Additional chord in the heart - Causes, symptoms and treatment. MF.

This article deals with such a structural anomaly, so widespread in recent times, as additional chords in the heart cavity. Recently, in connection with the improved quality of examination of newborns, including the echographic method( ultrasound of the heart), the frequency of cases of registration of this anomaly has increased. Many doctors, especially doctors of ultrasound diagnostics, interpret the concepts of trabecula and chord as equivalent, which is not entirely correct from the position of anatomy and physiology, but the fact remains and in the conclusion of the doctor you can see the diagnosis of "additional trabecula" instead of "extra chorda".

But before I highlight all aspects of this pathology, I would like to briefly dwell on the anatomical features of the heart.

The heart consists of four chambers - left and right atriums and left and right ventricles. In a normally functioning heart, blood moves from the atria to the ventricles. Unidirectional blood flow is provided by means of the heart valves between them, which close and open, respectively, the heart rate cycle. In order for the valves to retain their mobility and flexibility, on the ventricle side they are supported by "springs" - tendon threads, or chords. These threads alternately contract, pulling the valve on itself and passing blood to the ventricle, and relax, then the valve flaps close and the blood is not thrown back into the atrium.

Sometimes it happens that when the baby's heart is still developing during pregnancy, one or more( or about 35% of the cases) of additional strands in the ventricle is laid. An additional chord in the heart is nothing more than an additional connective tissue formation that occurs in the cavity more often than the left ventricle, and in most cases does not carry a significant hemodynamic load( that is, does not violate the function of the heart).Refers to small anomalies of heart development.

Depending on the location in the ventricle, longitudinal, diagonal and transverse chords are distinguished( the latter are less common).Longitudinal and diagonal do not interfere with the progress of blood through the chambers of the heart( these are hemodynamically insignificant chords), transverse ones can appear hemodynamically significant - to create an obstacle to the flow of blood, which affects the work of the heart muscle as a whole. Also, transverse chords in very rare cases can be attributed to provoking arrhythmogenic factors, that is, they are capable of causing cardiac rhythm disturbances( ERW syndrome, short PQ syndrome) in a more adult age.

Causes of the disease

The main reason for the appearance of an additional chord in the heart is considered to be heredity. If the mother has any diseases of the cardiovascular system, there is a large percentage that the child will be diagnosed with one or more of the cardiac abnormalities( open oval window, extra chord, mitral valve prolapse).At the same time, the adverse environmental impact, the influence of mutagenic factors( smoking, alcohol and drug use in pregnant women) can not be excluded as a cause, mainly during the period of the laying of connective tissue( up to 5-6 weeks of fetal development) and throughout pregnancy.

Symptoms of an additional chord

Based on what can you suspect a disease? If the additional chord in the heart is represented by a single thread, as it often happens, it does not manifest itself at all, the course of the disease throughout life is asymptomatic. It is possible to suspect this developmental anomaly right after birth on the basis of systolic murmur in the heart while listening to the child( in the overwhelming majority of cases the diagnosis is established in the period of newborn and early childhood, up to 3 years).The increase in the frequency of registration, as mentioned above, is due to the fact that according to the recently adopted medical diagnostic standards, each child aged 1 month is assigned ECHO-KG( ultrasound of the heart) to exclude the congenital pathology of the cardiovascular system.

In a number of cases, with intensive growth of a child with an additional chord, especially when the growth of the musculoskeletal system outpaces the growth of internal organs, including the heart, and therefore the load on it increases, cardialgia( pains in the region of the heart), sensationspalpitations, general fatigue, unmotivated weakness, psychoemotional lability and dizziness, as manifestations of neurocirculatory( vegeto-vascular) dystonia. There may be irregularities in the rhythm of the heart. This symptomatology often manifests itself in adolescence and can accompany a patient in adulthood.

If there are several additional chords in the heart, the doctor should remember that the connective tissue is not only in the heart, but in all internal organs and the musculoskeletal system, respectively, and the clinical manifestations can be from many organs and systems of the body. In such cases, we speak of connective tissue dysplasia, which is characterized by changes in the skeleton( scoliosis of the lower thoracic spine, deformity of the limbs, skeletal muscle disorders), alteration of the tracheobronchial tree framework, digestive system organs( bend or deformation of the gallbladder, hiatal herniadiaphragm, gastroesophageal reflux - throwing of gastric contents back into the esophagus), organs of the urinary system( nephroptosis - kidney depression, megaureter - extensorof the ureter, pyelectasia - expansion of the renal pelvis), etc. That is, with multiple chords in the heart, detected by ultrasound, and the above deviations in the structure of other organs, one should think that connective tissue is poorly developed not only in the heart, but throughout the body.

Thus, only a cardiologist and pediatrician with the involvement of other specialists can decide whether in each case there is an additional chord as an independent, separate disease;or an anomaly arose as a result of a lesion of connective tissue. In the first case, as a rule, there are no symptoms, in the second, the same symptoms appear on the part of other organs, which requires a comprehensive examination and monitoring of the patient.

Survey for suspicion of additional chord

Diagnosis of this abnormality is as follows:

• clinical examination with obligatory auscultation( listening) of the patient, at which the doctor will hear systolic murmur in the heart;
• ECHO-KG( ultrasound of the heart) is the "gold standard" in the diagnosis of an additional chord of the heart.

Heart of a human with echocardiographic examination( ultrasound of the heart).The additional chord is represented by an echocardic linear formation, which can be viewed in two planes of the section located in the cavity of the left ventricle( LV), closer to the mitral valve.

In addition to an ultrasound of the heart.the patient can be assigned ECG( with or without exercise) to exclude cardiac rhythm disturbances;daily ECG monitoring;loading tests( veloergometry).What exactly from the listed methods of inspection is necessary for the patient, the doctor on internal survey solves.

Treatment of

If the patient of does not have clinical manifestations of the additional chord , he does not need medicamental treatment. It is quite enough to observe the cardiologist and regular echographic examination in addition to the ECG at least once a year.

In situations where the patient is concerned about symptoms from the cardiovascular system , it is justified to prescribe medication.

• To improve the trophism( nutrition) in the myocardium( cardiac muscle), vitamins are prescribed: vitamin B1( thiamine) with lipoic acid;vitamin B2( riboflavin);vitamin PP( nicotinic acid).All vitamins are taken by courses lasting not less than a month and at least twice a year.
• Normalization of the processes of repolarization( conducting an electrical impulse through the fibers of the myocardium), the violation of which lies at the heart of cardiac arrhythmias, will be helped by preparations of magnesium and potassium: magnesium B6( magnesium citrate with vitamin B6) -the course for one month( contraindicated to children under six years old);magnerot( magnesium orotate) course for three to four weeks( contraindicated to persons under 18 years of age);potassium orotate course of three to five weeks( allowed for use in children according to age-related dosage);panangin( potassium and magnesium asparaginate) course of one month( safety of use in children is not proven).
• Antioxidants are prescribed to improve metabolism( metabolic processes) in myocardial cells: ubiquinone, L-carnitine preparations, cytochrome C.
• Nootropic drugs( piracetam, nootropilum) are prescribed when neurocirculatory dystonia appears.

And in any case, with an additional chord, general health measures are necessary: ​​
- hardening of the organism;
- rational nutrition, enriched with vitamins;
- long stay in the open air;
- observance of a mode of work and rest;
- exercise appropriate to the physical condition of the body - gymnastics, dances( in any case, the decision on the possibility to engage in a particular sport should be taken by the attending physician).

If a patient with has a transverse chord or if chords have multiple , cardiac arrhythmia develops( atrial fibrillation, paroxysmal tachycardia, extrasystole, Wolff-Parkinson-White syndrome, Morgagni-Edessa-Stokes syndrome), up todevelopment of life-threatening conditions, immediate hospitalization in the profile cardiological hospital is required with subsequent more detailed examination and treatment.

Sometimes, due to the fact that the beams of the conducting myocardium are included in the false chord, surgical methods of treatment - cryodestruction( destruction by cold impact) or excision of the chord - have to be resorted to.

Can complications develop without treatment?

Predicting in advance how this or that disease will develop in a patient is sometimes impossible. Concerning the additional chord of the left ventricle in particular, and small heart anomalies in general, it can be said that doctors have encouraging data - as a rule, these structural changes do not require special treatment in the event that they do not disrupt the function of the cardiovascular system. Complications develop rarely, and subject to adherence to medications, they can be minimized.

Forecast

Prognosis for life is favorable in the absence of significant hemodynamic and arrhythmogenic disorders.

Doctor therapist Sazykina O.Yu.