Cardiomyopathy

Cardiomyopathy is a group of inflammatory diseases of the heart muscle that develop for various reasons. It can also be called myocardial dystrophy. This disease mainly affects people of different age groups, and it has no preferences in the patient's field. For a long time doctors could not establish the exact cause of the development of this disease. But in 2006, the Cardiology Association in America decided to understand the causes that can cause myocardial damage under certain conditions.

In cardiomyopathy several types are distinguished: hypertrophic cardiomyopathy, dilated( ischemic) cardiomyopathy and alcoholic cardiomyopathy. These types of cardiomyopathy are characterized by specific features of the effect on the heart muscle. The principles of treatment for all types are almost identical and are aimed at eliminating the causes that cause cardiomyopathy and the treatment of heart failure.

Cardiomyopathy causes

When cardiac muscle damage during cardiomyopathy can be both primary and secondary process due to systemic diseases and may be accompanied by the development of chronic heart failure and in rare cases be the cause of sudden death.

The main groups of reasons for the development of primary cardiomyopathy are congenital, acquired and mixed. Secondary cardiomyopathy appears due to any diseases.
The pathology( congenital) of the heart appears due to a disruption in the insertion of myocardial cells during the development of the embryo. There are many reasons for its development: it can be the mother's bad habits, stresses, gene disorders, malnutrition, etc. There are also cardiomyopathy of pregnant women, as well as cardiomyopathy of inflammatory genesis. They are called myocarditis.

Secondary forms of cardiomyopathy may include: infiltrative cardiomyopathy, which is characterized by congestion between the cells of pathological inclusions. Such accumulations occur also in the cells themselves;Cardiomyopathy is toxic, the severity of which is determined by the damage to the heart muscle due to the adoption of antitumor drugs. Its development can include the phenomenon of minor changes in the electrocardiogram before the rapid development of heart failure, and then death. And also prolonged use of alcohol, especially in large quantities, can lead to inflammation in the heart muscle. It should be noted that this type of secondary cardiomyopathy is in the first place in Russia.

Metabolic cardiomyopathy develops due to metabolic disturbances in the myocardium and leads to wall dystrophy, as well as to violations of the contractile activity of the heart muscle. Its causes - menopause, overweight, poor and abnormal nutrition, gastrointestinal diseases, diseases in the endocrine system.

Alimentary cardiomyopathy develops due to eating disorders, especially with prolonged diets.

Cardiomyopathy in children is a frequent occurrence, which can have both congenital causes and acquired ones, formed during the child's growing up. In its majority, cardiomyopathy in children is caused by a violation of the physiological development of the cells of the heart muscle.

Cardiomyopathy symptoms

Symptoms of cardiomyopathy may appear for the first time at any age, but usually they are not particularly noticeable to the patient and often do not cause him any feelings until a certain point. Patients with cardiomyopathy usually reach the normal mark of life expectancy and can live to a very old age, but, nevertheless, the process of this disease can be complicated by the development of formidable complications.

Symptoms of cardiomyopathy are quite common and confusing them with the symptoms of other diseases is not so difficult. These include: shortness of breath, which at the beginning of the disease appears only with a very pronounced physical exertion;And pain in the chest, and dizziness, and weakness. These symptoms usually arise from violations of the contractile work of the heart.

When should I see a doctor for help? Many of these symptoms are a characteristic physiological feature of almost every one of us or not at all serious, thus not being an expression of chronic pathology. If the pain in the chest is long and aching, and also combined with very pronounced dyspnea, there are swelling of the legs, a sleep disorder and a feeling of lack of air during exercise. There may also be faints, which usually have their origin due to lack of oxygen in the brain, due to insufficient blood supply. In such moments, you need to immediately consult a doctor.

Diagnosis with cardiomyopathy: radiography, heart uzi, holter monitoring and magnetic resonance therapy.

Hypertrophic cardiomyopathy

This type of myocardial disease with unknown etiology, which is characterized by an increase or hypertrophy of the left ventricle, but sometimes, but less often, the right ventricle, often with obvious asymmetry, and with obvious diastolic filling of the left ventricle with a pronounced lack of dilatation in its cavityAnd the causes that caused this most hypertrophy. Sometimes there is isolated hypertrophy of the apical part of the ventricles or interventricular septum. The ventricular cavity of the left is somewhat reduced, whereas the left atrium is enlarged.
Hypertrophic cardiomyopathy is very common at a young age;The age of such patients can be about 30 years.

The stages of this disease are subdivided:

- The first stage( pressure gradient in the left ventricular outflow line is not more than 25 mmHg, patients do not complain)
- The second stage( pressure gradient in the output tract of the left ventricle not more than 36 mmHg, complaintsAppear at physical exertion)
- The third stage( pressure gradient in the left ventricular outflow not more than 44 mmHg. Patients are concerned about shortness of breath and angina
- Fourth stage( pressure gradient in the output traLeft ventricle is no more than 80 mm Hg, and sometimes even can reach 185 mm Hg. At such a stable height of the gradient, severe hemodynamic disorders occur with concomitant clinical manifestations.)

In the usual cases, the clinical picture is:
1) hypertrophy( mainly left) Myocardial ventricles;
2) the phenomenon of insufficient diastolic ventricular function;
3) the phenomenon of left ventricular outflow tract obstruction( not in all patients);
4) the phenomenon of heart rhythm disturbances.

The nature of heart pain in patients with hypertrophic cardiomyopathy is different. Most patients have signs of typical attacks of angina pectoris. There are some cases of the development of myocardial infarction with a characteristic clinic and severe pain syndrome, the character is extremely long, which corresponds to the classic infarction. Also there is a shortness of breath - the most frequent sign and a symptom of the disease. It is observed in approximately ninety percent of cases and is explained by an increase in the last diastolic pressure in the pulmonary veins, in the left atrium. This leads to an impaired gas exchange in the lungs.

Fainting and dizziness often occur due to physical and emotional stress, walking, with a rapid transition from horizontal to vertical position. Many patients complain of a worsening of the blood circulation of the brain, which is manifested by short-term periods of shutdown, consciousness of loss, speech disorders.
Periods of dizziness and loss of consciousness are also caused by arrhythmias and therefore, if there is such a symptomatology, an electrocardiogram is mandatory.

Diagnosis of the disease is determined on the facts that show a characteristic combination of the signs of the disease and the lack of data that indicate a similar pathology syndrome.
For hypertrophic cardiomyopathy, the following symptoms are characteristic:
1) Systolic murmur with localization on the left side of the sternum with a preserved II tone in combination;
2) in combination with mesosystolic murmur, preservation of I and II tones on FCG;
3) carotid sphygmogram changes;
4) according to ECG and X-ray study, an increase in the left ventricle;
5) typical signs found in echocardiography.

Often, beta-blockers are used to treat hypertrophic cardiomyopathy. They reduce the vulnerability of the myocardium to catecholamines, also reduce the need for oxygen and pressure gradients and prolong the time of diastolic filling and also improve the filling of the ventricle. Can also appoint calcium antagonists. If there are violations of the heart rhythm, then appoint Cordarone with a dosage of 600 or 800 mg per day for the first week, then 200 and 400 mg per day. And with the development of heart failure prescribe diuretics saluretics - Ureit and Furosemide;Aldosterone antagonists - Veroshpiron and Aldactone in appropriate dosages.

Dilated cardiomyopathy

In dilated cardiomyopathy, also called ischemic dilated cardiomyopathy, there is a definition of myocardial disease that is characterized by an increased increase in all cardiac chambers to a certain degree of cardiomegaly, often with an unequal thickening of all its walls, and with manifestations of diffuse and focal fibrosis, Which develops against the background of lesion of atherosclerotic coronary arteries. But not because of the formation of ventricular aneurysms, with manifestations of the organic pathology of the valvular or pathological presence apparatus.

Based on this, it can be assumed that ischemic cardiomyopathy is the so-called myocardial injury, which is caused by a pronounced diffuse atherosclerosis of the coronary arteries, which is manifested by cardiomegaly and congestive heart failure symptoms.

Ischemic cardiomyopathy appears more often at the age of fifty years, and among all patients, men can be 90 percent.
The cause of the development of ischemic cardiomyopathy can be multiple lesions of atherosclerotic or intramural, or cardiac branches of the coronary arteries. Also, ischemic cardiomyopathy has the character of cardiomegaly and congestive heart failure. The development of these manifestations is facilitated by the following factors pathogenetic: dilated cardiomyopathy is gaining development often in men, with age. Usually it can be about those patients who have had a history of myocardial infarction or who suffer from angina pectoris. In some cases, the picture with the clinic has nevertheless angina of tension, erotic heart failure and cardiomegaly.

Criteria for the diagnosis of ischemic cardiomyopathy include: the presence of angina pectoris, cardiomegaly, the presence of echographic and clinical signs of cardiac insufficiency, the detection in the myocardium of such sites that are in a state of hibernation.

Alcoholic cardiomyopathy

Patients with cardiomyopathy alcoholic make up from 20 to 40% of patients who have myocardial damage. This condition in a large percentage of cases has its development in men. But, despite the restriction of alcohol consumption in countries in the West, there are cases of alcoholic cardiomyopathy, registering with an unchanged frequency.

More often alcoholic cardiomyopathy is similar to an unfavorable prognosis in the Negroid race of subjects.
There are two forms of alcoholic cardiomyopathy: preclinical( asymptomatic) and manifest( with a clinic of cardiac chronic failure).Undoubtedly, it is important that according to the available data of a large number of authors, there is an alcoholic excess of abuse that does not correlate with structural changes in the myocardium and its function.

But still you can draw a few conclusions regarding the relationship between alcoholic cardiomyopathy and alcohol consumption. Persons who abuse alcohol without clinical manifestations of cardiac chronic insufficiency use more than 100 g / day of pure alcohol for five years or more.

Define specific mechanisms for the development of alcoholic cardiomyopathy: an apparent toxic effect of alcohol production on cardiomyocytes;When there is a deficiency of thiamine, which is related to the nutritional status of the characteristics of excessive use of alcohol;The effect of such substances that are added to alcohol( for example, cobalt, which is used as a preservative in the production of beer in the bank).

Damage to the heart muscle can be manifested by changes in the ECG and various rhythm disturbances, as well as violations of conduction of the heart, and symptoms of cardiac failure. To my great regret, until a certain moment, there was no pharmacotherapy of alcoholic cardiomyopathy, which completely satisfies the medical requirements from an evident point of view. Excessive use of alcohol is the extreme definition of exclusion for almost all large-scale studies of multicenter. Therefore, in all recommendations for the treatment of cardiac chronic insufficiency, attention is drawn to the fact that the scheme for therapy does not differ.

It should be determined such a fact - participation in the treatment process of an expert in narcology helps to reduce the pathological attraction to alcoholic beverages, and reliably improve clinical outcomes in alcoholic cardiomyopathy and prevent cases of passage of such a condition.

Cardiomyopathy treatment

The treatment of cardiomyopathy is very complicated and prolonged. This may be due to the complex etiology of this pathology. In the meantime, the treatment of cardiomyopathy largely depends on a certain cause. The goal of the cure is also a large increase in cardiac output and also in preventing further impairment of the adequate functioning of the cardiac muscle.

In the process of treatment, it is also important to carry out all activities if prescribed by a doctor.
In addition, you should pay attention to such moments that the patient must eliminate themselves. With excessive body weight, it is important to follow certain diets and lifestyle in order to gradually and effectively reduce the body mass. Such habits, like smoking and alcohol, have little effect on the birth of heart disease than the risk factors directly associated with this disease.

Exact physical activities and also alcoholic beverages must be absolutely excluded from life to reduce the load on the heart muscle. In exceptional cases, especially in the early stages, such interventions can improve treatment, as well as prevent its development.

Medicinal treatment of cardiomyopathy begins to be prescribed to those patients who have developed definite manifestations of the cardiomyopathy clinic. Medicinal preparations of the group of beta adrenoblokatorov, representatives of which are Bisoprolop and Atenolol.

In case of heart rhythm disturbances, the appointment of anticoagulants( drugs with increased blood clotting) is necessary because of the high risk of development of thromboembolic complications.

To plan surgical intervention and also to prevent the development of endocarditis, an infectious antibiotic intake is simply necessary. Medicinal preparation Verapamil should also be prescribed in the absence of effect from the main group of medicinal preparations. This drug has a beneficial effect on the main symptoms of cardiomyopathy due to a decrease in the expression of the cardiac muscle dysfunction.

Intervention with the help of surgery can be performed only on strict indications, as well as in the ineffectiveness of medication treatment. So if cardiomyopathy has a connection with heart rhythm disturbances, then in this case it is necessary to put a pacemaker with the help of implantation, which will maintain the heart rate at the right frequency. And yet, if there is a risk of sudden death( there were cases in the family), a defibrillator implantation is needed. This device will help to recognize the ventricles fibrillation, wrong rhythm, it does not allow to work in the right mode in the heart, and also send impulses for a certain reboot of the heart and for coordinated coordinated work.

Variants with severe cardiomyopathy that can not be corrected by surgical methods can be reconsidered as an option for the heart of transplantation. Such operations are best performed only in highly specialized clinics. There are also cases with a certain effect from stem cell treatment.

After a certain method of treatment, continuous monitoring with a therapist or cardiologist is necessary. His consultations are mandatory, especially in a dispensary. The frequency of dispensary observation should be 1-2 times a year, and with exacerbations - more often. Analyzes repeated are obliged to be spent at the general deterioration of a status, and also at planning of changes in courses of treatment.

Patients with life-threatening heart rhythm disorders in the history of the anamnesis also need to perform monitoring every year with the holter and with the ECG.And for a good treatment and for improving the quality of life, patients are extremely important: get rid of excess weight, give up alcohol and smoking, keep your blood pressure under control, impose a restriction on intense physical activity.

The prognosis of treatment depends on multiple factors, and how the treatment will be performed competently, and all the doctor's recommendations will be followed, plus to all the expressed degree of symptoms at the initial stage of the disease detection.

Qualitative methods for the prevention of this disease have not yet been developed. Therefore, an active lifestyle, a healthy balanced diet - that's the guarantee of good health!