Hypertrophy of both ventricles on the ECG. Violation of intraventricular conduction

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University them. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education – Specialist

Additional education:

"Cardiology"

State educational institution "Institute for Advanced Medical Studies" of the Ministry of Health and Social Development of Chuvashia

Cardiac hypertrophy is not a disease. This is a syndrome that speaks of trouble in the body. Why is it developing and what does it indicate? What are the prognosis for myocardial hypertrophy?

What is cardiac hypertrophy?

Heavy physical work, sports, illness, unhealthy image life creates conditions when the heart has to work harder. To provide the body's cells with uninterrupted good nutrition, he has to contract more often. And the situation turns out to be similar to pumping up, for example, biceps. The greater the load on the ventricles of the heart, the larger they become.

There are two types of hypertrophy:

• concentric when muscle walls the hearts thicken, but the diastolic volume does not change, that is, the chamber cavity remains normal;
• eccentric is accompanied by stretching of the ventricular cavity and simultaneous thickening of its walls due to the growth of cardiomyocytes.

With concentric hypertrophy, thickening of the walls subsequently results in a loss of their elasticity. Eccentric myocardial hypertrophy is caused by an increase in the volume of pumped blood. For various reasons, hypertrophy of both ventricles, separately of the right or left side of the heart, including atrial hypertrophy, can develop.

Physiological hypertrophy

Physiological is an increase that develops in response to periodic physical activity. The body tries to ease the increased load per unit mass of the muscle layer of the heart by increasing the number and volume of its fibers. The process occurs gradually and is accompanied by the simultaneous growth of capillaries and nerve fibers in the myocardium. Therefore, the blood supply and neural regulation in tissues remain normal.

Pathological hypertrophy

Unlike physiological, pathological enlargement of the heart muscles is associated with constant load and develops much faster. For some heart and valve defects, this process may take a matter of weeks. As a result, there is a disruption of the blood supply to the myocardium and the nervous trophism of the heart tissue. Blood vessels and the nerves simply cannot keep up with the growth of muscle fibers.

Pathological hypertrophy provokes an even greater increase in the load on the heart, which leads to accelerated wear, disruption of myocardial conductivity and, ultimately, to the reverse development of the pathology - atrophy of areas of the heart muscle. Ventricular hypertrophy inevitably entails enlargement of the atria.

Too much physical activity can play a cruel joke on an athlete. Hypertrophy, which first develops as a physiological response of the body, can eventually lead to the development of cardiac pathologies. In order for your heart to return to normal, you cannot suddenly stop playing sports. Loads should be reduced gradually.

Hypertrophy of the left heart

Left heart hypertrophy is the most common syndrome. The left chambers of the heart are responsible for pumping and releasing oxygenated blood into the aorta. It is important that it passes through the vessels unhindered.

A hypertrophied wall of the left atrium is formed for several reasons:

• stenosis (narrowing) mitral valve regulating blood flow between the atrium and left ventricle;
• mitral valve insufficiency (incomplete closure);
• narrowing of the aortic valve;
• hypertrophic cardiomyopathy - genetic disease, leading to pathological enlargement of the myocardium;
• obesity

Among the causes of LVH, hypertension ranks first. Other factors provoking the development of pathology:

• constant increased physical activity;
• hypertensive nephropathy;
• hormonal imbalances;
• narrowing of the aortic valve due to atherosclerosis or endocarditis.

LVH is divided into three stages:

• first or emergency, when the load exceeds the capabilities of the heart and physiological hypertrophy begins;
• the second is sustained hypertrophy, when the heart has already adapted to the increased load;
• the third is the depletion of the safety margin, when tissue growth outpaces the growth of the vascular and nervous network of the myocardium.

Hypertrophy of the right side of the heart

The right atrium and ventricle receive venous blood coming through the vena cava from all organs and then send it to the lungs for gas exchange. Their work is directly related to the condition of the lungs. Right atrial hypertrophic syndrome is caused by the following reasons:

• obstructive pulmonary diseases – chronic bronchitis, pneumosclerosis, bronchial asthma;
• partial blockage pulmonary artery;
• decreased lumen or, conversely, insufficiency of the tricuspid valve.

Right ventricular hypertrophy is associated with the following anomalies:

• heart defects (tetralogy of Fallot);
• increased pressure in the artery connecting the heart and lungs;
• decrease in the lumen of the pulmonary valve;
• violation of the septum between the ventricles.

How does cardiac hypertrophy manifest?

The initial stage of myocardial hypertrophy is asymptomatic. An enlarged heart during this period can only be detected during an examination. Subsequently, the signs of the syndrome depend on the location of the pathology. Hypertrophy of the left chambers of the heart is manifested by the following symptoms:

• decreased performance, fatigue;
• dizziness with fainting;
• heartache;
• rhythm disturbances;
• exercise intolerance.

Enlargement of the right side of the heart is associated with stagnation of blood in the veins and pulmonary artery. Signs of hypertrophy:

• difficulty breathing and chest pain;
• swelling of the legs;
• cough;
• feeling of heaviness in the right hypochondrium.

Diagnostics

The main methods for diagnosing hypertrophy are ECG and ultrasound of the heart. First, the patient is examined with auscultation, during which heart murmurs are heard. ECG signs are expressed in a displacement of the heart axis to the right or left with a change in the configuration of the corresponding teeth. In addition to electrocardiographic signs of hypertrophy, it is necessary to see the degree of development of the syndrome. For this purpose they use instrumental method– echocardiography. It gives the following information:

• the degree of thickening of the myocardial wall and septum, as well as the presence of its defects;
• volume of cavities;
• the degree of pressure between the vessels and ventricles;
• Is there reverse blood flow?

Tests using bicycle ergometry, during which a cardiogram is taken, show the resistance of the myocardium to stress.

Treatment and prognosis

Treatment is aimed at the main diseases that cause cardiac hypertrophy - hypertension, pulmonary and endocrine diseases. If necessary, antibacterial therapy is carried out. The medications used are diuretics, antihypertensives, and antispasmodics.

If you ignore the treatment of underlying diseases, the prognosis for cardiac hypertrophy, especially the left ventricle, is unfavorable. Heart failure, arrhythmia, myocardial ischemia, and cardiosclerosis develop. The most serious consequences are myocardial infarction and sudden cardiac death.

The necessary treatment, how long it needs to be carried out, whether it is possible to be completely cured.

Left ventricular diastolic dysfunction (abbreviated as LVDD) is insufficient filling of the ventricle with blood during diastole, i.e., the period of relaxation of the heart muscle.

This pathology is more often diagnosed in women of retirement age who suffer from arterial hypertension, chronic heart failure (abbreviated as CHF) or other heart diseases. In men, left ventricular dysfunction is detected much less frequently.

With such dysfunction, the heart muscle is unable to completely relax. This reduces the filling of the ventricle with blood. This dysfunction of the left ventricle affects the entire period of the cycle heart rate: if during diastole the ventricle was not filled enough with blood, then during systole (contraction of the myocardium) little of it will be pushed into the aorta. This affects the functioning of the right ventricle, leads to the formation of blood stagnation, and subsequently to the development of systolic disorders, atrial overload, and CHF.

This pathology is treated by a cardiologist. Possible involvement in healing process other narrow specialists: rheumatologist, neurologist, rehabilitation specialist.

It is not possible to completely get rid of such a disorder, since it is often provoked by an underlying disease of the heart or blood vessels or their age-related wear and tear. The prognosis depends on the type of dysfunction, the presence concomitant diseases, correctness and timeliness of treatment.

Types of left ventricular diastolic dysfunction

Reasons for development

More often, the reasons are a combination of several factors:

• elderly age;
• arterial hypertension;
• overweight;
• chronic heart pathologies: arrhythmias or other rhythm disturbances, myocardial fibrosis (replacement muscle tissue to fibrous, which is unable to contract and conduct electrical impulses), aortic stenosis;
• acute cardiac disorders, such as heart attack.

Impaired blood flow (hemodynamics) can be caused by:

• pathologies of the circulatory system and coronary vessels: thrombophlebitis, cardiac ischemia;
• constrictive pericarditis with thickening outer shell heart and compression of the cardiac chambers;
• primary amyloidosis, in which the elasticity of the myocardium decreases due to the deposition of special substances that cause atrophy of muscle fibers;
• post-infarction cardiosclerosis.

Symptoms

In approximately 45% of cases, LVDD is asymptomatic for a long time, especially in hypertrophic and pseudonormal types of pathology. Over time and with the most severe, restrictive type, the following manifestations are characteristic:

1. Dyspnea. Appears first only with intense physical activity, later at rest.
2. Weakness, fatigue, decreased tolerance to physical activity.
3. Heart rhythm disturbances, most often increased heart rate or atrial fibrillation.
4. Lack of air, compression in the chest area.
5. Cardiac cough, worse when lying down.
6. Swelling of the ankles.

On initial stages diastolic dysfunction, the patient is not aware of the onset of disruption of the heart, and attributes weakness and shortness of breath to banal fatigue. The length of this symptom-free period varies from person to person. See a doctor only when noticeable Clinical signs, for example, shortness of breath at rest, swelling of the legs, affecting a person’s quality of life.

Basic diagnostic methods

Among additional measures it is possible to study the function thyroid gland(determination of hormone levels), chest x-ray, coronary angiography, etc.

Treatment

It is possible to cope with impaired left ventricular diastolic function only if it is caused by cardiac surgical pathology, which can be completely eliminated surgically. In other cases, problems with cardiac diastole are corrected with medication.

Therapy is primarily aimed at correcting circulatory disorders. The quality of his future life depends on the timeliness, correctness of treatment and the patient’s strict compliance with medical recommendations.

Goals of treatment measures:

• elimination of heart rhythm disturbances (normalization of pulse);
• stabilization of blood pressure;
• correction of water-salt metabolism;
• elimination of left ventricular hypertrophy.

Forecast

Impairment of the diastolic function of the left ventricle cannot be completely stopped, but with adequate drug correction of circulatory disorders, treatment of the underlying disease, proper nutrition, work and rest schedule, patients with such a disorder live full life long years.

Despite this, it is worth knowing what a cardiac cycle disorder is - dangerous pathology, which cannot be ignored. If it progresses poorly, it can lead to a heart attack, stagnation of blood in the heart and lungs, and swelling of the latter. Complications are possible, especially with severe dysfunction: thrombosis, pulmonary embolism, ventricular fibrillation.

In the absence of proper treatment, severe dysfunction with severe CHF, the prognosis for recovery is unfavorable. In most of these cases, it ends in the death of the patient.

With regular proper treatment, dietary adjustments with limited salt, control over the condition and level of blood pressure and cholesterol, the patient can count on a favorable outcome, prolongation of life, and an active one.

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Ventricular myocardial dysfunction: causes, symptoms, treatment

In order for every cell of the human body to receive blood with vital oxygen, the heart must work correctly. The pumping function of the heart is carried out through alternate relaxation and contraction of the heart muscle - the myocardium. If any of these processes are disrupted, dysfunction of the ventricles of the heart develops, and the ability of the heart to push blood into the aorta gradually decreases, which affects the blood supply to vital organs. Myocardial dysfunction or dysfunction develops.

Ventricular dysfunction is a violation of the ability of the heart muscle to contract during systolic contraction to expel blood into the vessels and relax during diastolic contraction to accept blood from the atria. In any case, these processes cause disruption of normal intracardiac hemodynamics (blood movement through the heart chambers) and stagnation of blood in the lungs and other organs.

Both types of dysfunction have a relationship with chronic heart failure - the more impaired ventricular function, the higher the severity of heart failure. If CHF can occur without cardiac dysfunction, then dysfunction, on the contrary, does not occur without CHF, that is, every patient with ventricular dysfunction has chronic heart failure of the initial or severe stage, depending on the symptoms. This is important for the patient to take into account if he believes that taking medication is not necessary. You also need to understand that if a patient is diagnosed with myocardial dysfunction, this is the first signal that some processes are occurring in the heart that need to be identified and treated.

Left ventricular dysfunction

Diastolic dysfunction

Diastolic dysfunction of the left ventricle of the heart is characterized by a violation of the ability of the left ventricular myocardium to relax to fully fill with blood. The ejection fraction is normal or slightly higher (50% or more). In its pure form, diastolic dysfunction occurs in less than 20% of all cases. The following types of diastolic dysfunction are distinguished: impaired relaxation, pseudonormal and restrictive type. The first two may not be accompanied by symptoms, while the last type corresponds to severe CHF with severe symptoms.

Causes

• Cardiac ischemia,
• Post-infarction cardiosclerosis with myocardial remodeling,
• Hypertrophic cardiomyopathy - an increase in the mass of the ventricles due to thickening of their walls,
• Arterial hypertension,
• Aortic valve stenosis,
• Fibrinous pericarditis - inflammation of the outer lining of the heart, the heart “bag”,
• Restrictive myocardial lesions (endomyocardial Loeffler's disease and endomyocardial fibrosis of Davis) - compaction of the normal structure of the muscular and inner lining of the heart, which can limit the process of relaxation, or diastole.

Signs

An asymptomatic course is observed in 45% of cases of diastolic dysfunction.

Clinical manifestations are caused by increased pressure in the left atrium due to the fact that blood cannot flow into the left ventricle in sufficient volume due to its constant state of tension. Blood also stagnates in the pulmonary arteries, which is manifested by the following symptoms:

1. Shortness of breath, at first slight when walking or climbing stairs, then worse at rest,
2. Dry hacking cough, worsening when lying down and at night,
3. Feelings of interruptions in the work of the heart, chest pain accompanying heart rhythm disturbances, most often atrial fibrillation,
4. Fatigue and inability to perform previously well-tolerated physical activities.

Systolic dysfunction

Left ventricular systolic dysfunction is characterized by decreased contractility of the heart muscle and a reduced volume of blood ejected into the aorta. Approximately 45% of people with CHF have this type of dysfunction (in other cases, the function of myocardial contractility is not impaired). The main criterion is a decrease in left ventricular ejection fraction according to cardiac ultrasound results of less than 45%.

Causes

• Acute myocardial infarction (in 78% of patients with a heart attack, left ventricular dysfunction develops in the first day),
• Dilated cardiomyopathy - expansion of the cavities of the heart due to inflammatory, dyshormonal or metabolic disorders in the body,
• Myocarditis of a viral or bacterial nature,
• Mitral valve insufficiency (acquired heart disease),
• Hypertension on late stages.

Symptoms

The patient can mark as presence characteristic symptoms, or their complete absence. In the latter case, they speak of asymptomatic dysfunction.

Symptoms of systolic dysfunction are caused by a decrease in blood ejection into the aorta, and, consequently, depletion of blood flow in the internal organs and skeletal muscles. The most characteristic signs:

1. Paleness, bluish discoloration and coldness skin, swelling of the lower extremities,
2. Fatigue, causeless muscle weakness,
3. Changes in the psycho-emotional sphere due to depletion of cerebral blood flow - insomnia, irritability, memory impairment, etc.
4. Impaired kidney function, and changes in blood and urine tests that develop in connection with this, increased blood pressure due to activation of the renal mechanisms of hypertension, swelling on the face.

Right ventricular dysfunction

Causes

The above diseases remain relevant as causes of right ventricular dysfunction. In addition to them, isolated right ventricular failure can be caused by diseases of the bronchopulmonary system (severe bronchial asthma, emphysema, etc.), congenital heart defects and defects of the tricuspid valve and pulmonary valve.

Symptoms

Right ventricular dysfunction is characterized by symptoms that accompany blood stagnation in the organs of the systemic circulation (liver, skin and muscles, kidneys, brain):

• Severe cyanosis (blue color) of the skin of the nose, lips, nail phalanges of the fingers, tips of the ears, and in severe cases of the entire face, hands and feet,
• Edema of the lower extremities, appearing in evening time and disappearing in the morning, in severe cases - swelling of the whole body (anasarca),
• Liver dysfunction, up to cardiac cirrhosis in the later stages, and the resulting enlargement of the liver, pain in the right hypochondrium, abdominal enlargement, yellowness of the skin and sclera, changes in blood tests.

Diastolic dysfunction of both ventricles of the heart plays a decisive role in the development of chronic heart failure, and disorders of systole and diastole are parts of one process.

What examination is needed?

If a patient experiences symptoms similar to signs of dysfunction of the ventricular myocardium, he should consult a cardiologist or therapist. The doctor will conduct an examination and prescribe any additional methods examinations:

1. Routine methods - blood and urine tests, biochemical blood tests to assess hemoglobin levels, performance indicators internal organs(liver, kidneys),
2. Determination of potassium, sodium, sodium uretic peptide in the blood,
3. Blood test for hormone content (determining the level of thyroid hormones, adrenal glands) if there is a suspicion of an excess of hormones in the body that have a toxic effect on the heart,
4. ECG is a mandatory research method to determine whether there is myocardial hypertrophy, signs arterial hypertension and myocardial ischemia,
5. Modifications of the ECG - treadmill test, bicycle ergometry - this is the recording of an ECG after physical activity, which allows you to assess changes in the blood supply to the myocardium due to exercise, as well as assess tolerance to exercise in the event of shortness of breath with CHF,
6. Echocardiography is the second mandatory instrumental study, the “gold standard” in the diagnosis of ventricular dysfunction, allows you to assess the ejection fraction (normally more than 50%), assess the size of the ventricles, visualize heart defects, hypertrophic or dilated cardiomyopathy. To diagnose dysfunction of the right ventricle, its end-diastolic volume is measured (normally 15 - 20 mm, with dysfunction of the right ventricle it increases significantly),
7. X-ray of the chest cavity is an auxiliary method for myocardial hypertrophy, allowing to determine the degree of expansion of the heart in diameter, if hypertrophy is present, to see the depletion (with systolic dysfunction) or strengthening (with diastolic dysfunction) of the pulmonary pattern due to its vascular component,
8. Coronary angiography is the injection of a radiopaque substance into the coronary arteries to assess their patency, the violation of which accompanies coronary heart disease and myocardial infarction,
9. Cardiac MRI is not a routine examination method, but due to its greater information content than cardiac ultrasound, it is sometimes prescribed in diagnostically controversial cases.

When to start treatment?

Both the patient and the doctor must be clearly aware that even asymptomatic ventricular myocardial dysfunction requires prescription medications. Simple rules for taking at least one tablet a day can prevent the onset of symptoms for a long time and prolong life in case of severe chronic failure blood circulation Of course, at the stage of severe symptoms, one tablet cannot improve the patient’s well-being, but the most appropriately selected combination of drugs can significantly slow down the progression of the process and improve the quality of life.

So, at the early, asymptomatic stage of dysfunction, ACE inhibitors or, if they are intolerant, angiotensin II receptor antagonists (ARA II) must be prescribed. These drugs have organoprotective properties, that is, they protect the organs that are most vulnerable to the adverse effects of constantly high blood pressure, For example. These organs include the kidneys, brain, heart, blood vessels and retina. Daily intake of the drug in the dose prescribed by the doctor significantly reduces the risk of complications in these structures. In addition, ACE inhibitors prevent further myocardial remodeling, slowing the development of CHF. Among the drugs prescribed are enalapril, perindopril, lisinopril, quadripril, from ARA II losartan, valsartan and many others. In addition to them, treatment is prescribed for the underlying disease that caused the dysfunction of the ventricles.

At the stage of pronounced symptoms, for example, with frequent shortness of breath, nocturnal attacks of suffocation, swelling of the extremities, all main groups of drugs are prescribed. These include:

• Diuretics (diuretics) - veroshpiron, diuver, hydrochlorothiazide, indapamide, lasix, furosemide, torsemide eliminate blood stagnation in the organs and lungs,
• Beta-blockers (metoprolol, bisoprolol, etc.) reduce heart rate and relax peripheral vessels, helping to reduce the load on the heart,
• Calcium channel inhibitors (amlodipine, verapamil) - act similarly to beta blockers,
• Cardiac glycosides (digoxin, corglycon) - increase the strength of heart contractions,
• Combinations of drugs (noliprel - perindopril and indapamide, amosartan - amlodipine and losartan, Lorista - losartan and hydrochlorothiazide, etc.),
• Nitroglycerin under the tongue and in tablets (monocinque, pectrol) for angina pectoris,
• Aspirin (thromboAss, aspirin cardio) to prevent thrombus formation in blood vessels,
• Statins – to normalize blood cholesterol levels in atherosclerosis and coronary disease hearts.

What lifestyle should a patient with ventricular dysfunction follow?

First of all, you need to follow a diet. You should limit the intake of table salt from food (no more than 1 gram per day) and control the amount of liquid you drink (no more than 1.5 liters per day) to reduce the load on the circulatory system. Nutrition should be rational, according to the eating regimen with a frequency of 4 - 6 times a day. Fatty, fried, spicy and salty foods are excluded. It is necessary to expand the consumption of vegetables, fruits, fermented milk, cereals and grain products.

Second point Not drug treatment- This is a lifestyle correction. It is necessary to give up all bad habits, observe a work-rest schedule and devote sufficient time to sleep at night.

The third point is sufficient physical activity. Physical activity must correspond to the general capabilities of the body. It is quite enough to take walks in the evening or sometimes go out to pick mushrooms or go fishing. In addition to positive emotions, this type of rest contributes to the good functioning of neurohumoral structures that regulate the activity of the heart. Of course, during the period of decompensation, or worsening of the disease, all stress should be excluded for a period determined by the doctor.

What is the danger of pathology?

If a patient with an established diagnosis neglects the doctor’s recommendations and does not consider it necessary to take prescribed medications, this contributes to the progression of myocardial dysfunction and the appearance of symptoms of chronic heart failure. For everyone, this progression occurs differently - for some, slowly, over decades. And for some it happens quickly, within the first year from diagnosis. This is the danger of dysfunction - the development of severe CHF.

In addition, complications may develop, especially in cases of severe dysfunction with an ejection fraction of less than 30%. These include acute heart failure, including left ventricular failure (pulmonary edema), pulmonary embolism, fatal rhythm disturbances (ventricular fibrillation), etc.

Forecast

In the absence of treatment, as well as in the case of significant dysfunction accompanied by severe CHF, the prognosis is unfavorable, since the progression of the process without treatment invariably ends in death.

Diastolic dysfunction: causes, symptoms, diagnosis and treatment

Diastolic dysfunction is a relatively new diagnosis. Until recently, it was rarely exhibited even by cardiologists. However, diastolic dysfunction is now one of the most frequently detected heart problems using echocardiography.

Diastolic dysfunction: new diagnosis or difficult to diagnose disease

Recently, cardiologists and therapists are increasingly giving their patients a “new” diagnosis - diastolic dysfunction. At severe form disease, diastolic heart failure (HF) may occur.

Nowadays, diastolic dysfunction is found quite often, especially in older women, most of whom are surprised to learn that they have heart problems. Often, patients diagnosed with diastolic dysfunction may develop diastolic heart failure

Neither diastolic dysfunction nor diastolic heart failure are actually “new” diseases - they have always affected the human cardiovascular system. But only in recent decades have these two diseases become frequently identified. It's connected with widespread use in the diagnosis of cardiac problems using ultrasound methods (echocardiography).

It is believed that almost half of the patients admitted to the departments emergency care with acute heart failure actually have diastolic HF. But making the correct diagnosis can be difficult because once the patient's condition has been stabilized, the heart may appear completely normal on echocardiography unless the specialist specifically looks for signs of diastolic dysfunction. Therefore, inattentive and unwary doctors often miss this disease.

Characteristics of the disease

The cardiac cycle is divided into two phases - systole and diastole. During the first, the ventricles (the main chambers of the heart) contract, pushing blood out of the heart into the arteries, and then relax. When they relax, they refill with blood to prepare for the next contraction. This relaxation phase is called diastole. The cardiac cycle consists of systole (contraction of the heart) and diastole (relaxation of the myocardium), during which the heart fills with blood

However, sometimes due to various diseases the ventricles become relatively “hard”. In this case, they cannot relax completely during diastole. As a result, the ventricles are not completely filled with blood, and it stagnates in other parts of the body (in the lungs).

Pathological hardening of the walls of the ventricles and the resulting insufficient filling of them with blood during diastole is called diastolic dysfunction. When diastolic dysfunction is so severe that it causes congestion in the lungs (that is, accumulation of blood in them), it is considered to be diastolic heart failure.

Signs of heart failure - video

Causes

Most common cause diastolic dysfunction is natural influence aging on the heart. With increasing age, the heart muscle becomes stiffer, impairing the filling of the left ventricle with blood. In addition, there are many diseases that can lead to this pathology.

Diseases that provoke diastolic dysfunction - table

Classification

Based on echocardiography data, the following degrees of diastolic dysfunction are distinguished:

• I degree (impaired relaxation) - can be observed in many people, is not accompanied by any symptoms of heart failure;
• Grade II (pseudonormal cardiac filling) is diastolic dysfunction of moderate severity, in which patients often have symptoms of heart failure, and there is an increase in the left atrium in size;
• III (reversible restrictive cardiac filling) and IV (irreversible restrictive cardiac filling) are severe forms of diastolic dysfunction, which are accompanied by severe symptoms of HF.

Based on the symptoms, the functional class (type) of heart failure can be determined according to the New York Heart Association (NYHA) classification.

• FC I - no symptoms of HF;
• FC II - symptoms of heart failure during moderate physical activity (for example, when climbing to the 2nd floor);
• FC III - symptoms of HF with minimal physical activity (for example, when climbing 1 floor);
• FC IV - symptoms of heart failure at rest.

Symptoms

The symptoms that bother people with diastolic dysfunction are the same as those experienced in patients with any form of heart failure.

With diastolic heart failure, signs of pulmonary congestion come to the fore:

• dyspnea;
• cough;
• rapid breathing.

Patients with this diagnosis often suffer from these symptoms in the form of sudden attacks that appear without any warning. This distinguishes diastolic heart failure from other forms of heart failure, in which shortness of breath usually develops gradually over several hours or days.

The sudden and severe difficulty breathing that often occurs in diastolic heart failure is called a “pulmonary edema flare” episode.

Although the hallmark of diastolic HF is bursts of pulmonary edema, patients with this disease may also experience less severe episodes of difficulty breathing that develop more gradually.

Diagnostics

The presence of diastolic dysfunction can be detected using cardiac ultrasound - echocardiography. This examination method allows you to evaluate the characteristics of myocardial relaxation during diastole and the degree of stiffness of the walls of the left ventricle. Echocardiography can also sometimes help detect the cause of diastolic dysfunction. For example, it can be used to identify:

• thickening of the walls of the left ventricle in hypertension and hypertrophic cardiomyopathy;
• aortic stenosis;
• some types of restrictive cardiomyopathies.

However, many patients with evidence of diastolic dysfunction on echocardiography do not have other pathologies that could explain its presence. In such people it is impossible to determine the specific cause of the disease.

It should be noted that for each degree of diastolic dysfunction there are specific criteria for echocardiography, so they can only be determined using this study.

Treatment

The best treatment strategy for diastolic dysfunction and diastolic HF is to attempt to identify and treat the cause. Thus, the following problems need to be overcome:

1. Arterial hypertension. People with diastolic dysfunction often have elevated blood pressure that is difficult to detect. Moreover, very often such hypertension is treated inadequately. However, it is very important for patients with diastolic dysfunction to control their blood pressure within normal limits.
2. Cardiac ischemia. People with diastolic dysfunction should be evaluated for coronary artery disease. This disease is a common cause of diastolic dysfunction.
3. Atrial fibrillation. The rapid heartbeat caused by this rhythm disorder can cause significant deterioration in heart function in people with diastolic dysfunction. Therefore, rhythm control is a very important aspect in the treatment of a patient with atrial fibrillation and diastolic dysfunction.
4. Diabetes mellitus and overweight. Weight loss and glucose control help stop the worsening of diastolic dysfunction.
5. Passive lifestyle. Many people with diastolic dysfunction lead a predominantly sedentary lifestyle. Aerobic program physical exercise may improve diastolic heart function.

In addition to measures aimed at identifying and treating the causes of diastolic dysfunction, the doctor may prescribe medications that affect its symptoms. For this purpose, diuretics (Furosemide) are most often used, which remove excess water and sodium from the body, reducing the severity of symptoms of pulmonary congestion.

Furosemide helps reduce the intensity of symptoms in diastolic dysfunction

Prevention

The development of diastolic dysfunction can be prevented with the help of measures aimed at preventing cardiovascular diseases:

• rational and balanced diet low in fat and salt;
• regular exercise;
• control diabetes mellitus and blood pressure;
• maintaining normal weight;
• minimizing stress.

Forecast

In patients with diastolic dysfunction, the prognosis for recovery is favorable, but only if the patient unquestioningly follows all the specialist’s recommendations.

With diastolic HF, the chance of recovery is greater than with systolic HF, but less than in people with diastolic dysfunction without heart failure. Timely diagnosis and competent therapy can improve the prognosis of the disease.

Diastolic dysfunction is much more common than previously thought. This disease occurs in 15% of patients under the age of 50 years, and in 50% of people over 70 years of age. Therefore, we can say with confidence that the role of this disease in the development of heart failure is clearly underestimated.

Diastolic dysfunction of the left ventricular myocardium

Heart failure, like all diseases of cardio-vascular system, is among the most dangerous, i.e. those that lead to particularly severe consequences (disability, death). For the development of any pathology in the myocardium, there is a reason, and one of them is systolic disorders - a decrease in the ability of the heart to eject blood into the aorta (this leads to the development of left ventricular failure and pulmonary hypertension). As a result, such work problems reduce general level release and delivery of oxygen and nutrients through the blood to vital organs.

Diastolic myocardial dysfunction - what does it mean?

Dysfunction is a malfunction of the organ, translated from Latin as “difficulty in action”, diastolic dysfunction of the myocardium, respectively, this is a disruption of the process of the heart muscle and a decrease in the filling of the left ventricle with blood during diastole (its relaxation). Given this pathological process, the ability of the left chamber of the myocardium to pump blood into its cavity from the pulmonary artery decreases, thus reducing its filling during relaxation.

Diastolic dysfunction of the left ventricular myocardium is manifested by an increase in the ratio of final ventricular pressure and final volume during diastole. The development of this pathology is accompanied by a decrease in the compliance of the walls of the left chamber of the heart.

Fact! In 40% of patients with heart failure – systolic dysfunctions there is no left chamber, and acute heart failure is progressive diastolic dysfunction of the left ventricle.

As the left ventricle fills, there are three main stages of the process.

1. Relaxation. This is a period of relaxation of the heart muscle, during which the active removal of calcium ions from filamentous muscle fibers (actin, myosin) occurs. During this, contractions relax muscle cells myocardium, and their length increases.
2. Passive filling. This stage occurs immediately after relaxation; the process directly depends on the compliance of the walls of the ventricle.
3. Filling, which is carried out due to contraction of the atria.

Interesting! Despite the fact that cardiovascular diseases more often affect males, this dysfunction, on the contrary, “prefers” women a little more. Age category – from 60 years.

Varieties of this pathology

To date, this pathology are usually divided into the following types:

1. diastolic myocardial dysfunction type 1. This stage is characterized by disturbances (slowdowns) in the process of relaxation of the left ventricle of the heart in diastole. The required amount of blood at this stage arrives during atrial contractions;
2. diastolic myocardial dysfunction type 2 is characterized by an increase in pressure in the left atrium, due to which filling of the lower chamber is possible only due to the action of a pressure gradient (this type is called “pseudonormal”);
3. diastolic myocardial dysfunction type 3. This stage is associated with an increase in atrial pressure, a decrease in the elasticity of the ventricular walls and an increase in rigidity.

Depending on the severity of the pathology, an additional division has been adopted into:

• mild (type I disease);
• moderate (type II disease);
• severe reversible and irreversible (type III disease).

The main symptoms of external manifestations of dysfunction

Diastolic myocardial dysfunction quite often occurs asymptomatically, without revealing its presence for years. If pathology manifests itself, then you should pay attention to the appearance of:

• heart rhythm disturbances;
• shortness of breath, which was not there before, then it began to appear with physical activity, and over time - even at rest;
• weakness, drowsiness, increased fatigue;
• cough (which becomes stronger when lying down);
• severe sleep apnea (appears a couple of hours after falling asleep).

Factors provoking the development of pathology

First of all, it should be noted that the development of diastolic myocardial dysfunction is facilitated by its hypertrophy, i.e. thickening of the walls of the ventricles and interventricular septum.

The main cause of cardiac muscle hypertrophy is hypertension. In addition, the danger of its development is associated with excessive physical stress on the body (for example, intense sports, heavy physical labor).

Factors contributing to the development of the main cause – hypertrophy – are separately identified and these are:

• arterial hypertension;
• heart disease;
• diabetes;
• obesity;
• snoring (its effect is caused by involuntary cessation of breathing for a few seconds during sleep).

Methods for detecting pathology

Diagnosis of the development of a pathology such as diastolic dysfunction in the myocardium includes the following types of examinations:

• echocardiography in combination with Dopplerography (the study makes it possible to obtain an accurate image of the myocardium and assess functionality in a given period of time);
• electrocardiogram;
• ventriculography (in in this case Radioactive albumin is also used to determine the contractile function of the heart);
• X-ray examination of the lungs;
• laboratory blood tests.

Modern therapy of pathological disorders

For the treatment of diastolic myocardial dysfunction, conservative methods. The treatment plan begins with eliminating the causes of the pathology. Considering that the main development factor is hypertrophy, which develops as a result of hypertension, antihypertensive drugs are certainly prescribed and blood pressure is constantly monitored.

Among the drugs used to treat dysfunction, the following groups are distinguished:

• adrenergic blockers;
• drugs intended to improve wall elasticity and reduce pressure, promoting myocardial remodeling (angiotensin-converting enzyme inhibitors);
• thiazide diuretics;
• calcium antagonists.

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In medicine, myocardial hypertrophy is a pathological enlargement of the heart. This dangerous condition, as a rule, is not independent form diseases. Myocardial hypertrophy develops as a syndrome of some cardiac pathology and can worsen the prognosis of the underlying disease. The most common cause is left ventricular myocardial hypertrophy. Although it is possible to enlarge the right ventricle, as well as both at once. Statistics show that it causes death in people with heart disease in 80% of cases and leads to death in 4% of cases. sudden death.

Why does it happen?

Myocardial hypertrophy develops due to too much stress on the heart, which it experiences in certain diseases, with high physical activity, as well as from bad habits. Main reasons:

• heart defects (congenital and acquired);
• arterial hypertension;
• overweight;
• sports activities;
• smoking, alcoholism;
• sudden loads with a sedentary lifestyle.

May be the case genetic predisposition.

How is it developing?

With hypertrophy, not the entire muscle increases, but only actively contracting cells - cardiomyocytes, which make up 15-25% of the myocardium. The rest - about 75% - is connective tissue, forming a collagen framework. Thus, due to the increase in myocyte diameter, the myocardial muscle becomes hypertrophied, the heart needs more blood, it begins to work more intensely, the load on it increases - a vicious circle is obtained.

How does it manifest?

Symptoms of myocardial hypertrophy may be absent for a long time, which is what main danger. For many years a person is not even aware of his condition. Often, abnormal enlargement of the myocardium is detected when medical examinations, and sometimes during autopsy after sudden death.

Most often observed following signs left ventricular myocardial hypertrophy:

• chest pain, as with angina pectoris;
• heart rhythm disturbances;
• fainting;
• in some cases - swelling.

Diagnostics

Myocardial hypertrophy is usually detected when ultrasound examination heart, which is considered the most informative method. In some cases, it can be diagnosed using an ECG. Sometimes MRI is used to clarify the diagnosis.

Differences between normal and hypertrophied heart

How to treat?

Treatment of myocardial hypertrophy consists of complex measures. The main task is to reduce the heart to normal sizes.

An important part of treatment is a review of lifestyle. This includes:

• to give up smoking;
• refusal of alcoholic beverages;
• reducing the amount of salt in the diet, eliminating foods that increase blood pressure and cholesterol levels;
• diet to get rid of extra pounds or maintaining a normal weight.

Nutrition is aimed at weight loss, so you should avoid fatty foods. Daily calorie content should not exceed 1500-1700 kcal.

Equally important is reducing the amount of salt. As is known, as a result of losing body weight and reducing salt in the diet, blood pressure decreases, which is the cause of pathological enlargement of the heart muscle. There is especially a lot of salt in prepared foods: semi-finished products, fast food, sausages, cheeses and much more. The way out is homemade food. IN natural products animal and plant origin salt is contained in small quantities. During cooking, you can omit it at all or add very little.

Myocardial hypertrophy requires drug treatment of the underlying disease that caused the enlargement of the heart.

In particularly severe cases, surgical intervention may be necessary, during which the hypertrophied part of the muscle is removed.

During treatment, the patient's condition is monitored using an ECG.

Physical exercise

As for physical education, consultation with a doctor is required. Pathological enlargement of the myocardium requires a responsible approach. People with this syndrome are advised to take walks outside, swimming, Pilates, yoga, and aerobics. You can exercise three times a week from 30 minutes to one hour, depending on how you feel. From power types Sports, weight lifting, running will have to be abandoned.

Myocardial hypertrophy in athletes

Cardiac hypertrophy can also be observed in healthy people, for example, athletes, without any symptoms. During intense physical activity, the heart begins to work faster because it needs to pump large volumes of blood.

In people who regularly exercise, the heart muscle adapts to the stress and, as a result of increased oxygen consumption, it increases in size.

Athletes experience three types of myocardial hypertrophy: eccentric, concentric and mixed. In the first case, a proportional expansion of the myocardial walls occurs, muscle fibers increase in both width and length. The concentric form is distinguished by the fact that the ventricular cavity remains unchanged, and hypertrophy occurs due to an increase in cardiomyocytes (mitochondria and myofibrils).

Eccentric hypertrophy develops in people who engage in endurance sports such as long-distance running, ski race, swimming. The concentric form is found among athletes involved in gaming disciplines and static sports. Mixed myocardial hypertrophy develops in speed skaters, rowers, and cyclists, that is, in sports that are both static and dynamic.

In this regard, athletes with myocardial hypertrophy are not immune from strokes and heart attacks. Doctors do not recommend that they suddenly stop playing sports, otherwise complications may arise. Loads must be reduced gradually.

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HYPERTROPHY OF BOTH ARITS
Hypertrophy of both atria in children is relatively common. As a rule, biatrial hypertrophy occurs with simultaneous damage to the mitral and tricuspid valves, with atrial septal defects and some other combined congenital heart defects (for example, with transposition great vessels with atrial septal defect, etc.). In addition, biatrial enlargement is a frequent companion to chronic carditis. Diagnosis of biatrial hypertrophy is more difficult in isolation, since the basic electrocardiographic law - bioelectric asymmetry - is obscured, but easier than diagnosis of biventricular hypertrophy. The latter is explained by the fact that in the P wave the initial part corresponds to the activation of the right atrium, and the terminal part - to the left atrium.

Rice. 76. Electrocardiogram of Andrey S., 9 years old. Explanation in the text.
The following signs of biatrial hypertrophy in children can be distinguished:
a) two-phase Pv (H—). The amplitude of the initial deviation is more than 1.5 mm and slightly less (1 mm or more) of the terminal one. However, the width of the negative wave PV] is quite large and sometimes amounts to 0.03 - 0.04 s;
b) high widened and split P wave in the limb and precordial leads. Moreover, in leads II, III, aVF and right precordial (V2V3) it is pointed, high (a reflection of the activation of the right atrium), and in leads I, II, aVL and the left chest it is widened and split (a reflection of the activation of the left atrium);
c) increased amplitude (2 mm or more) of the P wave in the limb leads with its widening in the same leads to 0.12 s or more;
d) Macruz index equal to 1 or 1.6, with simultaneous widening of the P wave and lengthening of the P-R interval.
The combination of these signs makes it most likely to make a diagnosis of biatrial hypertrophy. It should be noted that the specificity of the given signs is not the same. The first one should be considered the most reliable. The degree of correlation of these features with various options biagreal increase (mass, pressure, volume) requires further clarification.
To illustrate, we give the following example.
Boy Andrey S., 9 years old. Diagnosis: chronic carditis. On the electrocardiogram (Fig. 76), along with changes in the ventricular complex, there are signs of hypertrophy of both atria: an almost equiphase PV graph] (the amplitude of the initial phase is sharply increased and
almost equal to the amplitude of the large negative terminal phase), broadened Pi,ii,aVL,v5_6 and at the same time pointed and symmetrical P in leads aVF, V2V3.
All this points to biatrial hypertrophy.

VENTRICULAR MYOCARDIAL HYPERTROPHY

The basis for an adequate hemodynamic effect is a normally functioning ventricular myocardium and synchronized contraction of both chambers. Various factors, affecting myocardial metabolism, as well as creating resistance to the movement of blood flow or changing its direction, provide conditions for more intense work of the ventricle and ultimately lead to its hypertrophy. The hypertrophic process enhances bioelectrical asymmetry, which is reflected in a certain way on the graph of the electrocardiogram curve. In ideal cases, changes in the ventricular complex are reduced only to an increase in the amplitude of the QRS complex waves, which is rarely observed even in the initial stages. As a rule, an increase in the amplitude of the QRS complex waves is accompanied by their simultaneous broadening, which indicates a combination of hypertrophy with changes in the myocardium (impaired metabolism, conductivity, etc.). In children of various ages ventricular myocardial hypertrophy is quite common and is often diagnosed, especially in early period childhood, presents significant difficulties. It was also noted above that diagnosing ventricular myocardial hypertrophy is more difficult than diagnosing atrial enlargement, because here the asynchronism of activation of the left and right sections is less captured. The diagnostic emphasis is placed on the basis of a chronotopographic assessment of ventricular vectors. The number of these vectors is extremely large and it is hardly advisable to study them in practice. In the conditions of analysis of vectorcardiograms, it is not difficult to estimate the vectors of excitation of the ventricles every 0.005 or 0.01 s. In electrocardiography, this is more complicated and it is generally accepted to study the three main moment vectors that reflect the sequence of activation of the ventricular myocardium: septal, or initial (0.015 s), left ventricular or simply ventricular (0.04 - 0.045 s) and basal (0.064 s) vectors. Spatially, normally, each vector has a specific direction: the 0.015 s vector is oriented to the right, forward, up or down in older children (the QRS loop in the frontal plane is written counterclockwise) and to the left, forward, up or down in young children (loop QRS in the frontal plane is recorded clockwise); the vector 0.04 -0.045 "s is directed to the left down (back) in older children and to the right up or down in newborns. Finally, the vector 0.064 s also depends on the age and position of the heart in chest can have two directions to the right: up and back or left - up - back. The first vector corresponds to the Q wave of the electrocardiogram, the second - R and the third - S.
It should be noted that it is advisable to use the term “ventricular myocardial hypertrophy” in contrast to the atria, because changes in the electrocardiogram correlate quite closely with an increase muscle mass. Thus, electrocardiographic signs of hypertrophy are basically associated with the asymmetry of the hypertrophic process, structural changes in the myocardium and the electrical position of the heart. It should also be noted that in the general electrical balance of forces of the hypertrophied myocardium, the basis is the EMF of the subepicardial layer. Therefore, all observed changes practically reflect the electrical situation primarily in this department.