Cardiomyopathy with dilatation of the heart cavities
Dilated cardiomyopathy (abbreviated DCM) is a myocardial pathology, characterized by a significant expansion (dilatation) of the chambers of the heart. Heart wall while preserving the normal thickness.
The situation is compounded by the fact that the background of the disease, weakens the contractility of the ventricles. The enlarged heart chambers are filled with blood, which leads to further stretching. Gradually the resources are depleted the heart muscle. Patients at high risk of sudden death.
According to statistics, the DCMP is most often diagnosed in people of working age, and men among them several times more than women. The frequency of the disease — about 1-2 patients in 2500 of the population annually.
In children and elderly, this pathology is less common.
The development of the disease
The term "cardiomyopathy" is used to describe primary disorders in the myocardium, the etiology of which is unclear. Patients with dilated cardiomyopathy, up to 60% of these patients.
Early detection of dysfunction is difficult because at the initial stage it is completely kompensiruet body. The disease begins with reducing the number of active myofibrils — the cell structures that reduce the heart muscle. At the same time reduces energy metabolism in the cells. All this impairs the pumping of blood.
The expansion of the cavities of the heart, as well as progressive tachycardia at first, retain a desired level of cardiac output. Within the boundaries of the norms held indicators such as stroke volume (the volume of blood pushed during one systole) and ejection fraction (amount of blood ejected by the ventricle into the aorta).
However, DCM progresses, and eventually develop these complications:
- The expansion of the ventricular myocardium.
- Dysfunction of the heart valves.
- Stagnation of blood in the circulatory system.
- Reducing the amount of blood ejected during systole into the aorta.
- The formation of chronic heart failure (CHF).
- Oxygen starvation of the muscle tissue.
Against the background of deterioration of blood supply of the body begins to manifest pathologically active neurohormonal systems.
Elevated levels of hormones negatively affect the composition of the blood and condition of the myocardium.
Stagnation of blood and the violation of its clotting lead to mural thrombi in the cavities of the heart. The bloodstream, they are carried through the major arteries and can clogthem.
Without treatment, the contractility of the heart weakens more and more. In conditions of insufficient blood supply comes degeneration of internal organs and tissues, emaciation and death.
Reasons. Risk factors
The disease are divided into two types:
- Primary or idiopathic dilated cardiomyopathy.
- Secondary DCM.
The concept of primary forms applicable to those cases where the nature of the pathological process is unknown. So far there are no clear criteria for the diagnosis of anomalies of this kind, but the doctors think that the trigger of the disease are:
- Genetic predisposition. Man transferred to innate features of the structure of the heart muscle, making it vulnerable to defeat.
- Autoimmune disorders — scleroderma, reactive arthritis, glomerulonephritis, systemic vasculitis, causing autoimmune myocarditis (acute inflammation of the heart).
The secondary form occurs as a result of pathologies affecting the work of the myocardium:
- Coronary heart disease.
- Valvular disease of the heart.
- Viral infections (herpes, hepatitis, cytomegalovirus, influenza, Coxsackie virus B).
- Cocaine intoxication, abuse of alcohol and tobacco, treatment with anticancer agents.
- Hormonal disorders, diet, starvation, lack in the diet of b vitamins, selenium, carnitine.
- Endocrine diseases — diabetes mellitus, adrenal disease, pituitary gland, thyroid gland.
- The long strain at the limit of physical and mental forces of man.
A significant role in causing the disease plays a bad heredity. According to statistics, one third of patients had relatives suffering from DCM. Familial forms of the disease have the worst prognosis.
For example, the expansion of the chambers of the heart often develops in patients with Barth syndrome (a genetic abnormality), which is accompanied by a number of cardiac pathologies.
DCM for a long time can does not occur, although the echocardiogram to notice signs of enlargement of the heart chambers. The first clear symptoms of dilated cardiomyopathy are usually associated with slower circulation and a fall in cardiac output to 45% (normal 50-60%). Degradation accompany the following symptoms:
- Shortness of breath, initially during exercise and then at rest, worse lying down (orthopnea).
- Attacks of breathlessness (cardiac asthma or pulmonary edema), when the disease started. Accompanied by a persistent cough with sputum, in which visible streaks of blood. The patient turning blue nails, lips, tip of the nose. The attacks usually happen at night.
- Heaviness in the legs, muscle weakness, fatigue.
- Swelling of the limbs, increasing by the end of the day and passing by the morning.
- Dull pain in region of liver, with dropsy of the abdominal cavity (symptoms of right heart failure).
- The attacks of tachycardia (tachycardia), "sinking" of the heart, fainting, dizziness.
- Renal dysfunction (too frequent or infrequent urination, change in amount of urine).
- Violations on the part of the brain — memory problems, insomnia, unexplained mood swings.
- Thromboembolism. The risk of detachment of a clot is increased if the disease is accompanied by atrial fibrillation.
- Cardialgia (pain in the breast atypical localization).
In severe DCMP patient half-sitting, half asleep, to make it easier to breathe. The stomach has increased due to the accumulation of fluid in the lungs audible gurgling rales. Face, feet and hands swollen, the slightest movement increases the shortness of breath.
The prognosis of dilated cardiomyopathy in the late stages of adverse. The reason for the death of the patient becomes detachment of a clot or progressive heart failure.
Diagnosis is difficult because clear criteria for defining disease is still not developed. Cardiologists usually work by exclusion. If the patient has no other identified cardiac pathology with similar symptoms, it is suspected dilated cardiomyopathy.
In DCM indicates a number of typical signs: tachycardia, cardiomegaly, valve insufficiency, rales in the lungs, protruding the liver, the swollen veins on the neck.
After collection of primary information and a detailed examination by a cardiologist assigns laboratory tests:
- General clinical analysis of blood and urine. The findings will show the changes characteristic of the disease: protein in urine, low hemoglobin, changes in the structure of blood.
- Biochemical blood tests to assess kidney and liver. Determine the level of uric acid, cholesterol, bilirubin, liver enzymes.
- Detailed coagulation. Is carried out for the detection of thrombi and evaluation of blood clotting.
- Immunological blood test detect autoimmune disorders, and antibody.
Such studies indicate the degree of stretching of the cavities, the size and condition of the cardiac muscle, eliminate or confirm the presence of tumors and congenital anomalies.
Electrocardiography and Holter monitoring help identify ventricular hypertrophy, arrhythmias, atrialarrhythmia.
Echocardiography shows the size of the ventricular chambers, the signs of stagnation of blood, the thickness of the myocardium.
Radiography is usually prescribed to patients with high body weight, if other methods prove uninformative. On the radiograph are distinguishable enlarged heart spherical.
Analysis of heart murmurs (phonocardiogram) shows the existing valve insufficiency, which can stop the reverse flow of blood through the ventricular stretched hole.
For a more accurate diagnosis are used for invasive (penetrating) examination methods:
- Coronary angiography. In the bloodstream and in the cavity of the heart introduces the contrast to get a clear image of an organ and to detect congestion in the bloodstream.
- Biopsy of the myocardium. Used to evaluate the state of muscle tissue. For the analysis is taken a microscopic fragment of the cardiac muscle together with the endocardium. The more damaged fibers, the worse the prognosis.
- Radionuclide ventriculography. In the patient's blood is injected radioactive drug. The images reveal a pronounced dilatation of the chambers and reduced contractile ability of the body, as well as show the thickness of the heart walls.
- Angiography of blood vascular. The bloodstream injection of contrast medium to assess the condition of vascular and the presence of blood clots.
The results of the examination, the doctor may refer the patient to the inspection of other specialists.
Treatment of the disease
Treatment of dilated cardiomyopathy is symptomatic. Main therapeutic areas:
- Treatment of major pathologies.
- Elimination of hazardous factors.
- Relief of arrhythmia.
- Prevention of thromboembolism.
The first thing the doctor will offer the patient with DCMP to change your lifestyle and introduce some limitations:
- The rejection of alcohol, Smoking.
- Weight loss, control of blood pressure. This will prevent the development of new damage to the heart muscle.
- Fluid restriction up to 5-7 cups a day, salt up to 3 g, especially in edema. Daily weighing in order to detect the disturbance of the water balance.
- Maintaining moderate physical activity.
- Exception antiarrhythmic and non-steroidal anti-inflammatory drugs.
- Anticoagulation (if there is a threat of thromboembolism, or identified atrial fibrillation).
The patient should immediately tune in to lifetime medication.
The drugs aimed at the prevention of complications. The development of CHF suspend the following medications:
- ACE inhibitors (enalapril, Perindopril, Ramipril). They are appointed at any stage of the disease.Drugs prevent tissue necrosis, inhibit the activity of neurohormonal systems, reduce the hypertrophy of muscle tissue.
- In-blockers (Atenolol, Metoprolol). In the first days of taking the pills the patient's condition may deteriorate, but further positive effect increases. Stabiliziruemost pressure, less swelling, reduced heart rate.
- Diuretics (diuretics). Assigned to all patients with DCMP. Drugs removed from cells excess water and salts.
- Cardiac glycosides (Strofantin, Digoxin) — medicines of plant origin. Prescribed for arrhythmia and insufficient contractile activity of the ventricles.
In the treatment of thromboembolism used antiplatelet agents, anticoagulants, thrombolytics.
Indications for surgical intervention are determined strictly individually, because the operation on the torn heart can lead to death.
The most effective way of relief recognized by the DCM heart transplantation. The survival rate of patients is high enough: after 10 years still alive and 72% were successfully operated. However, this method of mass distribution does not. Reasons — high cost of operation and shortage of donor material.
Cardiac surgery today provides the following methods:
- Implantation of a pacemaker.
- Implantation of an extracardiac net framework, contributing to gradual reduction of extended cavities.
- Partial ventriculectomy (extended remodeling of the left ventricle).
- Prosthetic heart valves that have lost their function.
- Implantation of mechanical pumps to the apex of the left ventricle, helping to pump blood into the aorta.
In children cardiomyopathy is a congenital or occurs as a result of birth injury, severe asphyxia, acute viral infections. Treated the same as adults.
The use of national resources at DCM ineffective. You can support the body with infusions of calendula, rose, motherwort, but dilatation of the ventricles do not stop this. Prognosis is poor: in the first five years killed half of cases.
High risk of sudden death from embolism, or arrhythmia. All blood relatives of the patient DCM should be screened, to the detection of pathology to start early treatment.