Angina

Diastolic dysfunction of the left ventricular myocardium type 1. What is associated with the formation of left ventricular diastolic dysfunction? Prevention measures

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.
An increase in attacks of sleep apnea 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 heart 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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Cardiovascular diseases occupy first place among all known pathologies. Left ventricular diastolic dysfunction is a dangerous type of abnormal abnormality that is prone to complications. The disease requires professional assistance from specialists and precise implementation of prescribed therapy.

Definition of diastolic dysfunction

The pathological process is a deviation characterized by insufficient filling of the left-sided ventricle with blood during diastole, that is, the moment of relaxation of the heart muscle.

Danger of pathology

If symptomatic manifestations are ignored or recommended treatment is refused, the disease contributes to further impairment of myocardial functionality and the appearance of signs of insufficient cardiac performance of a chronic course.

For each patient, the pathological process takes a different period - from several months to decades. Additional complications are presented:

pulmonary embolism;
swelling of the lung tissue;
ventricular fibrillation;
fatal.

Distinctive features of the violation

Symptomatic manifestations of the abnormal condition are presented:

a constantly present cough - in some cases, attacks are noted;
paroxysmal type of dyspnea - short-term cessation of breathing during sleep;
periodic shortness of breath.

Additional signs of the disease are:

painful sensations in the retrosternal space - attacks resemble ischemic damage to the heart muscle;
severe swelling of the tissues of the lower extremities;
sharp spasms;
feeling of insufficient oxygen supply.

Dysfunction or failure

The pathological process is characterized by a decrease in the volume of blood that enters the lower chambers of the organ. Against the background of the deviation, there is an increase in the load on the atrium - a compensatory increase in pressure indicators is observed in them, with the subsequent formation of congestion.

Violation of diastolic functionality leads to failure of the same name. In most cases, the diastolic type of heart failure is recorded with stable systolic work of the left ventricle.

The early stages of the development of the disease are dysfunctions, serious processes are classified as insufficiency.

Scheme of pathology development

Impaired functionality in the diastole phase in the left ventricle refers to age-related abnormal processes, the majority of patients are female. The disease provokes disturbances in circulatory processes and atrophic lesions of the structural elements of the myocardium.

The process of filling the heart chamber with blood includes several steps:

complete relaxation of the muscle tissue of the organ;
passive passage of blood into the ventricle - under the influence of differences in pressure;
Contraction of the atria provokes the release of the remaining blood into the ventricle.

If pathological changes occur in one of the above stages, then cardiac output does not fully occur. The anomaly provokes the formation of insufficient functionality of the left-sided ventricle.

Causes of ventricular dysfunction

The main primary sources of the disease are more often found as a combination of several factors:

elderly age;
hypertension;
excess body weight – with various degrees of obesity;
arrhythmic or other disturbances in the rhythm of contractions of the heart muscle;
fibrosis of myocardial tissue - replacement of muscle tissue with connective tissue, with a decrease in contractility and deviations in the conduction department;
aortic stenosis;
acute myocardial infarction.

Pathological changes in the process of blood circulation can provoke:

thrombophlebitis;
ischemic lesions of the heart muscle;
constrictive pericarditis - with an increase in the volume of the outer shell of the organ and subsequent pressure on the heart chambers;
primary amyloidosis - with a decrease in the level of elasticity of the myocardium, against the background of deposits of substances that cause atrophic changes;
post-infarction cardiosclerotic lesions.

Types of pathology

The disease is divided into separate types:

Hypertrophic origin– refers to the primary stage of the lesion, often recorded in patients with early stages of arterial hypertension. Patients experience a superficial change in muscle relaxation of the left ventricle.

Pseudonormal– recorded in patients with serious deviations in the performance of the heart muscle. Against the background of the anomaly, there is a decrease in the level of muscle relaxation and an increase in pressure in the left atrium. The filling of the ventricle of the same name occurs due to the difference in pressure marks.

Restrictive– the terminal stage of dysfunction is among the most dangerous. The filling of the ventricle is minimal - against the background of a decrease in the level of elasticity of its walls and an increase in their rigidity.

Etiology

The disease is formed against the background of individual primary sources:

arterial hypertension;
cardiomyopathic abnormalities in the form of hypertrophy;
periodic organ damage - myocardial infarction, ischemic disorders, chronic hypertension, hypertrophy of certain areas of the heart muscle.

Diagnosis of dysfunction

When seeking professional help, the patient undergoes a number of laboratory and instrumental examinations:

clinical and biochemical blood tests;
Holter monitoring;
Ultrasound using Doppler technique;
echocardiography.

Additional diagnostic measures are:

determination of hormonal levels;
X-ray images;
coronary angiography, etc.

Therapeutic measures

Drug therapy is aimed at correcting circulatory disorders. The main goals of treatment are:

normalization of the rhythm of organ contractions;
stabilization of blood pressure indicators;
restoration of water-salt metabolic processes;
elimination of hypertrophic changes in the left ventricle.

Commonly prescribed medications include:

beta blockers;
calcium antagonists;
ACE inhibitors;
sartans;
diuretics;
nitrates;
cardiac glycosides.

Forecast

Complete cure of diastolic dysfunction of the left ventricle cannot be achieved. To prolong the patient’s life, cardiologists recommend:

seek professional help in a timely manner;
do not interrupt the prescribed drug therapy (prescribed to correct problems of the circulatory system);
undergo full treatment of the underlying pathological process;
switch to the recommended diet;
comply with work and rest requirements.

If the above conditions are met, the prognosis becomes favorable - patients return to their usual way of life for many years.

Prevention of the disease

No specific preventive measures have been developed for the desired abnormal process. Cardiologists recommend adhering to certain rules:

treatment of chronic nicotine addiction;
constant monitoring of blood pressure indicators;
reducing the amount of table salt in the diet;
avoidance of excess water consumption;
control over your own body weight - if there is an excess of it, you should change the daily menu to a dietary table;
regular exercise – to the best of your ability, without overload;
periodic vitamin therapy;
preventive visits to a cardiologist - at least once a year;
refusal of alcoholic and low-alcohol products.

General activities will help improve the general condition of the body and bring it into adequate physical shape.

For clear and coordinated functioning of the heart, the harmonious functioning of the entire cardiovascular system is necessary. Diastolic myocardial dysfunction is a very serious pathology that causes chronic heart failure. The heart is a complex system, and each layer is responsible for an important function that helps maintain human vitality. Ventricular diastole is responsible for the contraction and relaxation of the heart muscle. The walls of the heart first relax, accepting blood, then push it out in the required direction.

Type 1 LV diastolic dysfunction: what is it? Diastolic dysfunction of the left ventricular myocardium is caused by the inability of the miotic threads to accept the required amount of blood. As a result, the left atrium increases production. This causes the atrium to become overloaded and increase in volume. This pathology sometimes causes downtime in the lungs and arteries, and this, in turn, impedes blood circulation throughout the body.

The study of disorders of diastolic heart function is an urgent task.

Worth knowing! Worsening of pathological abnormalities can lead to the development of chronic heart failure.

The disease is divided into several types:

Causes of the disease

Statistics note that the key factor in the formation of the disease is the failure of the myocardium to properly accept and expel blood. Due to the limited elasticity of muscle mass, some diseases can form: ischemic heart disease, heart attack.

The disease can manifest itself in both adults and newborns. In infants, increased blood supply to the lungs causes a number of complications:

increase in cardiac compartments in size;
the atria are overloaded;
the ability of the heart muscle to contract is impaired;
tachycardia develops.

The child does not always require special treatment, because the condition is not pathological.

Main symptoms of the disease

Diastolic myocardial dysfunction is not considered an independent disease. As a rule, this in itself is a sign of an already developing disease. This pathology leads to heart failure and is manifested by the following symptoms:

swelling of the legs;
high fatigue;
the appearance of shortness of breath even with little physical activity. If it manifests itself at rest, then the disease has already become serious;
increased heart rate;
the skin turns pale, especially in areas of the body distant from the heart.

Cough can also be considered one of the symptoms of heart failure. Most often it appears at night, indicating congestion in the lungs.

Diagnosis of diastolic heart failure

Diagnosing the disease at an early stage will help avoid irreversible changes.

To establish a diagnosis, three conditions are usually necessary:

manifestation of symptoms and signs of heart failure;
PV systolic function is normal or slightly decreased;
instrumental diagnostic methods reveal disturbances in the functioning of the LV and an increase in its stiffness.

Early diagnosis helps prevent irreversible changes in heart function

The main instrumental diagnostic methods include:

two-dimensional echocardiography with Doppler ultrasound is one of the most effective methods for determining the diagnosis;
radionuclide ventriculography will determine the failure of myocardial contractility;
EchoCG reveals;
A chest x-ray will help determine pulmonary hypertension.

Method of treating the disease

The main problem for effective treatment of the disease remains the restoration of full contractility of the organ. Diastolic dysfunction of the LV myocardium includes drug and surgical therapy. Therefore, treatment has several main directions:

stabilization of normal heart rhythm to prevent the development of arrhythmia;
treatment of ischemic disease;
stabilization of blood pressure.

For the purpose of complex treatment, the following groups of drugs are prescribed:

Adrenergic blockers	aimed at normalizing heart rate, reducing blood pressure, improving the nutrition of myocardial cells
Inhibitors or sartans	work, improve its elasticity, reduce the load. Significantly improve test results in patients with permanent heart failure
Diuretics	remove excess fluid, reducing asthmatic symptoms, and also help control blood pressure. The drug is prescribed in small quantities because it leads to a decrease in stroke volume
Calcium antagonists	promote myocardial relaxation, lower blood pressure
Nitrates	only additional medications that can be prescribed for myocardial ischemia

The treatment process takes place in a hospital, where the patient’s condition is monitored by medical staff.

A patient with ventricular dysfunction must follow a diet. To do this, you should limit your salt intake and monitor the liquid you drink - this will reduce the load on the circulatory system. You should eat rationally, adhering to the regime, you need to divide food into 4-6 times. You need to give up fatty, fried and spicy foods.

Treatment is aimed at correcting hemodynamic disorders

It is also important to adjust your lifestyle: get rid of bad habits, do not overexert yourself, and get enough sleep. Pay attention to physical activity. Loads must be rational and correspond to the body’s capabilities. You need to spend more time outdoors. If the disease becomes more complicated, you should eliminate exercise or consult a doctor.

Diastolic dysfunction of the left ventricle is a failure in the process of filling it with blood during diastole (relaxation of the heart muscle), i.e. the ability to pump blood from the pulmonary artery system into the cavity of this chamber of the heart decreases, and, consequently, its filling capacity decreases during relaxation. Diastolic impairment of the left ventricle is manifested by an increase in the ratio of such indicators as its final pressure and final volume during diastole.

Interesting! This disease is usually diagnosed in people over 60 years of age, most often in women.

The diastolic function of the left ventricle (its filling) includes three stages:

relaxation of the heart muscle, which is based on the active removal of calcium ions from the filaments of muscle fibers, relaxing the contracted muscle cells of the myocardium and increasing their length;
passive filling. This process directly depends on the compliance of the walls of the latter;
filling, which is carried out due to contraction of the atria.

Various factors entail a decrease in the diastolic function of the left ventricle, which manifests itself in a violation of one of its three stages. As a result of this pathology, the myocardium does not have enough blood volume to ensure normal cardiac output. This leads to the development of left ventricular failure and pulmonary hypertension.

Interesting! It has been proven that this pathological process precedes changes in systolic function, and can also lead to the development of chronic heart failure in cases where stroke volume and cardiac output, cardiac index and ejection fraction have not yet changed.

What caused this violation?

Violation of the diastolic function of the left ventricle, accompanied by deterioration of relaxation processes and a decrease in the elasticity of its walls, is most often associated with myocardial hypertrophy, i.e. thickening of its walls.

The main causes of cardiac muscle hypertrophy are:

cardiomyopathies of various origins;
hypertension;
narrowing of the aortic mouth.

Factors contributing to the development of hemodynamics during diastolic dysfunction in this part of the myocardium are:

thickening of the pericardium, which leads to compression of the chambers of the heart;
infiltrative damage to the myocardium as a result of amyloidosis, sarcoidosis and other diseases leading to atrophy of muscle fibers and a decrease in their elasticity;
pathological processes of the coronary vessels, especially ischemic disease, which leads to an increase in myocardial stiffness due to scar formation.

Important! People at risk for developing pathology include people who are obese and have diabetes.

How does the disease manifest?

Functional disorder of left ventricular diastole can be asymptomatic for a long time before the first clinical symptoms appear. The following clinical signs of left ventricular diastolic dysfunction are distinguished:

abnormal heart rhythm (atrial fibrillation);
severe dyspnea, which manifests itself a couple of hours after falling asleep;
cough that gets worse when lying down;
shortness of breath, which initially manifests itself only during physical exertion, and as the disease progresses, even at rest;
fatigue.

Types of pathology and their severity

Today, the following types of left ventricular diastolic dysfunction are distinguished:

I, which is accompanied by a violation of the relaxation process (its slowdown) of this chamber of the heart in diastole. The required amount of blood at this stage arrives during atrial contractions;
II, characterized by an increase in pressure in the left atrium, due to which filling of the adjacent lower chamber of the heart is possible only due to the action of a pressure gradient. This is the so-called pseudonormal type.
III, associated with an increase in pressure in the atrium, a decrease in elasticity and an increase in the rigidity of the walls of the ventricle (restrictive type).

Functional disturbance of diastole in this chamber of the heart develops gradually and is divided into 4 degrees of severity: mild (type I disease), moderate (type II disease), severe reversible and irreversible (type III disease).

How can the disease be identified?

If the diastolic function of the left ventricle is impaired and the disorder is detected in the early stages, then the development of irreversible changes can be prevented. Diagnosis of this pathology is carried out using the following methods:

two-dimensional echocardiography in combination with Dopplerography, allowing to obtain a real-time image of the myocardium and assess its hemodynamic functions.
ventriculography using radioactive albumin to determine the contractile function of the heart in general and the required chamber in particular;
ECG, as an auxiliary study;
X-ray of the chest to determine the first symptoms of pulmonary hypertension.

How is functional impairment treated?

As already noted, left ventricular diastolic dysfunction, the treatment of which depends on the type of disease, primarily affects hemodynamic processes. Therefore, the treatment plan is based on correcting disturbances in this process. In particular, regular monitoring of blood pressure, heart rate and water-salt metabolism is carried out, followed by their correction, as well as remodeling of myocardial geometry (reducing thickening and returning the walls of its chambers to normal).

Among the drugs that are used to treat functional disorders of diastole in this part of the heart, the following groups are distinguished:

adrenergic blockers;
drugs to improve the elasticity of the heart muscle, reduce pressure, reduce preload and promote myocardial remodeling (sartans and ACE inhibitors);
diuretics (diuretics);
drugs that reduce calcium levels in heart cells.

Heart diseases are increasingly encountered in medical practice. They must be carefully studied and examined in order to be able to prevent negative consequences. Left ventricular diastolic dysfunction is a common condition that can cause heart failure, accompanied by pulmonary edema or cardiac asthma.

Scheme of pathology development

Ventricular dysfunction is often an age-related disorder and occurs mainly in older people. Women are especially susceptible to this pathology. Diastolic dysfunction of the left ventricle causes hemodynamic disturbances and atrophic changes in the structure of the myocardium. The diastole period is characterized by muscle relaxation and filling of the ventricle with arterial blood. The process of filling the heart chamber consists of several stages:

relaxation of the heart muscle;
under the influence of pressure differences from the atrium, blood passively flows into the ventricle;
When the atria contract, the remaining blood is sharply pushed into the ventricle.

If one of the stages is violated, insufficient blood output is observed, which contributes to the development of left ventricular failure.

Causes of the disease

Ventricular dysfunction of the diastolic type can be caused by certain diseases that can significantly disrupt the hemodynamics of the heart:

The disease develops especially often in people with diabetes or obesity. In this case, the pressure on the chambers of the heart increases, the organ cannot fully function and ventricular dysfunction develops.

Signs of the disease

Diastolic dysfunction of the left ventricle for a long time may practically not bother the patient. However, this pathology is accompanied by certain symptoms:

If such symptoms are detected, it is necessary to seek medical help and undergo an examination to identify the cause of the discomfort and eliminate the disease at the initial stage.

Types of diastolic dysfunction

Since the disease gradually worsens the hemodynamics of the heart, several stages are distinguished:

Type 1 left ventricular diastolic dysfunction is treatable, while subsequent stages of the disease cause irreversible changes in the functioning and physiological state of the organ. That is why it is necessary to consult a doctor at the first manifestation of symptoms of the disease.

Diagnostic tests

To identify physiological changes and hemodynamic disorders of the heart, it is necessary to conduct a full examination, which includes several diagnostics:

Using the above methods, the types of left ventricular diastolic dysfunction are also determined.

Treatment of the disease

To eliminate disturbances in the hemodynamic process and prevent the development of irreversible changes, it is necessary to prescribe drugs that allow maintaining optimal heart performance (blood pressure, heart rate). Normalizing water-salt metabolism will reduce the load on the heart. Elimination of left ventricular hypertrophy is also required.

After the examination, the attending physician will select a suitable set of drugs that can maintain all indicators normal. Heart failure also plays an important role, the treatment of which requires compliance with a large number of medical recommendations.

Prevention of heart disease

To avoid the development of most heart pathologies, it is necessary to adhere to a healthy lifestyle. This concept includes regular healthy eating, sufficient physical activity, absence of bad habits and regular examinations of the body.

Left ventricular diastolic dysfunction, the treatment of which requires high professionalism of the doctor and strict adherence to all his prescriptions, is rare in young active people. That is why, as you age, it is important to maintain activity and periodically take vitamin complexes that help saturate the body with essential microelements.

Diastolic dysfunction of the left ventricular myocardium, which is detected in time, will not cause great harm to human health and will not cause serious atrophic changes in the cardiac tissue.