Cardiosclerosis - Causes, symptoms and treatment. MF.

Causes of cardiosclerosis
Symptoms
Diagnosis
Treatment and lifestyle
Complications and prediction

The ability of the heart to perform its pump function is provided by reducing each muscle cell individually. When a pathological process develops in the heart muscle( inflammation, malnutrition or death of cardiomyocytes), some of these cells cease to function, and instead of them a connective tissue appears in the heart. This process is called sclerosing, and the formation of the scar instead of the myocardium - cardiosclerosis .

Depending on the extent of the lesion, is allocated focal and diffuse cardiosclerosis. Focal, in turn, can be small and large focal, and is characterized by the appearance of small or large scars of whitish color between undamaged cardiomyocytes. Diffuse sclerosis is characterized by the proliferation of connective tissue in the form of a lattice, in cells of which there are normal myocytes.

In the initial stages of the disease, the remaining intact myocytes perform the usual load, but sooner or later there is a disturbance in their nutrition and they do not cope with their functions. Again, the death of other cells with the gradual formation of scars comes. In addition, the remaining cells are hypertrophied( thickened), and then stretched, which leads first to the formation of myocardial hypertrophy, and then to dilatation( expansion) of the heart chambers. This entails a violation of the contractile function and changes in hemodynamics - the flow of blood in the heart and the vessels with the development of chronic heart failure.

Cardiosclerosis is not a primary disease, as it always develops in the outcome of certain heart diseases, therefore, when examining and treating a patient, the cause should be identified and acted upon to prevent further growth of scar tissue.

Causes of cardiosclerosis

The following are the diseases that can lead to the development of cardiosclerosis:

1. Ischemic heart disease and myocardial infarction .Within two months or more, after an acute infarction, postinfarction small- or large-focal cardiosclerosis develops. The danger of large-sclerosis is that the scar in the thickness of the myocardium can lead to the formation of an aneurysm of the left ventricle, that is, part of the ventricular wall is a protrusion that can not contract, which reduces cardiac output, develops chronic heart failure and may develop acute insufficiencywith pulmonary edema. Also in the cavity of the ventricle, a parietal thrombus can form, which is fraught with the development of thromboembolic complications.

The figure shows a myocardial infarction: purple is the area of ​​necrosis, subsequently replaced by scar tissue.

2. Myocarditis - inflammatory processes in the thickness of the myocardium of a viral or bacterial nature. Most often, myocarditis is caused by measles, influenza, infectious mononucleosis, adenovirus, streptococcal, meningococcal infections. A special place is occupied by myocarditis of rheumatic nature - inflammation of the heart muscle as a result of acute rheumatic fever( rheumatic fever).As a result of myocarditis, usually develops diffuse cardiosclerosis

3. Cardiomyopathy - pathological changes in the anatomical structure of the myocardium. There is a restrictive( violation of relaxation of the chambers of the heart), hypertrophic( the walls of the ventricles are thickened) and dilated( the chambers of the heart are dilated and full of blood).Cardiomyopathy can lead to endocrine diseases - diabetes, obesity, thyroid disease, adrenal gland;toxic effects of alcohol, drugs, eating disorders - reducing the intake of protein and vitamins with food. As a result of cardiomyopathy due to the replacement of hypertrophied or stretched muscle cells, connective tissue elements develop diffuse fibrosis.

The figures depict hypertrophy of the myocardium and enlargement of the heart chambers in cardiomyopathies.

4. Myocardial dystrophy is a violation of myocardial nutrition. This is a group of metabolic abnormalities in the heart muscle, close in importance to cardiomyopathies, but having a significant difference - disturbances in myocardial nutrition can be reversible with the exclusion of the provoking factor, since changes in the architecture of the heart are not observed until the formation of diffuse cardiosclerosis. To lead to the development of myocardial dystrophy, the diseases listed in the previous paragraph, as well as other extracardiac( out-of-cardiac) factors - infections, anemia, stress, autoimmune diseases, renal and hepatic insufficiency, physical activity, professional sports.

5. Atherosclerosis - deposition of cholesterol plaques in the walls of blood vessels. It leads to disruption of myocardial nutrition due to the impassability of the coronary arteries, which is the cause of coronary artery disease and myocardial infarction.

6. Hypertensive disease can lead to the development of angiogenic cardiosclerosis( vascular origin), since the long-existing vasospasm accompanying hypertension creates an additional burden on the heart with the development of left ventricular hypertrophy.

Symptoms of cardiosclerosis

The degree of symptom severity depends on the manifestations of the underlying disease that caused cardiosclerosis, and varies from complete absence to a detailed clinical picture, sometimes with sudden development of life-threatening conditions( pulmonary edema, ventricular fibrillation, left ventricular aneurysm rupture, etc.).The symptomatology of cardiosclerosis is determined by the nature of myocardial damage( focal or diffuse), as well as the localization of scars, since the location of even small foci near the conduction system of the heart can cause persistent rhythm disturbances.

Often, small-focal and moderately diffuse cardiosclerosis occurs asymptomatically and is detected only with the help of additional diagnostic methods. However, the reason for going to the doctor can be the appearance of such symptoms as:

- dyspnea that occurs with significant, but previously well-tolerated physical exertion;
- fast fatigue,
- palpitations with load and at rest,
- dizziness,
- feeling of lack of air in the horizontal position,
- slight swelling of the feet that occur in the evening.

All these symptoms can be a manifestation of the initial stages of chronic heart failure, so when they occur in a patient with a cardiac disease, he needs to visit the attending physician.

As the proliferation of connective tissue lasts for years, a pronounced diffuse cardiosclerosis is formed. For him, the following symptoms are typical:

- pronounced dyspnea, first with minor exercise, then at rest;
- episodes of "cardiac" asthma - attacks of suffocation in prone position, more often at night;
- persistent disturbances of the rhythm and conduction of the heart, accompanied by rapid heartbeat, irregular heartbeat, pain in the chest. Often develop atrial fibrillation, atrial and ventricular extrasystole, blockade of the bundle of the bundle, atrioventricular blockade of
- edema of the lower extremities, abdominal skin, waist, in the terminal stage of the entire body;
- pain in the right hypochondrium and abdominal enlargement due to high blood filling of the liver.

In cases of transmural( extensive) myocardial infarction, as well as repeated myocardial infarction, a large focal cardiosclerosis may form in the patient. Clinically, this type can manifest itself by various disorders of rhythm, the increase in angina attacks, the development of signs of heart failure.

Sometimes a large foci of scarring under the influence of intracardiac pressure seems to bulge from the heart, and then it is said that the patient has heart aneurysm( more often left ventricle) .This condition significantly disturbs intracardiac hemodynamics, since an aneurysmal protrusion can not contract to push blood into the aorta, blood stagnates in the aneurysmal cavity, which also leads to a decrease in cardiac output. Aneurysm can occur both asymptomatically and with manifestations of ventricular tachycardias and chronic heart failure.

Diagnosis of cardiosclerosis

The disease can be suspected already at the stage of acquaintance with the patient's complaints and anamnesis( life history), as the information about previous cardiac and out-of-cardiac diseases plays a big role in the diagnosis. Therefore, the patient needs to characterize as much as possible his chronic illnesses and, if possible, provide the necessary medical documentation( an outpatient card, extracts from the case histories, the results of the studies, etc.).

The physician at the examination can reveal the following objective signs of cardiosclerosis:

- the pulse can be normal, fast or slow, irregular, weak filling and tension,
- blood pressure lowered, normal or increased;
- when listening to the chest, heart sounds are weakened, canlisten to pathological noises and tones, in the lungs, stagnant dry wheezing in the lower parts or across all fields, or wet bubbling rale( with pulmonary edema),
- when palpation( probing) the abdomen is determined byElongated liver, percussion( finger tapping) - accumulation of fluid in the abdominal cavity,
- the swelling of the lower limbs, hands, the recumbent patients - the loins, the sacrum, the whole body.

To confirm the diagnosis, the doctor prescribes laboratory and instrumental research methods:

- general blood test - allows to judge the presence of anemia, inflammatory process in the body,
- general urine analysis - helps diagnose renal dysfunction( protein, increased white blood cell count),
- biochemical blood test - determines the violation of liver function( hepatic transaminases, bilirubin) and kidneys( urea, creatinine), the presence of diabetes mellitus( glue level
- immunological blood tests - help in the diagnosis of viral, autoimmune diseases, rheumatism,
- hormonal blood tests - reveal the pathology of the thyroid gland, adrenal glands, diabetes mellitus, sex hormone abnormalities in menopause, etc.,
- Thyroid ultrasound, internal organs of are assigned to identify the causes of cardiomyopathy or myocardial dystrophy,
- chest radiograph of - can show an extensioncardiac myopia, pulmonary congestion,
- ECG standard and its variants - Holter monitoring, transesophageal ECG, exercise ECG( treadmill) or with pharmacological tests. They are used for diagnosis of rhythm disturbances, myocardial ischemia, as well as lesions of sclerosis or diffuse changes in the myocardium. Signs of sclerosis on the ECG are a negative T wave in the leads corresponding to the lesion zone( for small-sclerosis), a deep and wide Q tooth without a rise or depression of the ST segment( for large-focus),
- echocardiography( ultrasound of the heart) is a method that allows to visualizeheart with the help of ultrasound reflection and evaluate intracardiac hemodynamics, the presence of aneurysms, parietal thrombi, areas of hypo- and akinesia of myocardium( reduced or absent contraction), calculate the force of contractions, fractionImpact volume, ie parameters characterizing the contractility of the heart and the amount of blood pushed into the aorta
- Coronary angiography( CAG) - is assigned to assess the patency of the coronary arteries in coronary artery disease, as well as addressing the issue of bypass or stenting,
- radioisotope heart studies ( perfusion scintigraphy of the myocardium) allows to estimate the degree of absorption of "healthy" myocardium of radioactive particles with visualization of the image on the monitor.

At the discretion of the attending physician, the listed diagnostic methods can be canceled or supplemented by others, such as MRI or MSCT of the heart, adrenal glands, pancreas and other organs.

Treatment of cardiosclerosis

Therapy of cardiosclerosis is to treat the underlying disease and prevent the progression of the process. Directly the process of sclerosing is irreversible, that is, if there are already scars, they can not get anywhere from them, but it is possible and necessary to prevent the appearance of new scars.

In treatment of coronary heart disease and prevention of repeated myocardial infarctions , such drugs as betta-adrenoblockers( betalk, carvedilol, bisoprolol, etc.), nitroglycerin( nitromite, nitrospray) under the tongue, long-acting nitrates( nitrosorbide, monochinke), inhibitorsACE( enalapril, prestarium, noliprel), diuretics( hypothiazide, indapamide), antiplatelet agents( aspirin preparations that prevent the formation of thrombi - aspirin Cardio, cardiomagnet).

Medical treatment of myocarditis is reduced to the appointment of antiviral and antibacterial drugs( ribavirin, antibiotics of the penicillin series, etc.), antiplatelet agents and anticoagulants if necessary( aspirin, heparin), nonsteroidal anti-inflammatory drugs( nimesulide, diclofenac), immunostimulating, restorative drugs and vitaminsinterferon, B vitamins, carnitine, etc.).

Therapy for cardiomyopathy and myocardial dystrophy is aimed at treating initial diseases - thyrotoxicosis, diabetes mellitus, alcoholism, anemia. Betatblockers, ACE inhibitors and angiotensinogen receptor blockers( lorist) are also prescribed. These drugs have cardioprotective properties, that is, prevent further myocardial remodeling. Antioxidants are prescribed( ubiquinone, carnitine, cytochrome C), vitamins( folic and lipoic acids, B vitamins), drugs that improve the nutrition of the heart muscle( riboxin, mexidol) and preparations of magnesium and potassium( magnerot, panangin).

Hypertensive disease is treated with the same antihypertensive drugs, sedatives( sedatives).

Treatment of atherosclerosis consists mainly of dieting and taking lipid-lowering medications( atorvastatin, lovastatin, simvastatin).
If rhythm disturbances and conduction occur, antiarrhythmic drugs( allapinin, propanorm, cordarone), bettablockers, antiaggregants and anticoagulants( warfarin) are prescribed.

Therapy of chronic heart failure is aimed at the elimination of stagnation in small and large circles of the circulation and in the normalization of contractility of the myocardium. Assign combinations of all of the above drugs, cardiac glycosides( strophanthin, digoxin) are added to the treatment regimens.

Surgical treatment of is prescribed in the absence of the effect of drug therapy and consists in the installation of an pacemaker for rhythm disturbances, excision of the walls of left ventricular aneurysm, aortic coronary artery bypass grafting and stenting of coronary arteries in IHD.

The individual treatment regimen is established by the attending physician at full-time admission. Do self-diagnosis and self-treatment is unacceptable.

Lifestyle with cardiosclerosis

With the development of this disease, the patient must visit the cardiologist every six months or every year, if necessary, other specialists - endocrinologist, therapist, cardiac surgeon with regular diagnostic activities.

The patient needs to lead a healthy lifestyle with total refusal of alcohol and smoking, with adequate motor activity in the fresh air( without significant physical exertion).In the first two weeks after myocardial infarction, it is very important to observe complete bed rest, and then have more rest, spend more time outdoors, eat right and do not experience significant psychoemotional loads for a good early recovery period, because it is during this time that the scarring processheart muscle.

In any cardiological diseases that led to cardiosclerosis, a diet with restriction of table salt, animal fats, excluding fatty, fried, sharp, salty foods is prescribed. It is recommended to eat more vegetables, fruits, and sour-milk products. Low-fat meat and fish are allowed. In case of non-cardiac diseases that caused cardiosclerosis, the diet is discussed by the doctor individually( for example, with anemia, diabetes mellitus).

Complications of cardiosclerosis

The main complications are acute heart failure, ventricular fibrillation, thromboembolic complications, rupture of left ventricular aneurysm.

Prevention of complications is the timely diagnosis( for example, blood clots in the heart), competent treatment of the resulting rhythm disturbances with the use of surgical methods of treatment, if necessary, and the use of anticoagulants under the control of laboratory indicators of the blood coagulation system( eg, taking warfarin under a regularcontrol of INR).

Forecast

In general, the prognosis of cardiosclerosis is favorable with regular intake of prescribed drugs. With the development of complications, the prognosis becomes heavier and is determined by their nature.

Doctor therapist Sazykina O.Yu.