Cardiosclerosis - Causes, Symptoms and Treatment .MF .
Symptoms Diagnosis Treatment
forecast ability of the heart to perform its pumping function is provided by reducing each muscle cell individually.When the heart muscle is developing a pathological process (inflammation, eating disorders or death of cardiomyocytes), part of the cells fails, and instead appears connective tissue in the heart.This process is called sclerosis and scar formation in place of the myocardium - cardiosclerosis .
Depending on lesion volume recovered focal and diffuse cardio .Focal, in turn, can be fine and macrofocal, and characterized by the occurrence of small or large scars whitish between intact cardiomyocytes.To diffuse sclerosis is characterized by proliferation of connective tissue in the form of a lattice, in which the cells are normal myocytes.
In the initial stages of the disease remain intact myocytes perform the usual load, but sooner or later there is a violation of their food and they can not cope with
Cardiosclerosis not a primary disease, since it always develops in the outcome of some heart disease, so the examination and treatment of the patient should identify the cause and act on it to prevent further growth of scar tissue.
to diseases that can lead to the development Cardiosclerosis include the following:
1. Coronary artery disease and myocardial infarction .Within two months or more after the acute myocardial infarction develops small- or macrofocal cardio.Danger macrofocal sclerosis that scar in the thickness of the myocardium can lead to the formation of the left ventricular aneurysm, that is part of the ventricular wall is a protrusion, which can not be reduced, because of which decreases cardiac output, develop chronic heart failure and may develop acute failurewith pulmonary edema.Also mural thrombus may occur in the ventricular cavity, which is fraught with the development of thromboembolic complications.
The picture shows a myocardial infarction: purple highlighted necrosis zone, then is replaced by scar tissue.
2. Myocarditis - inflammation of the thicker nature of viral or bacterial attack.More often than not lead to myocarditis viruses, measles, influenza, infectious mononucleosis, adenovirus, streptococcal, meningococcal infection.A special place is myocarditis rheumatic nature - an inflammation of the heart muscle as a result of acute rheumatic fever (rheumatic fever).As a result of myocarditis develops, usually diffuse cardio
3. Cardiomyopathy - pathological changes in the anatomical structure of the myocardium.Often restrictive (impaired relaxation of the heart chambers), hypertrophic (thickened ventricular wall) and dilated (enlarged heart chambers and filled with blood).By cardiomyopathy can cause endocrine diseases - diabetes, obesity, thyroid disease, adrenal gland;toxic effects of alcohol, drugs, eating disorders - a decrease in revenues of protein and vitamins from food.As a result of cardiomyopathy - hypertrophic or replacement of the stretched muscle cells of the connective tissue elements of developing diffuse fibrosis.
Figures depict myocardial hypertrophy and enlargement of the heart chambers in cardiomyopathies.
4. myocardial - violation of myocardial supply.This is a group of metabolic disorders in the cardiac muscle, which is close in meaning to cardiomyopathy, but having a significant difference - the violation of myocardial supply may be reversed to the exclusion of a provoking factor, since the change of heart architectonic not observed before the formation of diffuse Cardiosclerosis.Lead to the development of myocardial dystrophy are listed in the preceding paragraph of the disease, as well as other non-cardiac (extracardiac) factors - infection, anemia, stress, autoimmune diseases, kidney and liver failure, exercise, professional sports.
5. Atherosclerosis - the deposition of cholesterol in the walls of blood vessels.It leads to disruption of supply of the myocardium due to obstruction of the coronary arteries, which is the cause of coronary heart disease and myocardial infarction.
6. Hypertensive disease can lead to the development of angiogenic Cardiosclerosis (of vascular origin), as the existing long vasospasm accompanying hypertension, creates an additional burden on the heart with the development of left ventricular hypertrophy.
degree of symptoms depends on the manifestations of the underlying disease that caused the cardio, and varies from complete their absence to the developed clinical picture, sometimes with sudden development of life-threatening conditions (pulmonary edema, ventricular fibrillation, rupture of left ventricular aneurysm, etc.).Symptoms Cardiosclerosis determined by the nature of myocardial injury (focal or diffuse), as well as localization of scars, as the location of even small foci near the cardiac conduction system can cause persistent arrhythmias.
often small-focal and diffuse moderate cardio are asymptomatic and detected only by means of additional diagnostic techniques.However, the reason for seeking medical attention can serve as the appearance of symptoms such as:
- shortness of breath that occurs when significant but previously well-tolerated physical exertion;
- palpitations under load and at rest,
- the feeling of lack of air in a horizontal position,
- slight swelling of the feet, resulting in the evening.
All these symptoms may be a manifestation of the initial stages of chronic heart failure, so when they occur in a patient with any heart condition it is necessary to visit the doctor.
progression of proliferation of connective tissue, which lasts for years, formed a pronounced diffuse cardio.It is characterized by the following symptoms:
- dyspnea, first at light load, then alone;
- episodes of "heart" of asthma - asthma attacks in the supine position, often at night;
- persistent violation of rhythm and conduction of the heart, accompanied by palpitations, disruptions in heart, chest pain.Often develop atrial fibrillation, atrial and ventricular premature beats, bundle branch block, atrioventricular block
- lower limb swelling, skin of the abdomen, waist, in the terminal stage of the whole body;
- pain in the right upper quadrant of the abdomen and an increase due to the increased blood supply to the liver.
In cases transmural (extensive) myocardial infarction and reinfarction in patients can form macrofocal cardio.Clinically, this type can be manifested by various rhythm disturbances, increased frequency of angina attacks, the development of heart failure.
Sometimes major focus of scarring under the influence of intracardiac pressure as it protrudes from the surface of the heart, and then talk about a patient heart aneurysm (usually the left ventricle) .This state is in material breach of intracardiac hemodynamics, as aneurysmal diverticulum is not able to contract to push blood into the aorta, the aneurysm cavity in stagnant blood, which also leads to a decrease in cardiac output.An aneurysm can occur as symptoms and manifestations of ventricular tachycardia and congestive heart failure.
To suspect the disease may be at the stage of familiarization with complaints and anamnesis (history of life) of the patient, as the information previously transferred cardiac and extracardiac diseases play an important role in diagnosis.much detail as possible so patients need to describe their chronic disease and possibly provide the necessary medical records (outpatient card, extracts from case histories, research results, etc.).
doctor at survey can reveal the following objective signs Cardiosclerosis:
- pulse can be normal, fast or slow, spasmodic, weak filling and tension,
- blood pressure reduced, normal or elevated,
- on auscultation of the chest heart sounds relaxedcan be heard pathological noises and tones in the lung congestion dry rales in the lower parts or all of the fields or wet bubbling rale (swelling in the lungs),
- palpation (palpation) of the abdomen is determined by an enlarged liver, percussion (rapping finger) - clusterfluid in the abdominal cavity,
- defined lower limb edema, brushes, in bedridden patients - lumbar, sacrum, the whole body.
To confirm the diagnosis the doctor prescribes laboratory - instrumental research methods:
- CBC - gives an indication of the presence of anemia of inflammation in the body,
- general analysis urine - helps to diagnose renal dysfunction (protein increasedwhite blood cell count),
- blood chemistry - detects abnormal liver function (liver transaminases, bilirubin) and kidneys (urea, creatinine), presence of diabetes (blood glucose),
- immunoassays blood - to help in the diagnosis ofviral disease, autoimmune diseases, rheumatism,
- hormonal blood tests - reveal the pathology of the thyroid gland, adrenal glands, diabetes, disorders of metabolism of sex hormones during menopause, etc.,
-. thyroid ultrasound, internal bodies are appointed in order to identify the causes ofcardiomyopathy or myocardial dystrophy,
- chest organ cells - may show enlargement of the heart borders with cardiomyopathy, the stagnation in the lung tissue,
- ECG standard and its variety - monitoring Holter, transesophageal electrocardiogram, ecg with physical activity (treadmill) or pharmacological tests.They are used for the diagnosis of arrhythmias, myocardial ischemia, as well as foci of sclerosis or diffuse changes in the myocardium.Symptoms of multiple sclerosis on an electrocardiogram are negative T waves in leads corresponding to the affected area (for melkoochagovogo sclerosis), deep and wide Q wave without pulling or ST segment depression (for macrofocal),
- echocardiogram (ultrasound of the heart) - a method to visualizeheart with reflection and evaluate ultrasound intracardiac hemodynamics, the presence of aneurysms, parietal thrombus, areas of hypo- and akinesia infarction (lack or loss of reduction), to calculate the force of contraction, ejection fraction, stroke volume, ie, the parameters that characterize the contractile ability of the heart and the amount of bloodis pushed into the aorta,
- coronary angiography (CAG) - appointed to assess the patency of coronary arteries in coronary artery disease, as well as addressing the issue of carrying out bypass or stenting,
- radioisotope studies heart (myocardial perfusion scintigraphy) to evaluate the extent of absorption"healthier" myocardial radioactive particles from the image visualization on the monitor.
At the discretion of the attending physician listed diagnostic techniques may be canceled or amended by others, such as MRI or MSCT of the heart, adrenal glands, pancreas, and other organs.
Cardiosclerosis therapy is to treat the underlying disease process and progression of prevention.Just the process of sclerosis is irreversible, that is, if you already have scars, will not escape from them, but prevent new scarring is possible and necessary.
In treatment of coronary heart disease and the prevention of recurrent myocardial infarction used drugs such as beta - blockers (betalok, carvedilol, bisoprolol, etc.), nitroglycerin (Nitromintum, nitrosprey) sublingual nitrates long-acting (nitrosorbid, monocinque)ACE inhibitors (enalapril, prestarium, noliprel), diuretics (hydrochlorothiazide, indapamide), antiplatelet therapy (aspirin drugs that prevent blood clots - aspirin Cardio, cardiomagnil).
Medication myocarditis comes to the appointment of antiviral and antibacterial drugs (ribavirin, penicillin antibiotics, etc.), antiplatelet agents and anticoagulants if necessary (aspirin, heparin), non-steroidal anti-inflammatory drugs (nimesulide, diclofenac), immunostimulatory, restorative preparations and vitamins(interferon, B vitamins, carnitine, etc.).
Therapy cardiomyopathy and myocardial dystrophy aimed at the treatment of the original disease - thyrotoxicosis, diabetes mellitus, alcoholism, anemia.Also appointed bettablokatory, ACE inhibitors and receptor blockers to angiotenzinogenu (lorista).These drugs have cardioprotective properties, ie prevent further myocardial remodeling.Prescribe antioxidants (ubiquinone, carnitine, cytochrome C), vitamins (folic acid and lipoic, B vitamins), drugs that enhance the power of the heart muscle (Riboxinum, mexidol) and preparations of magnesium and potassium (magnerot, Pananginum).
Hypertensive disease is treated the same antihypertensive drugs, sedatives (sedatives).
atherosclerosis Treatment consists mainly of a diet and taking lipid-lowering drugs (atorvastatin, lovastatin, simvastatin).
Faults rhythm and conduction appointed by antiarrhythmic drugs (VFS, propanorm, Cordarone), bettablokatory, antiplatelet agents and anticoagulants (warfarin).
therapy of chronic heart failure aimed at the elimination of stagnation in the small and large circulation and normalization of myocardial contractility.Appointed by the combination of all of these drugs in treatment regimens are added cardiac glycosides (strofantin, digoxin).
Surgery appointed in the absence of the effect of drug therapy and is to install a pacemaker in violation of rhythm, excision of the wall of the left ventricle aneurysms, aorto - coronary bypass surgery and stenting of the coronary arteries in coronary artery disease.
Individual treatment regimen established by the attending physician on the internal reception.Engage in self-diagnosis and self-treatment is unacceptable.
Lifestyle in cardiosclerosis
With the development of the disease the patient should be every six months or a year to visit a cardiologist, if necessary, other specialists - endocrinologist, physician, heart surgeon with a regular diagnostic activities.
patient should maintain a healthy lifestyle with a complete rejection of alcohol and smoking, with adequate physical activity in the fresh air (without significant physical exertion).In the first two weeks after myocardial infarction is very important to observe the complete bed rest, and subsequently more rest, longer stay in the fresh air, eat right and not experience significant psycho-emotional stress for a good flow of the early recovery period, as at this time there is scarring processheart muscle.
In all cardiac diseases, leading to cardio is assigned a diet with restriction of salt, animal fats, except for fatty, fried, spicy, savory dishes.