Cardiomyopathy - a group of inflammatory diseases of the heart muscle, emerging for various reasons.Also, it can be called a myocardial dystrophy.This disease mainly affects people of different age groups, and it has no preference field of the patient.For a long time doctors could not determine the exact cause of this disease.But in 2006, American Heart Association has decided to understand the reasons which may, under certain conditions, to cause myocardial damage.
In cardiomyopathy identify several varieties: hypertrophic cardiomyopathy, dilated (ischemic) cardiomyopathy and alcoholic cardiomyopathy.These types of cardiomyopathy characterized by certain features of the impact on the heart muscle.The principles for the treatment of all types are practically identical and are aimed at eliminating the causes of cardiomyopathy and heart failure treatment.
With the defeat of the heart muscle during cardiomyopathy can be both primary and secondary proces
main group of primary causes of cardiomyopathy is a congenital, acquired and mixed.Secondary cardiomyopathy occurs due to any disease.
Pathology (congenital) heart occurs because of irregularities in the laying of myocardial cells during embryonic development.The reasons for its development of a large array: it can be bad habits mother, stress, genetic disorders, poor diet, etc.Sometimes pregnant women as cardiomyopathy, and cardiomyopathy inflammatory genesis.They are called myocarditis.
The secondary forms of cardiomyopathy may include: infiltrative kardimiopatiya, which is characterized by the accumulation of abnormal inclusions between cells.These savings are in the cells themselves;kardimiopatiya toxic, which is determined by the severity of the defeat of the heart muscle as a result of the adoption of anti-tumor drugs.To its development can be attributed the phenomenon of the minor changes in the electrocardiogram to the rapid development of heart failure and then death.Also prolonged alcohol consumption, particularly in large quantities can lead to inflammation of the heart muscle.It should be noted that this type of secondary cardiomyopathy ranks first in Russia.
Metabolic cardiomyopathy develops due to metabolic disorders in the myocardium and leads to degeneration of the walls, as well as violations of the contractile activity of the heart muscle.Its causes - menopause, overweight, bad and unhealthy diet, gastrointestinal diseases, diseases of the endocrine system.
Alimentary cardiomyopathy develops because of malnutrition, especially during prolonged diets.
cardiomyopathy in children is a frequent phenomenon, which can be either congenital reasons or purchased formed during maturation of the child.The majority kardimiopatiya in children is caused due to breach of physiological development of heart muscle cells.
kardimiopatii symptoms may first manifest itself at any age, but usually they are not very zamechaemy for the patient and often do not cause him any feelings to a certain point.Patients with cardiomyopathy typically reach a normal level of life expectancy and can live to a ripe old age, but, nevertheless, the disease process may be complicated by the development of severe complications.
Symptoms in kardimiopatii quite common and mix them with the symptoms of other diseases not so difficult.These include: shortness of breath, which at the beginning of the disease appears only in very severe exertion;and chest pain, dizziness, and weakness.These symptoms usually occur due to violations of contractility of the heart.
When you need to see a doctor for help?Many of these symptoms are characteristic physiological feature of almost every one of us or not at all are serious, thus not being an expression of chronic diseases.If the chest pain is long and aching in nature, and is combined with a very severe shortness of breath, swelling of the legs there, sleep disturbances and feeling short of breath during exercise.It may also be syncope, which typically have their appearance due to lack of oxygen in the brain due to insufficient blood supply to it.In such moments you need to immediately contact a doctor.
Diagnostics for kardimiopatii: radiography, ultrasound of the heart, Holter monitoring, and magnetic resonance therapy.
This kind of disease infarction of unknown etiology that is characterized by an increase or left ventricular hypertrophy, but sometimes, but rarely the right ventricle, often with the explicit asymmetry, and clear violations of diastolic filling of the left ventricle with severe absencedilatation in the cavity and the reasons that caused this very hypertrophy.Sometimes there is an isolated hypertrophy of the apical part of the ventricles and the interventricular septum.Left ventricular cavity somewhat reduced, whereas the left atrium expanded.
Gipertrofichkaya cardiomyopathy often occurs at a young age;age of these patients may be about 30 years.
subdivided several stages of the disease:
- The first stage (the pressure gradient in the outflow tract of the left ventricle is not more than 25 mm Hg, patients do not complain)
- The second stage (the pressure gradient in the outflow tract of the left ventricle is not more than 36 mm Hgcomplaints appear on exertion)
- Third stage (pressure gradient in the outflow tract of the left ventricle is not more than 44 mmHg. Patient disturb dyspnea and angina
- Fourth stage (pressure gradient in the outflow tract of the left ventricle is not more than 80 mm Hg,and sometimes can even reach 185 mm Hg. With such a stable altitude gradient there are marked hemodynamic instability associated with clinical manifestations)
In normal cases, the clinical picture are:
1) the phenomenon of hypertrophy (mostly left) ventricular myocardium;
2) effects of insufficient ventricular diastolic function;
3) the phenomenon of obstruction of left ventricular outflow tract (not all patients);
4) phenomenon of cardiac arrhythmias.
nature of pain in the heart in patients with hypertrophic cardiomyopathy is different.In most patients, there are indications of typical angina attacks.There are some cases of myocardial infarction with a characteristic clinic and severe pain, the nature of very very long, which corresponds to the classical heart attack.Also, there is shortness of breath - the most common sign and symptom of the disease.It occurs in about ninety percent of the cases and is due to increase in the last diastolic pressure in the pulmonary veins in the left atrium.This leads to disruption of gas exchange in the lungs.
Fainting and dizziness often arise because of physical and emotional stress, walking at a fast transition from horizontal to vertical.Many patients complain of poor circulation of the brain, which appears short-lived periods of shutdown, loss of consciousness, speech disorders.
periods of dizziness and loss of consciousness are also caused by arrhythmias and therefore the existence of such symptoms electrocardiogram is mandatory.
diagnosis of the disease is determined on the facts, which show a characteristic combination of symptoms of the disease and the lack of data, which showed a similar syndromes of pathology.
for hypertrophic cardiomyopathy characterized by the following symptoms:
1) systolic noise with the localization of the left edge of the sternum with the stored tone II combined;
2) in combination with mezosistolicheskim noise preservation I and II on the PCG tones;
3) carotid sphygmogram change;
4) according to ECG and X-ray studies of left ventricular enlargement;
5) detected in echocardiography typical symptoms.
often for the treatment of hypertrophic kardimiopatii used beta-blockers.They reduce the vulnerability of the myocardium to catecholamines, reduces the need for oxygen and pressure gradient, and prolong diastolic filling time and also improves ventricular filling.Another may prescribe calcium antagonists.If there is a cardiac arrhythmia, the Kordaron administered at a dosage of 600 or 800 mg daily during the first week, then at 200 and 400 mg per day.And with the development of heart failure prescribed diuretics saluretics - Uregei and furosemide;aldosterone antagonists - Veroshpiron aldactone and in appropriate dosages.
When dilated kardimiopatii, also known as ischemic dilated cardiomyopathy is the case is the definition of myocardial diseases, which is characterized by high increase in all chambers of the heart to the extent determined cardiomegaly, often with unequal thickening of its walls, and the manifestations of diffuseand focal fibrosis that develops in the atherosclerotic lesions of the coronary arteries.But not because of the formation of ventricular aneurysm with symptoms of organic disease of the valve apparatus or pathological fistulae availability.
On this basis, we can assume that ischemic cardiomyopathy - the so-called myocardial damage, which is caused by a significant expression diffuse coronary atherosclerosis, which is shown cardiomegaly and congestive heart failure symptoms.
ischemic cardiomyopathy appears more often in the age of fifty years, and among all male patients may be 90 percent.
The cause of ischemic cardiomyopathy can be plural atherosclerotic lesion or intramural or cardiac coronary artery branches.Also ischemic cardiomyopathy has the character of cardiomegaly and congestive heart failure.The development of these displays show the following factors promote the pathogenetic: dilated cardiomyopathy development gains are often in men with age.Usually, we can talk about those patients who have had myocardial infarction or angina pectoris.In some cases, the picture with the clinic has yet angina, heart failure and eronicheskuyu cardiomegaly.
criteria for diagnosis of ischemic cardiomyopathy include: presence of angina, cardiomegaly, the presence of sonographic and clinical signs of heart failure, the discovery of such sites in the myocardium that are in a state of hibernation.
Patients with alcoholic cardiomyopathy ranged from 20 to 40% of patients who have myocardial damage.Such a condition has a large percentage of its development in men.But, despite the restriction of use of alcoholic beverages in the countries of the West, there are cases of alcoholic cardiomyopathy, registering at a fixed frequency.
Most alcoholic cardiomyopathy is similar to poor prognosis in blacks subjects.
There are two forms of alcoholic cardiomyopathy: preclinical (asymptomatic) and manifest (the clinic with chronic heart failure).Of course, important is the fact that, according to reports of a large number of authors, there is the severity of alcohol abuse is not correlated with the structural changes of the myocardium and its function.
But you can still make some conclusions about the relationship between alcoholic cardiomyopathy and alcohol consumption.People who abuse alcohol without clinical manifestations of heart failure, chronic use of more than 100 g / day of pure alcohol for five years or more.
identifies specific mechanisms of alcoholic cardiomyopathy: a clear toxic effect of alcohol products in cardiomyocytes;when thiamine deficiency, which is connected with the peculiarities of the nutritional status of the excessive use of alcohol;the effect of such substances that are added to alcoholic beverages (for example, cobalt, which is used as a preservative in the formulation of the beer in the bank).
heart muscle damage may be manifested by changes in the ECG and various arrhythmias, and cardiac conduction disturbances, and symptoms of chronic heart failure.Unfortunately, up to a point not available on pharmacotherapy works alcoholic cardiomyopathy, which fully meet the requirements of evidence-based medicine point of view.Excessive alcohol consumption is the ultimate definition of the exception for almost all large multicenter studies.Because all recommendations for the treatment of chronic heart failure, attention is drawn to the fact that the scheme for the treatment does not have differences.
must define a fact - participation in the treatment process psychiatrist helps reduce pathological attraction to alcohol, and significantly improve clinical outcomes in the alcoholic cardiomyopathy and prevent cases of passing such a state.
cardiomyopathy treatment process is very complicated and long.This may be due to the complex etiology of this disease.Meanwhile, treatment of cardiomyopathy is largely dependent on the specific cause.The goal of treatment is also to a large increase in cardiac ejection and also in preventing further violations of the proper functioning of the heart muscle.
In the course of treatment is also important to carry out all activities if their doctor prescribes.
addition, should pay attention to such moments that the patient should eliminate yourself.If overweight, it is important to follow certain diet and lifestyle in order to gradually and effectively reduce the body weight went.Such habits like smoking and alcohol, to a small extent influence the birth of heart disease than the risk factors associated with the disease directly.
Expressed exercise and also alcoholic drinks have to be completely removed from life in order to reduce the burden on the heart muscle.In exceptional cases, especially in the early stages of such measures can improve treatment and prevent the development of it.
Drug treatment of cardiomyopathy are beginning to appoint to those patients who developed clinical manifestations of certain expressions of cardiomyopathy.Medications beta adrenoblakatorov group, whose members are the Bisoprolop and atenolol.
When violations of cardiac rhythm should be the appointment of anticoagulants (drugs at an elevated blood clotting) due to the high risk of thromboembolic complications.
for planning surgery and for the prevention of infectious endocarditis antibiotics is a must.The drug is verapamil should also appoint the absence of the effect of the core group of medical preparations.This drug has a beneficial effect on the main symptoms of cardiomyopathy due to a decrease of severity of heart muscle dysfunction.
intervention via surgery can be carried out only under strict indications, as well as the ineffectiveness of treatment drugs.So if cardiomyopathy has a connection with cardiac arrhythmia, in which case you need to help put a pacemaker implant, which will keep your heart rate at the desired frequency.Yet if there is a risk of sudden death (there were cases in the family) need implantation of a defibrillator.