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Moderate signs of left ventricular dysfunction. What is left ventricular dysfunction?

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 severe 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 observe signs 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.

The human heart is a rather complex organ, where all its elements fulfill their specific task with full responsibility. Each stage in this work is very important for the life of the whole organism. The heart is a kind of pump that pumps blood out of the arteries and vessels and throws it into the aorta. One of the main functions in this mechanism is performed by ventricular diastole. It is responsible for the moment of compression of the heart muscle, which alternates with the relaxation stage.

Left ventricular diastolic dysfunction is a process where the heart muscles are unable to relax completely, causing the organ to receive insufficient amounts of the blood it needs. During normal heart function, there are the following stages:

relaxation of the heart muscle;
movement of blood along a specific route;
saturation of all necessary components of the heart with blood.

With diastolic function of the left ventricle, the process of filling with blood at the moment of its relaxation is disrupted. The body wants to correct this situation and in order to fill the blood deficit, the left atrium works to the maximum to fill the gap in the current situation. As a result of such hard work, it increases in size, and this situation leads to its overload. Persistent high blood pressure and myocardial ischemia are the most common causes of this disease.

Type 1 left ventricular diastolic dysfunction is observed to a greater extent in older people, particularly women. The main causes of left ventricular diastolic dysfunction are:

Myocardial ischemia.
Arterial hypertension.
Advanced age.
Overweight.
Aortic stenosis.

Insufficient elasticity of the muscle tissue of the heart, which leads to impaired ability to contract and relax, is a major factor in the disease. Left ventricular diastolic dysfunction can occur in both adults and newborns. Special treatment is not needed here; this condition does not pose a great danger, the exception being the prematurity of the baby or in the case when the child has suffered oxygen starvation.

A clear distinction must be made between diastolic dysfunction and diastolic heart failure. If the second term includes the first, then diastolic dysfunction does not always indicate heart failure.

Symptoms and types of disease

Hypertrophied or diastolic dysfunction of the left ventricle type 1 is the most common variant of the disease. In the initial stages, the disease can develop almost asymptomatically. The person feels absolutely no discomfort. The heart adapts to changes and works harder. Hypertrophy consists of reducing the pumping of blood from the pulmonary artery to the ventricle during its filling. The main signs of the disease are:

shortness of breath during active actions at the initial stage, with the progression of the disease - shortness of breath in any condition;
rapid heartbeat;
cough that gets worse in a horizontal position;
arrhythmia;
feeling of lack of air at night.

It is also important to note the prevalence of this disease. In patients with arterial hypertension, left ventricular diastolic dysfunction occurs in 50-90% of cases, so it is very important to monitor your high blood pressure. In addition, signs of this disease appear in almost any heart disease.

Diagnosis, prevention and treatment of disease

The problem of early diagnosis of the disease is that it is almost impossible to immediately identify the disease, and most often patients seek help in the later stages, when the serious disease has advanced. As a rule, type 1 left ventricular diastolic dysfunction occurs due to age-related changes and is characterized by an asymptomatic course. Most often, the disease is detected in people over forty-five years of age.

Unfortunately, today the treatment of left ventricular diastolic dysfunction does not have a clear scheme, so experts recommend the following main stages of approach to solving this problem:

Complete smoking cessation.
Constant control of high blood pressure.
Normalization of heart function.
Maximum reduction in the amount of salt and water in the diet;
Reducing excess body weight.
Active lifestyle, gymnastics, walks in the fresh air.
Proper balanced nutrition with the obligatory addition of vitamins and minerals.

Effective treatment of the disease directly depends on timely and correct diagnosis. First of all, it is necessary to pay attention to those factors that contribute to the development of left ventricular diastolic dysfunction. The main drugs used in the treatment of the disease are:

Medicines, the main effect of which is based on the treatment of hypertension, improving the mechanism of nutrition of heart muscle cells.
Drugs that have a positive effect on improving the elasticity of the heart muscle and reducing blood pressure.
Medicines that relieve shortness of breath and normalize blood pressure by removing fluid from the body.
Medications that help reduce the amount of calcium also combat hypertension.
Medicines that are prescribed only when a precise diagnosis of coronary heart disease is made. They are also prescribed if the first group of medications is not suitable.

Diagnosis and treatment in the initial stages of the disease help prevent irreversible processes in the human body. Left ventricular diastolic function can be determined using the following methods:

X-ray of the chest cavity, with the help of which the main signs of increased pressure in the pulmonary artery system are established;
electrocardiography makes it possible to detect the presence of changes in the heart muscle, signs of insufficient oxygen supply to it;
two-dimensional echocardiography with the study of blood flow in the vessels, with the help of which you can obtain reliable information about the presence of the disease in the body;
radionuclide ventriculography, using this method, disorders of contractility of the heart muscle are diagnosed. This method is indicated when echocardiography is unsuccessful.

At first glance, it seems that minor disruptions in the functioning of the myocardium, especially when the symptoms are not clearly expressed, do not pose any danger to human health. But in fact, if proper treatment of left ventricular diastolic dysfunction is not started in a timely manner, this can lead to serious consequences, which manifest themselves in the form of arrhythmia, large drops in blood pressure and other, to put it mildly, unpleasant moments. Therefore, it is necessary to carefully consider your health problems, take into account all the factors and risks that can lead to a serious illness, and at the slightest suspicion, seek help from a specialist, especially for those who have congenital heart failure or existing heart pathologies.

It is among the most dangerous, i.e. those that lead to particularly severe consequences (disability, death). For the development of any pathology in the myocardium, there is a reason, and one of them is systolic disorders - a decrease in the ability of the heart to eject blood into the aorta (this leads to the development of left ventricular failure and pulmonary hypertension). As a result, such operational problems reduce the overall level of release and delivery of oxygen and nutrients through the blood to vital organs.

Diastolic myocardial dysfunction - what does it mean?

Dysfunction is a malfunction of the organ, translated from Latin as “difficulty in action”, diastolic dysfunction of the myocardium, respectively, this is a disruption of the process of the heart muscle and a decrease in the filling of the left ventricle with blood during diastole (its relaxation). With this pathological process, the ability of the left chamber of the myocardium to pump blood into its cavity from the pulmonary artery decreases, thus reducing its filling during relaxation.

Diastolic dysfunction of the left ventricular myocardium is manifested by an increase in the ratio of final ventricular pressure and final volume during diastole. The development of this pathology is accompanied by a decrease in the compliance of the walls of the left chamber of the heart.

Fact! In 40% of patients with heart failure, there is no systolic dysfunction of the left chamber, and acute heart failure is progressive diastolic dysfunction of the left ventricle.

As the left ventricle fills, there are three main stages of the process.

Relaxation. This is a period of relaxation of the heart muscle, during which the active removal of calcium ions from filamentous muscle fibers (actin, myosin) occurs. During this, the contracted muscle cells of the myocardium relax and their length increases.
Passive filling. This stage occurs immediately after relaxation; the process directly depends on the compliance of the walls of the ventricle.
Filling, which is carried out due to contraction of the atria.

Interesting! Despite the fact that cardiovascular diseases more often affect males, this dysfunction, on the contrary, “prefers” women a little more. Age category – from 60 years.

Varieties of this pathology

Today, this pathology is usually divided into the following types:

type 1 diastolic myocardial dysfunction. This stage is characterized by disturbances (slowdowns) in the process of relaxation of the left ventricle of the heart in diastole. The required amount of blood at this stage arrives during atrial contractions;
diastolic myocardial dysfunction type 2 is characterized by an increase in pressure in the left atrium, due to which filling of the lower chamber is possible only due to the action of a pressure gradient (this type is called “pseudonormal”);
diastolic myocardial dysfunction type 3. This stage is associated with an increase in atrial pressure, a decrease in the elasticity of the ventricular walls and an increase in rigidity.

Depending on the severity of the pathology, an additional division has been adopted into:

mild (type I disease);
moderate (type II disease);
severe reversible and irreversible (type III disease).

The main symptoms of external manifestations of dysfunction

Diastolic myocardial dysfunction quite often occurs asymptomatically, without revealing its presence for years. If pathology manifests itself, then you should pay attention to the appearance of:

heart rhythm disturbances;
shortness of breath, which was not there before, then it began to appear during physical activity, and over time - at rest;
weakness, drowsiness, increased fatigue;
cough (which becomes stronger when lying down);
severe sleep apnea (appears a couple of hours after falling asleep).

Factors provoking the development of pathology

First of all, it should be noted that the development of diastolic myocardial dysfunction is facilitated by its hypertrophy, i.e. thickening of the walls of the ventricles and interventricular septum.

The main cause of cardiac muscle hypertrophy is hypertension. In addition, the danger of its development is associated with excessive physical stress on the body (for example, intense sports, heavy physical labor).

Factors contributing to the development of the main cause – hypertrophy – are separately identified and these are:

arterial hypertension;
heart disease;
diabetes mellitus;
obesity;
snoring (its effect is caused by involuntary cessation of breathing for a few seconds during sleep).

Methods for detecting pathology

Diagnosis of the development of a pathology such as diastolic dysfunction in the myocardium includes the following types of examinations:

echocardiography in combination with Dopplerography (the study makes it possible to obtain an accurate image of the myocardium and assess functionality in a given period of time);
electrocardiogram;
ventriculography (in this case, radioactive albumin is also used to determine the contractile function of the heart);
X-ray examination of the lungs;
laboratory blood tests.

Modern therapy of pathological disorders

Conservative methods are used to treat diastolic myocardial dysfunction. The treatment plan begins with eliminating the causes of the pathology. Considering that the main development factor is hypertrophy, which develops as a result of hypertension, antihypertensive drugs are certainly prescribed and blood pressure is constantly monitored.

Among the drugs used to treat dysfunction, the following groups are distinguished:

adrenergic blockers;
drugs intended to improve wall elasticity and reduce pressure, promoting myocardial remodeling (angiotensin-converting enzyme inhibitors);
thiazide diuretics;
calcium antagonists.

In the human body, everything is arranged with amazing functionality, since in order to maintain the vital functions of the body, all systems and organs must work simultaneously clearly and harmoniously. The functions performed directly depend on the internal structure of the organs. The apparent simplicity of their morphological structure is deceptive, because, in fact, every little thing matters here. That is why malformations of organs and any pathologies that develop as a result of various ailments can pose a threat to life. This is especially evident when such pathologies concern the main organ of a person - his heart.

One of the serious pathologies that causes the development of heart diseases and subsequently leads to chronic heart failure is diastolic myocardial dysfunction. How does this condition manifest itself?

Features of the heart

First of all, let’s trace the relationship between the structure of the heart and the functionality of this organ. Being a kind of fur consisting of muscle tissue, the heart, contracting, circulates the blood supplied to it throughout the body. Further flow of venous blood into the lungs gives it the opportunity to get rid of carbon dioxide and become enriched with oxygen. Arterial blood in the systemic circulation carries oxygen to cells, provides them with nutrition and releases them from residual products of metabolic processes.

However, in order to push blood in the right direction, the walls of the heart first need to relax to accept it. Thus, the process of contracting the muscle alternates with the process of relaxing it. The period of relaxation of the heart muscle, which is equivalent in importance to the cardiac cycle with the period of its compression, is called ventricular diastole.

Diastolic dysfunction

Relaxation of the heart muscle in combination with elongation of muscle fibers, accompanied by a decrease in pressure in the ventricles, leads to the pumping of blood into them. Atrial compression also contributes to this result. Thus, the loss of the ability of the myocardial muscle fibers to relax during the diastole period, called diastolic dysfunction of the left ventricular myocardium, leads to insufficient blood flow into it. However, in this situation, the left atrium takes on the task of compensating for the weak activity of the ventricles, since it has the need to contract with increased load in order to draw in maximum blood. This provokes its overload, an increase in volume and an increase in pressure.

This condition is often preceded by systolic dysfunction, which results in stagnation of blood in the lungs and then in the veins, which significantly impairs blood flow throughout the body.

Further deterioration of the condition provokes the development of chronic heart failure. A decrease in blood supply to the heart muscle also leads to ischemia, which is complicated by the degeneration of myocardial fibers into scars consisting of connective tissue, and later to focal necrosis of muscle tissue.

Thus, cardiosclerosis develops with diastolic myocardial dysfunction, sometimes accompanied by a compression disorder.

Causes of the disease

It can be argued that the main cause of this disease is a deterioration in the ability of the myocardium to contract and relax, caused by a decrease in the elasticity of muscle tissue. This is caused by the following diseases:

This condition can also be observed in newborns immediately after birth and is called transient myocardial dysfunction. An increase in blood supply to the lungs and their hyperventilation in infants leads to the following consequences:

Increase in the size of the heart chambers.
Atrial overload.
Impaired contractility of the heart muscle.
Tachycardia.

This condition is not pathological and does not require additional treatment, however, in premature infants and in infants who have suffered hypoxia, it may last longer - approximately 15 days.

Types of diastolic dysfunction

Left ventricular diastolic dysfunction can be of 3 types:

Hypertrophic.
Normal.
Restrictive.

Type 1 diastolic myocardial dysfunction, that is, hypertrophic dysfunction, is the most common type of disease, which is asymptomatic in the first stages, and therefore the most insidious. It is based on a decrease in the ability to pump blood from the pulmonary artery into the ventricle during the rapid filling stage due to insufficient elasticity of the myocardium.

Treatment of the disease

Unfortunately, modern medicine has not yet found ways to restore myocardial contractility. Treatment of this disease comes down to the treatment of diseases against which this condition developed. Therefore, the tasks of doctors are:

Normalization of heart rate, in order to avoid the development of arrhythmias, for which beta blockers are taken.
Treatment of ischemia with nitrates.
Stabilization of blood pressure, which is facilitated by the use of diuretics.

Treatment should definitely be carried out under the supervision of a doctor.

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 refers to disruption of the left ventricle during its relaxation period (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.

Characteristics of right ventricular infarction, causes of the disease and methods of treatment and prevention