Cardiomegaly - this change in the form of parameters and the total weight of the heart in the direction of increasing these parameters, which is the main manifestation of chronic heart and sometimes noncardiac abnormalities.In most situations, this term is meant not a separate disease entities, and the syndrome. cardiomegaly are both innate and acquired types, so this pathology can occur in patients of different age groups.
idiopathic cardiomegaly version is a rarity, but now, thanks to the use of highly accurate diagnostic methods can be detected even fetal cardiomegaly.The appearance of cardiomegaly congenital form is triggered by inherited genetic factors, in this connection, the outlook for the maintenance of normal quality of life of these patients is extremely doubtful.
main factors provoking the formation of cardiomegaly acquired forms are various pathological changes of the heart of organic and inorganic nature.A notable fact is that increasing
Also do not forget about the physiological variant cardiomegaly, which occurs in people hypersthenic body type and professional athletes.The increase in tension and cardiac muscle fibers in this situation is a compensatory mechanism and should not be regarded as pathological.
Currently in cardiology practice there is a significant increase in the incidence of cardiomyopathy of alcoholic origin, which inevitably provokes the development of cardiomegaly due to a significant expansion of the cavities of the heart.This clinical variant cardiomegaly has extremely poor prognosis and high mortality caused by complications of accession.
pediatric cardiomegaly increasingly difficult for viral myocarditis arising as a manifestation of childhood viral diseases.This category of pathological changes in the myocardium is the result of the launch of autoimmune mechanisms.
Due to the fact that the development of cardiomegaly takes a long period of time and occurs on the background of existing cardiac disease, patients do not have specific complaints, allowing to set the right conclusion without the use of additional methods of examination.For the most part, patients complain that reflect underlying pathology.That is, in a situation when a person is suffering for a long time, hypertension, primary symptoms, which he will celebrate, are symptoms of high blood pressure, the more pronounced in the crisis course of the disease (headache, nausea, dizziness).
Unfortunately, cardiomegaly is classified as "clinically latent syndromes" that masquerade as symptoms of other diseases.The majority of patients with cardiomegaly noted pain in the heart, which has nothing to do with a typical bout of anginal pain, but can significantly impair the quality of life of the patient.This pain is usually relieved by taking quick valokordin 15 drops once.Signs of cardiomegaly in patients often accompanied by development of clinical heart failure, symptoms of which is growing slowly progressive dyspnea, minor cardiac rhythm disturbances, dizziness, and decreased performance.
At the initial examination of a patient with cardiomegaly should be carefully collected history data, which can assist in the verification of the reasons for its development.In addition, details of the complaints of the patient helps to clarify the nature and character of cardiomegaly.For example, pathognomonic of this disease is the deterioration of the patient during the night the day, during which marked the progression of shortness of breath and in severe cardiomegaly occurrence of paroxysmal cardiac asthma.
Almost 100% of cardiomegaly, arising as a result of the progression of the background cardiac pathology, patients reported a progressive decrease in the usual physical stress tolerance.Many people do not believe that this symptom is related to the progression of cardiomegaly and cardiologists hold the opposite opinion.
significant increase in cardiac parameters can diagnose cardiologist already during the initial examination of the patient on the basis of percussion and auscultation changes.Thus, the expansion of the relative cardiac dullness observed in severe dilatation of the right heart.In addition, there is an extension, and a shift of the apical impulse.Auscultation changes largely reflect the concomitant loss of the valve unit and is the appearance of noise in different points of auscultation.Diagnosis of venous hypertension and stagnation of the systemic circulation from an experienced doctor is not difficult, and is to identify signs of soft tissue swelling of the lower extremities, ascites, skin and vascular manifestations.
as diagnostic measures, allowing reliably establish the fact of changes in the shape and size of the heart, you can use accessible and sophisticated in terms of technical performance of instrumental methods of diagnosis (ray imaging, electrocardiographic monitoring).However, a survey of the impact of the patient, allowing to establish the root cause of cardiomegaly, currently used angiography, transesophageal echocardioscopy and even a needle biopsy, the accuracy of which reaches 100%.
standard method of diagnosis related to screening methods survey of any category of patients is an X-ray, but it should be borne in mind that this method makes it possible to recognize the expressed degree of cardiomegaly due to a significant expansion of the cavities of the heart due to the thinning of its muscular wall.In some situations, the discovery of cardiomegaly with a standard X-ray examination does not constitute a difficulty lies in the visualization of the modified shadow of the mediastinum, increased cardiothoracic index and the formation of the typical configuration of the heart.Addition to standard X-ray examination of the chest X-ray is a side view with a simultaneous contrast of the esophagus, allowing indirectly determine the localization of the affected parts of the heart.Differential diagnosis of cardiomegaly during X-ray examination should be conducted with diseases such as pericardial cysts, neoplasms of the mediastinum and pericarditis, since all these diseases, one way or another, are visualized as the extended shadow of the mediastinum.
Electrocardiographic examination of the patient allows to establish indirect signs of cardiomegaly only in situations where the size of the heart increased due to hypertrophy of the left or right-sided, although these changes are characteristic for a number of cardiac pathologies.
In a situation where cardiomegaly is suspected in children, as well as the need to detail the changes not only the size but also the structure of the muscle tissue, to evaluate the hemodynamic parameters, the only reliable method of diagnosis is the echocardiogram, performed in a standard transthoracic access.During the ultrasound examination of the heart structures required to evaluate the state of the valve device, the presence of focal or diffuse myocardial injury, as well as examines the cavity for the presence of mass lesions.
invasive methods of investigation of the heart to which the intracavitary catheter, are used as therapeutic and diagnostic measures and are the most informative way to determine the cause of cardiomegaly.Using these methods to evaluate changes in intracavitary pressure gradient, the state of valvular heart disease, the presence of coronary artery disease and abnormal shunt.
If you find a person signs cardiomegaly patient should be warned that this pathology involves the development of irreversible myocardial changes and the cavities of the heart and to remove these lesions only effective method is surgical.Otherwise, the conservative treatment and not medical methods are applied in order to eliminate a possible worsening of the current cardiomegaly and prevent complications.
not medical methods of preventive treatment is to correct food behavior (limit foods rich cholesterol and triglycerides, as well as severely restricting admission of salt in the body with food).If cardiomegaly, accompanied by cardiovascular insufficiency should pay special attention to and control of the water regime of daily urine output.If possible, the patient should limit physical activity, if there is a severe degree of heart failure.
basic direction of medical treatment of a patient with cardiomegaly is a causal treatment, drugs that can compensate for hemodynamic disturbances, as well as to eliminate factors contributing for cardiomegaly.In a situation where an increase in size of the cavities or the thickness of the heart wall, observed in a patient with a history of hypertensive, drugs of choice are combined antihypertensive agents, as part of which must be contained diuretics (Enap H - 1 tablet in the morning).If cardiomegaly developed against ischemic damage to the heart, the multicomponent therapy should include the following categories of medicinal agents: beta-blockers (Egilok in a daily dose of 50 mg), acting nitrates (Kardiket retard 40 mg per day), cardiac glycosides (digoxin supportingdosage of 125 mcg).
Due to the fact that cardiomegaly often accompanied by violation of hemodynamics of systemic circulation, attention should be given to patients with signs of stagnation, accompanied by severe edema syndrome.In this situation, the only valid method medication correction is adequate diuresis stimulation using diuretics different pharmacological actions (Furosemide at a daily dosage of 40 mg, a daily dose Veroshpiron least 0.025 mg).
Among the surgical techniques used palliative treatment of cardiomegaly operational benefits to eliminate valve defects.