Cardiomyopathy - Causes, symptoms and treatment. MF.

Cardiomyopathy is a group of inflammatory diseases of the muscle tissue of the heart with a different cause. The obsolete name of this group of diseases is myocardial dystrophy. This disease affects people of different age groups and has no preferences for sex. For a long time, doctors could not determine the true cause of the development of cardiomyopathy, and in 2006 the American Cardiology Association decided to understand by reason of a group of causes that, under certain conditions and circumstances, cause myocardial damage.

Allocate: hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy. These types of cardiomyopathy have their own characteristic features of affecting the heart muscle, but the principles of treatment are the same and are directed mainly at eliminating the causes of cardiomyopathy and treating chronic heart failure.

Hypertrophic cardiomyopathy( HCM) is a disease characterized by hypertrophy( thickening) of the wall of the left and / or occasionally the right ventricle of the heart.

In the picture healthy heart and heart of the patient with hypertrophic cardiomyopathy

Dilated cardiomyopathy( DCMP) is a disease of the myocardium, characterized by the development of dilatation of the heart cavities( enlarged volumes of all the heart chambers), with the appearance of systolic dysfunction, but without increasing the thickness of the walls.

Restrictive cardiomyopathy is rare and characterized by the rigidity of the walls of the heart, a poor ability to go into the relaxation phase. As a result, delivery of blood and oxygen to the left ventricle of the heart is difficult, blood circulation in the whole body is disrupted. In some cases, restrictive cardiomyopathy is observed in children, due to hereditary factors.

Causes of cardiomyopathy

Myocardial damage in cardiomyopathy can be a primary or secondary process due to systemic diseases and is accompanied by the development of heart failure and, in rare cases, sudden death.

There are three main causes of the development of primary cardiomyopathy: congenital, mixed, and acquired. Secondary include cardiomyopathies due to some disease. As already mentioned above, there are a lot of reasons for this pathology, but with the development of cardiomyopathy, the symptoms will be similar regardless of the cause that caused this condition.

Congenital heart disease develops as a result of disruption of the laying of myocardial tissue during embryogenesis. There are a lot of reasons, starting from the bad habits of the future mother and ending with stress and malnutrition. Also known are cardiomyopathies of pregnant women and inflammatory cardiomyopathies, which can essentially be called myocarditis.

Secondary forms include the following types.

Cardiomyopathy of accumulation or infiltrative .It is characterized by the accumulation between cells or in cells of pathological inclusions.

Toxic cardiomyopathy .The severity of damage to the heart muscle when interacting with drugs, especially antitumor drugs, varies: from asymptomatic changes on the ECG to fulminant heart failure and death. Prolonged use of alcohol in large quantities, can lead to the development of inflammation in the heart muscle( alcoholic cardiomyopathy), this reason is in the first place in our country, as the most frequently detected.

Endocrine cardiomyopathy ( metabolic cardiomyopathy, dysmetabolic cardiomyopathy) occurs due to a metabolic disorder in the heart muscle, often leading to wall dystrophy and impaired contractility of the heart muscle. Causes - diseases of the endocrine system, menopause, obesity, unbalanced diet, diseases of the stomach and intestines. If cardiomyopathy develops as a result of diseases of the thyroid gland and diabetes, hypertrophic cardiomyopathy takes place.

Alimentary cardiomyopathy is formed as a result of eating disorders, and in particular with prolonged diets with limited meat products or starvation, the lack of vitamin B1 consumption of selenium, carnitine affects the heart.

Symptoms of cardiomyopathy that may occur in a patient.

Symptoms can appear at any age, usually they are not very visible to the patient and do not cause him to worry until a certain moment. Patients with cardiomyopathy achieve normal life expectancy and live to a very old age. Nevertheless, the course of the disease can be complicated by the development of formidable complications.

Symptoms are quite common and confuse them with other diseases quite easily. These include dyspnea, which in the initial stage occurs only with severe physical exertion;pain in the chest, dizziness, weakness. These symptoms are due to dysfunction of the contractility of the heart.

The question arises, when will he seek help from a doctor? Many of these symptoms can be a physiological feature of each of us or have a non-serious nature, as a manifestation of chronic pathology. It is worth pondering if the pain in the chest has a long "aching" nature and is combined with pronounced dyspnea. If there are swelling of the legs, a feeling of lack of air during exercise and a sleep disorder. Unexplained syncope, which can occur due to lack of blood supply to the brain. Do not wait for the development of further complications consult a doctor.

Diagnostic measures.

• It is necessary that your doctor in detail asked you about whether you had a heart disease in your family, whether there are relatives who died suddenly, especially at a young age.
• It is necessary to conduct a thorough examination with listening to the heart tones, as the frequency and the number of noise can be fully confident about this or that pathology of the heart.
• To exclude another cardiac pathology, it is necessary to conduct a biochemical blood test( markers of myocardial necrosis, electrolyte blood composition, serum glucose and lipid spectrum).
• Special attention should be given to functional indicators that reflect the condition of the kidneys and liver. General clinical studies of blood and urine.
• Radiography of chest organs helps to detect in most patients signs of an increase in the left heart, which indicates an overload. However, in a number of cases, radiology may not have any pathology.
• It is necessary to perform electrocardiography for all patients with suspected cardiomyopathy. You may be asked to record a Holter monitoring of an electrocardiogram that is performed to assess cardiac rhythm disturbances and the effect of the nervous system.
• Ultrasound is the "gold" standard in the diagnosis of cardiomyopathies.
• Magnetic resonance imaging is indicated to all patients before surgery. The method has a better resolving power than EchoCG, it allows to evaluate the features of the structure of the myocardium and to see pathological changes.

To understand on your own, what disease from a wide variety of similar is yours, is not possible. Correct diagnosis can be done only by a cardiologist. It is necessary to differentiate diseases accompanied by an increase in the myocardium of the left divisions: aortic stenosis, myocardial hypertrophy against hypertension, amyloidosis, athletic heart, genetic pathology. To exclude genetic diseases and syndromes, it is necessary to consult a specialist in genetic disorders. Consultation of a cardiosurgeon is necessary if: there is a pronounced increase in the thickness of the wall of the left heart, increased pressure in the output sections of the left ventricle, inefficiency of treatment with medicines. It is also necessary to consult an arrhythmologist.

Treatment of cardiomyopathy.

Treatment of cardiomyopathy is rather complicated and long-lasting. This is due to the polytyology of this pathology. While the treatment of cardiomyopathy depends on the specific cause, the goal of treatment is to maximize cardiac output and prevent further disruption of cardiac muscle function. In the treatment it is very important to observe all the activities that the doctor prescribes to you.

It is very important to pay attention to the moments that the patient must independently liquidate. At the expressed mass of a body it is very important to adhere to diets and a way of life for gradual and effective weight reduction. Harmful habits, such as alcohol and smoking, have the least effect on the development of heart disease than direct risk factors. Intensive physical activity and alcohol should be completely excluded from the way of life, in order to reduce the burden on the heart. In some cases, in the early stages of the disease, these activities can facilitate treatment and prevent its development.

Drug treatment is prescribed to sick people who have pronounced clinical manifestations of cardiomyopathy. Preparations from the group of β-adrenoblokatorov, representatives of which are Atenolol and Bisoprolol.

In the presence of rhythm disturbances, the appointment of anticoagulants is necessary because of the increased risk of thromboembolic complications.

When planning surgical intervention and to prevent the development of infective endocarditis, antibiotics are needed.

The drug Verapamil can be administered in the absence of the effect of the main group of therapeutic agents. The drug has a beneficial effect on the symptoms of cardiomyopathy by reducing the severity of cardiac muscle dysfunction.

Surgical intervention is performed according to strict indications and in case of ineffectiveness of drug treatment. If cardiomyopathy is associated with rhythm disturbances, in this case it is necessary to implant a pacemaker that will maintain the heart rhythm at the correct frequency. If there is a risk of sudden death( there were episodes in the family), a defibrillator implantation is necessary. This device can recognize ventricular fibrillation, an abnormal rhythm that does not allow the heart to work in the right mode and send an impulse to restart the heart for correct coordinated work.

Severe variants of cardiomyopathy that can not be corrected for surgical methods can be considered as a potential option for heart transplantation. But such operations are carried out only in highly specialized clinics.

Some successes have been obtained in the treatment of cardiomyopathy by stem cells.

After passing through one of the methods of treatment, it is necessary to observe a physician or general practitioner from a doctor, consultations of a cardiologist at a cardiology center or a dispensary are mandatory. Multiplicity of observation 1 - 2 times a year, in the presence of indications - more often. Repeated examinations should be performed if the general condition worsens or when planning a course of treatment change. Patients with life-threatening rhythm disturbances in the history must annually perform Holter ECG monitoring. To successfully treat and improve the quality of life, patients need to: reduce excess body weight, stop smoking and alcohol, control blood pressure, and limit intense physical activity.

Complications of cardiomyopathy and prognosis.

• Heart failure. Cardiomyopathy can lead to a decrease in blood flow from the left ventricle, which leads to heart failure.
• Valve dysfunction. Expansion of the left ventricle can make it difficult to pass blood through the valves, resulting in a reverse flow of blood. This causes the heart to decrease less efficiently.
• Edema. Cardiomyopathy can cause fluid accumulation in the lungs, abdominal tissues, legs and feet, because your heart can not pump effectively blood, like a healthy heart.
• Heart rhythm disturbances( arrhythmia). Changes in the structure of the heart and changes in pressure on the heart chamber can cause problems with the heart rhythm.
• Sudden cardiac arrest. Cardiomyopathy can cause sudden cardiac arrest.
• Embolism. Blood pool( stasis) in the left ventricle can lead to the formation of blood clots that can enter the bloodstream, cut off blood flow to vital organs, and cause a stroke, heart attack or damage to other organs.

The prognosis depends on many factors, how effectively you will be treated and follow all the prescriptions of the doctor, what degree of symptoms you have at the stage of primary detection. Effective ways to prevent this pathology is not developed. Therefore, an active lifestyle, proper nutrition is a guarantee of your health!

Doctor therapist Zhumagaziev E.N.