Diagnosis of LVDH: what is it, should it be treated, dietary habits and regimen, in children, an additional chord of the left ventricle

The heart is the most important organ of the human body, without which its functioning and vital activity is impossible. The human heart has an elongated conical shape, a hollow structure and is divided into four chambers inside. Conventionally, the heart muscle can be divided into two types: "arterial heart", which includes the left atrium and ventricle and through which blood passes, and the "venous heart" (right atrium and right ventricle). Blood enriched with iron, vitamins and oxygen enters the venous part through the venous trunks for further processing. The ventricle and atrium on the left side are connected by a mitral valve - two interconnected plates that prevent blood flow back during heart contraction.

The work of the mitral valve is carried out thanks to the chords - fibrous tissues in the form of long tendon threads, the structure of which resembles muscle fibers. The chords of the left ventricle are attached to the trabeculae - tendon formations, which can be conditionally considered anomalies in the development of the heart muscle that are not associated with the work of the heart valve. One of the pathologies of the left ventricle, which is often detected in the first year of a child's life, is LVDC. Diagnosis "LVH" (

accessory chord of the left ventricle) is put on the basis of ultrasound diagnostics and does not mean any malformations of the heart that can lead to the development of heart failure. However, children with this diagnosis should be monitored by a therapist and cardiologist.

Risk factors during intrauterine development

An additional chord (it is also called an abnormal chord of the left ventricle - LVAC) in most cases is formed in children whose parents had the same developmental pathology. The prevalence of the anomaly among genetically predisposed infants is about 28%. This is a large enough indicator, therefore the expectant mother during pregnancy should monitor her regimen, nutrition, emotional state and other factorsthat can have a negative impact on the health of the fetal cardiovascular system.

Cardiologists consider infectious diseases of the mother and the fetus in the first trimester of pregnancy to be one of the main causes of LVH. The most dangerous period is considered to be the period from 5 to 7 weeks, when the formation of blood vessels and heart muscle occurs. The maximum risk is observed in children whose mothers have had "childhood" infections (measles, chickenpox, etc.) at 5-6 weeks of gestation, so women it is recommended to give all prophylactic vaccinations 6-10 months before planning pregnancy, taking into account the timing of revaccination (if vaccination was not carried out in childhood).

Other factors that can affect the development of the heart during the first trimester include:

• strong emotional distress and chronic stress;
• malnutrition low in magnesium, potassium and other elements that regulate work hearts (found in nuts, dried fruits, buckwheat and oatmeal, pomegranate juice, liver, veal);
• taking potent drugs (aminoglycosides, hormonal drugs, systemic glucocorticosteroids);
• the use of wine alcohol and ethanol;
• smoking;
• increased physical activity.

Living in a polluted area can also negatively affect the functioning of the fetal heart muscle, since everything substances that a woman inhales enter the systemic circulation and enter the respiratory system through the placenta fetus.

Important! The minimum risk factor for the formation of anomalies in the development of the left ventricle of the heart is the intake of drugs, which contain alcohol even in minimum concentration (drops "Tonsilgon", syrup "Pertussin", etc.), so you can take any medication during pregnancy only with permission doctor.

Is it possible to recognize the pathology on your own?

In the absence of abnormal development of the right ventricle, the additional chord of the left ventricle does not give a pronounced clinical symptoms and for a long time proceeds without any pronounced signs and symptoms. During the first year of life, pathology is detected by chance during an electrocardiogram and ultrasound heart in children at risk of developing cardiovascular diseases, as well as having signs cyanosis - blue discoloration of the nasolabial triangle.

Signs of LVH in children of the younger age group (from 3 to 6-7 years old) can be:

• tall and thin physique (subject to a balanced and regular diet);
• deformation of bone tissue (dysplasia of the hip joints, scoliosis);
• increased mobility of the knee and elbow joints;
• myopia of varying degrees and other types of ametropia (the child squints, trying to make out objects that are at a great distance from him);
• pathological mobility of the kidneys against the background of their displacement or prolapse (nephroptosis);
• poor digestion.

Older children attending educational institutions may complain of increased fatigue, drowsiness, poor memory, and decreased concentration. In physical education, they may experience shortness of breath or mild tachycardia.

Note! Children with LVDH at any age are characterized by emotional lability, therefore, frequent mood swings during the day, which lasts a long time, should be a reason for referring to specialist.

What is the danger?

Most experts agree that single longitudinal chords do not have any effect on the work of the heart and do not disrupt it even in the event of separation from the valve, which is extremely rare. Transverse and diagonal chords can have a pathological effect on the work of the mitral valve, especially if their number is more than 1-2 pieces. Serious changes in the work of the cardiovascular system in children with abnormal development of the chord of the left ventricle not identified, but some cardiologists consider LV DCH an additional risk factor for the development of atrial fibrillation arrhythmias.

Other possible complications (with a developmental rate of less than 10%) in children with an accessory left ventricular chord may include:

• underdevelopment of connective fibers;
• violation of the speed of blood flow;
• premature excitement of the muscular layer of the heart;
• change in heart rate.

By themselves, additional chords do not have a pronounced effect on the work of the heart muscle and cannot cause serious complications, but with a combination of unfavorable conditions, LV DCH can become a provoking mechanism of some heart pathologies and vessels.

Diagnostics

The main method for diagnosing an abnormal left ventricular chord is ultrasound examination. For children of the first year of life, it is prescribed only according to indications, for example, after a sore throat or in the presence of risk factors for the development of heart disease. An unscheduled ultrasound of the heart can be prescribed if systolic murmurs were detected during listening - noises heard during the period of contraction between the first and subsequent tones of the heart muscle. In some cases, for example, with multiple chords, one ultrasound is not enough to establish an accurate diagnosis and an objective assessment of the child's health, so the doctor may prescribe additional survey.

Supportive diagnostic methods for suspected LVD include:

• electrocardiography;
• daily monitoring using holter;
• veloergometry (a method of electrocardiographic research to determine individual exercise tolerance).

Bicycle ergometry is used mainly in older children and adolescents. To draw up a complete clinical picture, the child is also assigned a laboratory study of the biochemical parameters of blood and urine.

Should LVHC be treated?

Single abnormal chords of the left ventricle do not pose a health hazard to the child and do not affect heart rate, so there is no need for medical correction or limitation of the child's mobility. With multiple, diagonal or transverse chords, supportive and symptomatic therapy is indicated. The standard treatment regimen for LVDC is shown in the table below.

Table. The classic treatment regimen for LVDC and associated pathologies.

Group of drugs	What to take
Potassium and magnesium preparations to maintain the normal functioning of myocardial cells	"Asparkam", "Panangin", "Potassium and magnesium asparaginate"
Vitamin supplements and complexes, which include niacin and B vitamins	Magnelis, Magnerot, Alphabet, Pikovit, Complivit
Diuretics for edema of subcutaneous fat	Furosemide, Lasix, Furon
Antihypertensive medicines for high blood pressure	"Dopegit", "Methyldopa"
Antiarrhythmic drugs	"Disopyramide", "Moracizin", "Lidocaine"

For severe cardiac arrhythmias, surgical treatment is indicated, but the need for surgical treatment is very rare.

Recommendations for regime and nutrition

Children diagnosed with LVH should receive a complete and balanced diet high in mineral salts and vitamins. Fresh fruits and vegetables are rich in heart-healthy elements. Every day, the child should eat at least 300 g of fruits and the same amount of vegetables.. Citrus fruits (grapefruits, tangerines), apples, pears, bananas are especially useful. For children at risk of heart pathologies, persimmon is a valuable food product - it contains a large amount of potassium and magnesium, as well as essential vitamins and acids. Fresh herbs should be regularly added to the first and second courses. It is better if these are fresh leaves, but in winter it is allowed to use frozen raw materials.

Other must-have foods in the baby's diet should be:

• fresh meat (you should not buy frozen meat and poultry parts, since chlorine, which is used during freezing, can negatively affect the work of the heart);
• fish (including fatty fish);
• milk and dairy products;
• dried fruits;
• nuts;
• cheeses;
• berries;
• eggs of chickens and quails.

Exercise may be limited as directed by a doctor, especially if the child has signs of an irregular heart rhythm or pressure problems. Long walks (at least 1 hour), as well as active games on the street, are useful for such children. The total duration of stay in the fresh air should be at least 2-3 hours a day.

A good night's rest is of great importance for the prevention of complications. To reduce the child's excitability before bedtime, an hour before preparing for a night's rest, you should eliminate all sources of noise and harsh lighting (turn off the TV, computer, dim main light). Overactive children can be given lemon balm tea or warm milk with a teaspoon of honey before going to bed. Young children, as well as children and adolescents with increased nervous excitability, can be recommended a daytime sleep of 1-1.5 hours.

LVDH is not a disease, but an abnormal development of the heart muscle during intrauterine growth. Treatment of pathology is aimed at eliminating symptoms, restoring normal heart rhythm and maintaining the full volume of myocardial and mitral valve functions.

Video - Excessively mobile accessory chord in the left ventricle