- Syphilitic aortitis with damage to the coronary vessels;
- Myocardial infarction.
Left ventricular failure can manifest itself both in acute form and in the form of gradually increasing circulatory failure.
The main treatment for left ventricular failure is:
- Strict bed rest;
- Long-term oxygen inhalation;
- The use of cardiovascular drugs - cordiamine, camphor, strophanthin, corazol, korglykon.
The heart, like the entire body, requires rest to continue productive functioning. If the heart chambers do not relax properly, diastolic dysfunction of the left ventricular myocardium develops. This pathology leads to serious disruptions in the functioning of the heart organ. Now it remains to find out at what point the heart rests, because it works without stopping.
Rest for the heart
The heart is a complex “motor,” if only for the reason that it works and at the same time rests. The point is that the heart chambers: the ventricles and atrial chambers alternately compress. During systole (compression) of the atria, ventricular diastole occurs (they rest), and vice versa, when the ventricles begin to work, the atria rest at this time.
Thus, ventricular diastole is the period when this section is in a relaxed state and filled with blood. During further contraction of the heart, blood is sent through the vessels and delivered to all human organs. Cardiac function, measured by the volume of blood sent to the cardiac chambers, also depends on the coherence and completeness of relaxation - the moment of diastole.
Definition of diastolic dysfunction
Left ventricular diastolic endothelial dysfunction (LVED) seems to be a difficult medical definition. But its essence is simple. This implies a disruption of the left ventricle during its relaxation (diastole). This process is associated with a pathological disorder of relaxation of the myocardium of the left chamber of the heart. In this case, the required relaxation of the ventricular myocardium does not occur. Therefore, it fills too slowly and is not fully filled with blood.
The amount of blood going to the lower part of the heart is reduced, which increases the load on the atria. The pressure in them increases due to overcrowding with blood, and stagnation develops. With such cardiac dysfunction, diastolic failure often occurs, but in many cases this pathology manifests itself with unchanged systolic performance of the ventricle.
Simply put, the earliest pathological change in the performance of the ventricles is their impaired function during the rest period; heart failure during diastole becomes a serious problem with this pathology. There may be no left ventricular systolic dysfunction.
Structure of the heart organ
Causes of ventricular dysfunction
A painful change in the functioning of the ventricular myocardium in the diastole stage can develop due to an increase in its weight (hypertrophy) or due to a change in the structure of the myocardial tissues themselves. Note that almost all heart diseases to some extent affect the functioning of the left ventricle. Most often, diastolic dysfunction of the LV manifests itself in the following diseases:
- cardiomyopathy;
- arterial hypertension;
- aortic stenosis;
- arrhythmias of various etiologies;
- inflammatory diseases of the pericardium and endocardium.
Sick heart An increase in size or loss of elasticity of the muscles of the ventricles also occurs during the natural aging process of the body. Patients over sixty years of age are at risk. High blood pressure on the vessels causes an increase in the load on the ventricle of the heart, causing its size to increase and the myocardium to hypertrophy. A violation of the structure of the myocardium causes a loss of its ability to adequately relax. These changes first cause dysfunction and later the development of heart failure.
Types of pathology
There are three types (stages) of left ventricular diastolic dysfunction:
- Type 1 left ventricular diastolic dysfunction is identified as a mild form of the disease. Pathological disorders in the myocardium are at the initial level, their second name is hypertrophic dysfunction. At an early stage, the disease passes without symptoms, and this is its danger. In the case of an asymptomatic course of the disease, cardiac function failure is not observed, therefore this type of dysfunction can be diagnosed by echocardiography.
- Type 2 disease is a pathology of moderate severity. Due to the weak contractile function of the ventricle on the left and the reduced amount of blood released from it, the atrium on the left side begins to compensate for this. It is forced to act for two departments at once. Therefore, pressure increases in the corresponding atrium, resulting in its hypertrophy. This type of left ventricular diastolic dysfunction has clinical signs of heart failure and congestive pathologies in the lungs.
- The third is the restrictive type of dysfunction. This type of pathology is considered severe. It is accompanied by a significant reduction in the elastic properties of the ventricle, persistently increased blood pressure in the atrial region, and pronounced symptoms of CHF.
Danger of disease
If a patient with endothelial diastolic dysfunction ignores the doctor’s advice and refuses to take prescribed medications, this leads to the progression of myocardial pathology and the appearance of signs of chronic heart failure. In patients, this development of the disease does not proceed in the same way. For some - slowly, for decades. And in other patients - quickly, within the first year from diagnosis. The greatest danger of dysfunction is the further development of chronic heart failure.
Danger of disease In addition, there is a risk of complications, especially in severe forms of dysfunction, when the vascular endothelium wears out and the blood ejection fraction does not even reach 30 percent. Thus, thromboembolism, left ventricular failure, irreparable heart rhythm disturbances, etc. may develop.
Treatment
Both the doctor and the patient must clearly understand that even the initial form of ventricular myocardial dysfunction requires the prescription of medications. Simple rules for taking medications make it possible to prevent the occurrence of symptoms for a long time and increase life expectancy in the development of chronic heart failure.
Treatment At the stage of pronounced symptoms, a person will not be able to alleviate his well-being with pills alone. But still, an optimally compiled list of drugs will help to significantly slow down the development of the disease and qualitatively improve the patient’s life.
Thus, at the initial stage of dysfunction, the patient must certainly use ACE inhibitors, and if there is intolerance to them, the doctor will prescribe other substitute medications. These drugs have organoprotective functions - they protect human organs that are most vulnerable to the negative effects of high pressure in the blood vessels. Among these organs: the brain, kidneys, retina, heart and blood vessels.
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