Dilated cardiomyopathy - Causes, Symptoms and Treatment .MF .
Symptoms Diagnosis Treatment
Complications and prognosis
For regular, rhythmic contractions of the heart to the body's needs providing an adequate volume of blood ejected by the aorta, certain conditions are required.First, the normal thickness of the heart wall and heart chambers standard sizes - the atria and ventricles.There are many reasons that could disrupt the biochemical processes in the cells of the myocardium, which may lead to a change in the configuration of the heart - a thickening of the heart walls and / or increase the volume of the heart chambers.It is developing such diseases as cardiomyopathy.
Cardiomyopathy - the outcome of certain cardiac or systemic disease characterized by dysfunction of contraction and relaxation of the heart, and show symptoms of chronic heart failure, stagnation of blood in the organs and in the heart, heart rhythm disturbances.
Also acquired as a result of certain diseases, cardiomyopathy can be congenital or idiopathic - with no est
Dilated cardiomyopathy - a disease characterized by enlargement of the heart chambers with thick or normal heart wall.Due to the overcrowding in the blood of the heart cavities develop systolic dysfunction - reduction in force of ventricular contraction and reduced blood ejection fraction in the aorta below 45% (more than 50% of normal).From this suffering blood flow to internal organs and developing congestive heart failure.
addition dilated, hypertrophic is still (with a sharp thickening of the walls of the atria or ventricles) and restrictive (with the "soldering" external or internal membrane of the heart - the pericardium or endocardium to the heart muscle with limited mobility latter).
prevalence of dilated cardiomyopathy is from 1 to 10 per 100,000 population.In newborn infants, occurs in approximately 50% of all cardiomyopathies and in 3% of all heart disease, often (40% of all cases) require a heart transplant at the age of two.Among adults, usually ill person 20 - 50 years, most men (60%).
Causes of dilated cardiomyopathy
Only 40% of patients can not establish the exact cause of cardiomyopathy.In other cases, the disease is considered to be the primary, or idiopathic.
Causes of secondary dilated cardiomyopathy:
- viral infections - Coxsackie viruses, influenza, herpes simplex, cytomegalovirus, adenovirus,
- genetically caused immune disorders (defect subpopulation of T - lymphocytes - natural killer cells), inborn features of the heart structure at the molecularlevel,
- toxic damage of myocardium - alcohol, drugs, poisons, anticancer drugs,
- dysmetabolic disorders - hormonal changes in the body, fasting and diet with protein deficiency, B vitamins, carnitine, selenium and other substances,
- autoimmune diseases- rheumatoid arthritis, systemic lupus erythematosus often cause autoimmune myocarditis, the outcome of which may be cardiomyopathy.
symptoms of dilated cardiomyopathy
Sometimes the signs of the disease may not appear for months or even years, until heart function offset.As decompensation or immediately following symptoms appear:
1. The symptoms of congestive heart failure:
- shortness of breath when walking at first, then alone,
- nightly attacks of cardiac asthma, pulmonary edema episodes - pronounced dyspnea in the supine position, the hauntingcough, dry or with frothy sputum pink color, sometimes streaked with blood, blue nail varnish, tip of the nose and ears, edema - pronounced cyanosis of the face, lips, limbs,
- lower limb swelling, worse in the evening and disappearing after a night's sleep,
- a feeling of heaviness, moderate dull pain in the right hypochondrium.Due to increased hyperemia of the liver and stretching its capsule,
- an increase in abdominal volume due to fluid accumulation (ascites) of - for cardiac cirrhosis of the liver in the later stages of heart failure,
- impaired renal function - change rate and urinary volume - rare or frequent, large orsmall portions,
- signs of cerebral blood flow - impaired memory, attention, distraction, mood swings, insomnia and other symptoms dyscirculatory (in this case venous) encephalopathy.
Heart failure has four stages according to the degree of symptoms and exercise intolerance (I, II A, II B, III and IV stage).
2. Symptoms that are typical of disorders of left ventricular systolic function.
At initial decrease patient ejection fraction bother weakness, fatigue, pallor, cold hands and feet, dizziness.
With a significant reduction in cardiac output develops pronounced weakness, inability to carry out the minimum types of household activity, dizziness and sudden loss of consciousness, with little physical effort.
3. Symptoms of arrhythmias. more than 90% there are various arrhythmias, manifested a sense of disruptions in the heart, a sense of fading, and cardiac arrest.Most often it develops atrial fibrillation, sometimes difficult to restore rhythm, so in these patients formed a permanent form of atrial fibrillation.Perhaps the development of atrioventricular block, bundle branch block, ventricular premature beats and other arrhythmias.
patients with advanced heart failure caused by dilated cardiomyopathy, as follows - takes half-sitting position, even during sleep, because it is easier to breathe.His breathing noisy, with labored breath, you can hear the gurgling in the distance wheezing in the lungs due to pronounced blood stagnation.Face bloated, swollen hands and feet, stomach increased in volume, sometimes edema subcutaneously - fatty tissue throughout the body - developed anasarca.The slightest movement, even within the bed aggravates shortness of breath and causes discomfort.
diagnosis of dilated cardiomyopathy
When patients such complaints should consult a doctor or therapist cardiologist.The diagnosis may be suspected on the basis of the survey and examination of the patient.
Auscultation of the heart and lungs weakened heart sounds are heard, in most cases, arrhythmic, characterized by abnormal heart sounds (gallop rhythm).Apical impulse spilled, shifted to the left and down.
Blood pressure may be normal, increased at the beginning of the disease, or more often lowered.Pulse is normal or weak filling and tension spasmodic.
Showing laboratory methods:
- clinical analyzes - common blood and urine tests, blood chemistry with the evaluation of liver and kidney function (ALT, AST, bilirubin, urea, creatinine, alkaline phosphatase, and others.),
-study of blood coagulation -. INR, prothrombin time, and the index, while the blood clotting, etc.,
- glycemia (sugar curve) for people with diabetes,
- rheumatologic tests (antibodies to streptolysin, streptogialuronidaze, the level of C - reactive protein andetc.) for the differential diagnosis of rheumatic heart disease,
- definition of sodium - ureticheskogo peptide in the blood,
- hormonal studies - the level of thyroid hormones, adrenal glands.
- echocardiography - the most valuable non-invasive study of the heart muscle and heart function.It allows you to differentiate cardiomyopathy from heart disease, clarify ischemic myocardial damage, to determine the size of the heart chambers and the thickness of the walls.The most important criterion, which is determined by ultrasound of the heart and on which depends the life prognosis - a cardiac ejection fraction (EF).Normally, an ejection fraction of a healthy person is 55 - 60%, with cardiomyopathy - below 45 - 50%, and the critical value is less than 30%.
- ECG and its modification - daily monitoring of ECG, ECG stress (treadmill test), CHPEFI - Transesophageal electrophysiological study (appointed not for everyone, since it is not mandatory for dilated cardiomyopathy).
- chest X-ray - noted increased and extended shadow of the heart, increased pulmonary pattern on lung fields.
radiograph of the patient with dilatation of the heart chambers
- ultrasound of the internal organs, the thyroid gland, adrenal glands.
- possibly MRI heart ventriculography, myocardial scintigraphy in diagnostically difficult cases.
dilated cardiomyopathy must be differentiated from diffuse myocarditis, coronary heart disease and ischemic cardiomyopathy, pericarditis, heart defects.Therefore, if you suspect a heart disease patient must consult a doctor.
treatment of dilated cardiomyopathy
Treatment of early stage heart failure begins with lifestyle interventions and nutrition, as well as the elimination of modifiable risk factors (alcohol, smoking, obesity).
- ACE inhibitors - captopril, perindopril, ramipril, lisinopril, and others are shown in all patients with systolic dysfunction..Improves survival and prognosis, reduce the number of hospitalizations.You should be administered under the supervision of indicators of kidney function (urea and creatinine).Appointed indefinitely, perhaps for life.
- diuretics deduce the excess fluid from the lungs and internal organs.Appointed veroshpiron, spironolactone, furosemide, torasemide, Lasix.
- cardiac glycosides tahiforme indispensable for atrial fibrillation and reduced ejection fraction.Appointed digoxin strofantin, Korglikon.It should be clearly observed the dosage of drugs, as an overdose develops glycoside poisoning intoksikatsiya- these drugs.
- beta - blockers (metoprolol, bisoprolol, etc.) are assigned to the reduction in heart rate, blood pressure.Also improve the prognosis.
These groups of drugs significantly reduce the symptoms of left ventricular dysfunction, reduce dyspnea and edema, increase exercise tolerance and improve quality of life in general.
- blood-thinning drugs (anticoagulants) : aspirin, tromboAss, etc. Showing atsekardol to prevent increased formation of blood clots in the bloodstream..Warfarin or clopidogrel, or Plavix used in atrial fibrillation under the control of INR once a month (or under the control of prothrombin index).
- nitrates - short-acting drugs (nitrosprey, Nitromintum) may be recommended for patients with an increase in shortness of breath when walking or with concomitant angina.Intravenously in a hospital administered nitroglycerin for relief of left ventricular failure and pulmonary edema.
- calcium channel antagonists (nifedipine, verapamil, diltiazem) are usually prescribed to patients with other forms of cardiomyopathy instead of beta - blockers in the presence of contraindications to the latter.But in case of violation of the left ventricular systolic function, the appointment is contraindicated, as they "relax" the heart muscle, and already incapable to contract properly.Nifedipine also increases heart rate, which is unacceptable when tahiforme atrial fibrillation.However, if you can not use beta - blockers may appointment of amlodipine or felodipine.
Surgical treatment of dilated cardiomyopathy:
- implanted cardioverter - defibrillator in the presence of life-threatening ventricular tachyarrhythmias
- implanted pacemaker shown at the expressed disturbances of intraventricular conduction, when uncoupling synchronous contractions of the atria and
ventricles - of the heart transplantation
Indicationsand contraindications for surgical treatment of cardiology and cardiac surgery are determined strictly individually, as tolerated by the body exhausted heart surgery is unpredictable and may develop an adverse outcome.
life When cardiomyopathy is necessary to implement the following recommendations:
- rejection of bad habits
- reduction of excess weight, but not by means of starvation diets or exhausting, but with proper eating.There should be a power mode: 4 - 6 meals a day in small portions with a predominant use of liquid foods, foods cooked in boiled or steamed.It is necessary to eliminate fried foods, spicy, salty, fatty foods and spices.Limited pastries, fatty meats and poultry.At the same time, it should enrich the diet of omega-3 unsaturated fatty acids contained in marine fish (salmon, mackerel, salmon, trout, caviar).Also useful in the food content of vitamins, minerals, selenium, and zinc.Particularly rich in selenium, oatmeal, tuna, buckwheat, eggs, wheat bran, peas, sunflower seeds, mushrooms, bacon.
- restriction of salt in the diet to 3 grams per day, and in severe Edema syndrome - 1.5 g per day, fluid intake restriction, including the dishes with the first 1.5 liter per day.
- mode of operation, allowing devote sufficient time to rest and sleep (at least 8 hours of sleep a night)
- physical activity of the patient must be present on a daily basis, but according to the degree of severity of heart failure.Even if the patient most of the time in bed due to severe shortness of breath, edema, etc., it still has to move at least in the range of bed and perform simple rotational movements of the head, hands and feet, as well as breathing exercises.Complex physical therapy can be discussed with your doctor.
- Vaccination against influenza and pneumococcus is a person with a family history of myocarditis and cardiomyopathy.In the treatment of SARS and other respiratory diseases such persons necessarily use of recombinant interferon (viferon, Genferon, kipferon etc.).
- correction of comorbidities - diabetes, hypertension, hyper - and hypothyroidism, etc.
-. Focus on the fruitful cooperation with the attending physician, the installation of a positive result of treatment, the implementation of all recommendations and chronic administration of essential drugs - the key to success in the treatment of cardiomyopathy.
Complications dilated cardiomyopathy
congestive heart failure and cardiac arrhythmias are often seen as a complication of cardiomyopathy, but essentially, they are mostly its clinical manifestations, as developed in almost all patients, and the general symptoms of cardiomyopathy consists of the symptoms of these disorders.
Hazardous effects include thromboembolism - blood clots in the heart cavity.Due to stagnation and the slow movement of blood platelets, the cells are deposited on the walls of the heart and parietal thrombus formed, which may be carried by the blood current major arteries and clog them clearance.These include pulmonary, femoral, mesenteric artery ischemic stroke.Prophylaxis - continuous administration of drugs, blood thinners.
Frequent ventricular premature beats, ventricular tachycardia can cause ventricular fibrillation, cause heart failure and death.To prevent the occurrence of fatal arrhythmias may be constant reception of beta - blockers and cardiac glycosides.
prognosis of the natural history of dilated cardiomyopathy without treatment unfavorable, because the heart is completely ceases to perform the function of the pump, leading to degeneration of all organs, exhaustion and death.
When medication prognosis favorable for life - a five-year survival rate of 60 - 80% and a ten-year survival after heart transplants - 70 - 80%.
Labor prognosis is determined by the stage of circulatory disorders.In the first stage of heart failure patients can run, but he was contraindicated hard physical work, night shifts, business trips.
therapists Sazykina OJ