myocardial - it is non-inflammatory nedegenerativnoe defeat myocardial layer of the heart, the pathogenesis of which is laid metabolic disorders in cardiomyocytes accompanied by a significant decrease not only the intensity but also the regularity of the heart.
result dismetabolic processes in cardiomyocytes, it is a transition to the anoxic airway, which inevitably provokes a decrease in the efficiency trophicity myocardial layer of the heart.
myocardial currently still poorly understood as a separate nosology, and requires the attention of scientists in terms of determining the tactics of patients with this pathology.
In daily practice specialists of any profile, including cardiologists, using a single standard classification of ICD-10, in which each nosological form designated serial number (myocardial code ICD-10: I42).The practical use of this code allows a doctor anywhere in the world to recognize verified a particular patient diagnosis.
main precipitating factor in relation to the development of myocardial dystrophy is any physiological or pathological condition associated with a mismatch requirements of the heart muscle for energy resources and capabilities of the body to produce this amount of energy.In most situations, this pathology is a consequence of other clinical entities and is called "myocardial secondary."
Depending on the origin, myocardial divided into two broad categories: formed on the background of a heart disease or developing on the background of diseases not associated with impaired cardiac function.As cardiac diseases, against which can develop myocardial dystrophy, may make any heart disease, in addition to inflammatory myocardial damage.
most common situation in which develops the energy imbalance in the myocardium is prolonged deficiency of vitamins and essential nutrients in the human body that occurs during prolonged unbalanced diet, hunger.Furthermore, when excessive physical activity in professional athletes as well as during pregnancy myocardial does not develop due to insufficient supply of nutrients to the body, as a result of the excess of consumption.
According to the etiopathogenetic classification of this pathology is allocated a number of specific forms: tonzillogennaya myocardial (loss of cardiomyocytes as a result of intoxication effects in inflammation of the tonsils), intoxication myocardial (alcohol), due to a toxic effect on cardiomyocytes.For the development of alcoholic myocardial dystrophy it is a necessary condition for a long period for alcoholism.In addition, myocardial toxic can be provoked by prolonged exposure on the human body of toxins of various kinds (benzene, nicotine, aniline) and drugs when they overdose.
Neuroendocrine myocardial formed against various violations of the hormonal status of the patient, as well as violations of neurohumoral regulation.Dystrophic myocardial damage develops due to the fact that the structure of the nervous system are constantly excited state, accompanied by excessive production and release of adrenaline into the bloodstream.The above changes will inevitably provoke an increase in the load on the myocardium, which ends with the formation of irreversible degenerative changes.
Although poly etiology of this disease all etiopathogenetical options myocardiodystrophy characterized by a single pathogenetic mechanism of development, which is based on a violation of the energy of intracellular metabolism.Development myocardiodystrophy if severe anemia is due to the formation of hematic hypoxic damage, which inevitably provokes the development of the energy deficit in the myocardium.Thus, any form of anemia, both in acute and chronic course accompanied by the development of degenerative changes in the myocardium.
long time myocardial heart is accompanied by the formation of a reversible changes in myocardial layer, and only in the final stage of the disease in the patient's notes the development of degenerative changes irreversible.
Regarding the development of myocardial dystrophy in childhood the most common etiologic factor is the transferred rickets at an early age, but the debut of the clinical manifestations of accounts for school age when the greatly increased physical and emotional load.In a situation where signs myocardiodystrophy observed in the newborn child should be examined this patient for the presence of foci of intrauterine infection, as well as signs of perinatal encephalopathy, as these pathological conditions are favorable background for the development of degenerative changes of the myocardium directly after birth.
All clinical manifestations myocardiodystrophy based on violations of cardiac hemodynamics, caused moderate to severe decrease in contractile function of the heart.The most typical complaints of patients suffering from myocardial dystrophy, is a feeling of aching pain in the projection of the heart, a sense of discomfort and disruption of rhythm of cardiac activity, which are of short duration and not accompanied by significant disorder disability rights.Non-specific complaints arising from a violation of blood supply to the brain structures are headaches, inability to perform familiar exercise, recurrent episodes of dizziness and drowsiness.
In a situation where myocardial accompanied by the development of degenerative changes of the myocardium and the appearance of symptoms of heart failure stagnant, the patient has pathognomonic symptoms of a pronounced edema syndrome both peripheral and central type, progressive respiratory disorders and heart rhythm as arrhythmia,tachycardia and paroxysmal atrial fibrillation.This clinical syndrome observed in all variants of myocardial dystrophy, but each Etiopatogenetichesky version of this cardiac disease characterized by the development of specific manifestations.
myocardiodystrophy children has some features of the course, manifested a long latency period, during which the child is absolutely not experience any clinical manifestations.This period is dangerous because without the use of routine methods of diagnosis becomes more difficult early diagnosis verification and there is a high risk of cardiovascular complications on the background of well-being.
tonsillogenic myocardial characterized in that the development of clinical signs occur a few days after suffering a sore throat and is manifested in the form of the appearance of intense pain in the heart, progressive weakness, disruption of the heart, low grade fever and arthralgia.
With regard to diagnostic procedures, allowing reliably verify the diagnosis applied electrocardiography, echocardioscopy and phonocardiography.The main electrocardiographic criteria myocardiodystrophy is the appearance of wrong orientation and deformation of the T wave in some leads, distorted wave U and ST-segment depression of at least 1 mm.These changes are not specific, and their detection is imperative perform daily holter electrocardiographic monitoring.
more specific changes characterized by myocardial when performing echocardiography, as in this situation, the patient revealed signs of hemodynamic disturbances in the absence of an organic lesion of the myocardium.Changes phonocardiography at myocardiodystrophy develop only at the stage of cardiac decompensation, and manifest themselves in the form of registration gallop rhythm and systolic murmur in the projection of the apex of the heart.
Laboratory changes during myocardiodystrophy revealed only in the terminal phase and are manifested in the form of reduced mitochondrial activity of cardiomyocytes.Detection of these changes reflect the extremely unfavorable for myocardial dystrophy, and is a negative prognostic sign.
In difficult diagnostic cases in which the patient has clinical manifestations and hemodynamic disorders that do not meet the identified changes in the myocardium, recommended the implementation of needle biopsy of the heart muscle.For this purpose it is extracted endomyocardial material under local anesthesia.This technique is complex in execution, so the practical application of its minimum.
in cardiology practice professionals use clinical classification of myocardial dystrophy, according to which can be divided three stages of development of this pathology.In the initial stage it is marked compensatory increase in function of the heart muscle in response to dysmetabolic violations occurring in the myocardium.Clinically, this condition is manifested by nonspecific prolonged cardialgia and some decrease in tolerance of physical activity.Instrumental methods of imaging are not accompanied by the detection of pathological changes in the structure of the cardiovascular system.Stage Clinical compensation characterized by the development cardiohemodynamic and respiratory disorders.In this situation, in routine electrocardiographic study identifies the characteristics of hypertrophy of the left heart.Decompensated stage myocardiodystrophy provokes pronounced health problems and treatment of the patient should be pathogenetically substantiated.
major etiologic factor in the occurrence of dishormonal option myocardiodystrophy is an imbalance of the normal ratio of thyroid hormones that results in a violation of its basic functions.Keep in mind that equally as hyperactivity and insufficient production of thyroid hormones the same negative impact on the state of the electrolyte and energy metabolism of myocardium.In case of insufficient production of thyroid hormones occurs the system slowing down the metabolic processes of the whole organism.Slow metabolism in the myocardium is accompanied by the development of arterial hypotension, pain in the heart aching.Excessive production of thyroid hormones, in contrast, is accompanied by an acceleration of metabolic processes, manifested in the form of appearance cardialgia stabbing character, violation of rhythm of cardiac activity, and increased irritability.
In addition, violation of testosterone production in men and estrogen in women, is observed as a physiological involutive changes can become an agent provocateur of metabolic disorders in the myocardium.In cardiac classification is even a separate nosological form dishormonal variant of this disease called "climacteric myocardiodystrophy."
development of degenerative changes in cardiomyocytes under estrogen deficiency in menopause is because hormones exert a controlling effect upon the electrolyte balance in the cells of the whole body, including cardiac myocytes (increase the concentration of iron, phosphorus, copper, stimulation of synthesis of fatty acids), so that failureestrogen creates conditions for the development of myocardial dystrophy.Recent research examining the prevalence dismetabolic myocardiodystrophy among postmenopausal women have shown the need for a preventive screening of all women during this period.
Note that dyshormonal myocardial may develop in pregnant and have a negative impact on the normal development of the fetus, but this pathology is not an absolute indication for abortion, it is sufficient only to the dynamic ultrasound monitoring.The preferred method of delivery in this situation is operative.
Early verification myocardiodystrophy is of great importance in preventing the development of complications and improve the prognosis for a full recovery of the patient.
myocardial mixed genesis
emergence myocardiodystrophy mixed genesis exposed face of early childhood, suffering from severe anemia in conjunction with the neuroendocrine and electrolyte disturbances.In addition, this form of myocardial dystrophy occurs in adult patients suffering from disorders of the hormonal status as a result of thyroid disease.A fundamental factor for a diagnosis of "myocardial mixed origin" is poly etiology, that is a combination of several precipitating factors that combine to create the conditions for the development of degenerative changes in the myocardium.
The primary changes of the myocardium at myocardiodystrophy complex origin is a violation of the contractile its functions, especially of the left heart.However, in the absence of applied timely treatment, myocardial has a very negative effect on the automatism, conductivity and excitability of almost all departments of the myocardium, which provokes heavy cardiohemodynamic violations.
debut in pathology and pathogenetic manifestations of the disease, clinical symptom in the form of a short pain in the projection of the heart, are observed only after excessive physical activity and at rest patients reported absolutely no changes in their health.
myocardial mixed genesis differs rapidly progressive course, and resistance to the use of drug treatment, so the only effective therapy is the transplantation of stem cells.
myocardial complex genesis
This option myocardiodystrophy has extremely severe and the appearance of it is not associated with any other cardiac pathologies.The main precipitating factor in the development myocardiodystrophy complex origin still remains a systemic violation of the metabolism in the body, including in the cardiomyocytes, which can be combined with other, unrelated to cardiac activity changes.
Initial clinical manifestations kardiomiodistrofii complex genesis is so non-specific that in most cases a reliable diagnosis at this stage set is not possible.At the stage of pronounced degenerative changes of the myocardium clinical manifestations may simulate other cardiac disease (fatigue, false angina, respiratory disorders, the rhythm of cardiac activity).In this regard, the fundamental criterion for the verification of the diagnosis is the use of a wide range of instrumental studies proved informative.
In most cases, myocardial complex origin occurs in chronic form, however, with accompanying acute conditions existing in the patient, as well as marked reduction in immunity may be a sharp development of degenerative changes in the myocardium.As a rule, such a background state is a significant hypertension, pulmonary embolism, and in this case significantly increases the risk of death due to contracture dystrophy infarction.