Heart aneurism – thinning and a vybukhaniye of the site of a myocardium of the heart camera. Aneurism of heart can be shown by short wind, heartbeat, , attacks of cardiac asthma, heavy violations of a warm rhythm, tromboembolichesky complications. As the main methods of diagnosis of aneurism of heart serve the ECG, EhoKG, a chest X-ray, a ventrikulografiya, KT, MPT. Treatment of aneurism of heart provides excision of an anevrizmatichesky bag with an ushivaniye of defect of a cardiac muscle.
Heart aneurism – the limited protrusion of the thinned myocardium wall which is followed by sharp decrease or total disappearance of sokratitelny ability of pathologically changed site of a myocardium. In cardiology of an aneurysm of heart comes to light at 10-35% of the patients who had a myocardial infarction; 68% of sharp or chronic aneurisms of heart are diagnosed for men aged from 40 up to 70 years. Most often aneurism of heart is formed in a wall of the left ventricle, is more rare – in the field of an interventricular partition or the right ventricle. The size of aneurism of heart fluctuates from 1 to 18-20 cm in the diameter. Violation of sokratitelny ability of a myocardium in the field of aneurism of heart includes (lack of sokratitelny activity) and dyskinesia (vybukhany walls of aneurism in a systole and its zapadeniye — in a diastola).
Heart aneurism reasons
In 95-97% of cases as the reason of aneurism of heart serves the extensive transmuralny myocardial infarction, mainly left ventricle. The vast majority of aneurisms is localized in the field of a front sidewall and a top of the left ventricle of heart; about 1% - in the field of the right auricle and a ventricle, an interventricular partition and a back wall of the left ventricle.
The massive myocardial infarction causes destruction of structures of a muscular wall of heart. Under the influence of force of intracardial pressure the nekrotizirovanny wall of heart stretches and becomes thinner. The essential role in formation of aneurism belongs to the factors promoting increase in load of heart and intra ventricular pressure – to an early rising, arterial hypertension, tachycardia, repeated heart attacks, the progressing heart failure. Development of chronic aneurism of heart of an etiologicheska also pathogenetic is connected with a postinfarkty cardiosclerosis. In this case under the influence of pressure of blood there is a protrusion of a wall of heart in the field of a soyedinitelnotkanny hem.
Much less than postinfarction aneurisms of heart, meet congenital, traumatic and infectious aneurisms. Traumatic aneurisms arise owing to the closed or open injuries of heart. It is possible to carry the postoperative aneurisms which are often arising after operations on correction of congenital heart diseases to the same group (Fallo's tetrad, a stenosis of a pulmonary trunk, etc.)
Classification of aneurisms of heart
On time of emergence distinguish sharp, subsharp and chronic aneurism of heart. Sharp aneurism of heart is formed during the period from 1 to 2 weeks from a myocardial infarction, subsharp – within 3-8 weeks, chronic – over 8 weeks.
In the sharp period the wall of aneurism is presented by the nekrotizirovanny site of a myocardium which under the influence of intra ventricular pressure vybukhat knaruzh or in a ventricle cavity (at localization of aneurism in the field of an interventricular partition).
The wall of subsharp aneurism of heart is formed thickened endokardy with a congestion of fibroblast and gistiotsit, again formed retikulyarny, collagenic and elastichesky fibers; on the place of the destroyed miokardialny fibers connecting elements of various degree of a maturity are found.
Chronic aneurism of heart represents the fibrous bag which is microscopically consisting of three layers: endokardialny, intramuralny and epikardialny. In an endokarda of a wall of chronic aneurism of heart there are growths of fibrous and gialinizirovanny fabric. The wall of chronic aneurism of heart is thinned, sometimes its thickness does not exceed 2 mm. In a cavity of chronic aneurism of heart pristenochny blood clot of various size which can cover only an internal surface of an anevrizmatichesky bag often is found or occupy almost all its volume. Friable pristenochny blood clots easily are exposed to fragmentation and are a potential source of risk of tromboembolichesky complications.
Aneurisms of heart of three types meet: muscular, fibrous and fibrous and muscular. Usually aneurism of heart is single though 2-3 aneurisms at the same time can be found. Aneurisms of heart can be true (are presented by three layers), false (are formed as a result of a rupture of a wall of a myocardium and are limited to pericardiac unions) and functional (are formed by the site of a viable myocardium with a low sokratimost, vybukhayushchy in a systole of ventricles).
Taking into account depth and extensiveness of defeat true aneurism of heart can be flat (diffusion), meshkovidny, fungoid and in the form of "aneurism in aneurism". At diffusion aneurism the contour of external protrusion flat, flat, and from a cavity of heart is defined deepening in the form of a bowl. Meshkovidny aneurism of heart has a roundish convex wall and the wide basis. Fungoid aneurism is characterized by existence of big protrusion with rather narrow neck. The concept "aneurism in aneurism" designates the defect consisting of several protrusions concluded one in another: such aneurisms of heart have sharply thinned walls and are most inclined to a gap. At inspection diffusion aneurisms of heart come to light more often, is more rare - meshkovidny and are even more rare - fungoid and "aneurisms in aneurism".
Heart aneurism symptoms
Clinical displays of sharp aneurism of heart are characterized by weakness, short wind with episodes of cardiac asthma and hypostasis of lungs, the long fever raised by perspiration, tachycardia, violations of a warm rhythm (bradycardia and tachycardia, premature ventricular contraction, fibrillation of auricles and ventricles, blockade). At subsharp aneurism of heart symptoms of insufficiency of blood circulation quickly progress.
To clinic of chronic aneurism of heart there correspond pronounced symptoms of heart failure: short wind, sinkopalny states, stenocardia of rest and tension, feeling of interruptions in work of heart; in a late stage – swelling of veins of a neck, hypostases, , a gepatomegaliya, ascites. At chronic aneurism of heart fibrous can develop perikardit, causing development of adhesive process in a chest cavity.
The Tromboembolichesky syndrome at chronic aneurism of heart is presented by sharp occlusion of vessels of extremities (more often than podvzdoshny and femoral and popliteal segments), a plechegolovny trunk, arteries of a brain, kidneys, lungs, intestines. Extremity gangrene, a stroke, a heart attack of a kidney, TELA, occlusion of mezenterialny vessels, a repeated myocardial infarction can become potentially dangerous complications of chronic aneurism of heart.
The rupture of chronic aneurism of heart occurs rather seldom. The rupture of sharp aneurism of heart usually happens for 2-9 day after a myocardial infarction and is fatal. Clinically the rupture of aneurism of heart is shown by the sudden beginning: sharp pallor which quickly is replaced by a tsianotichnost of integuments, cold then, overflow of veins of a neck blood (the certificate of a tamponada of heart), consciousness loss, a cold snap of extremities. Breath becomes noisy, hoarse, superficial, rare. Usually death comes instantly.
Diagnosis of aneurism of heart
Patognomonichny symptom of aneurism of heart is the pathological prekordialny pulsation found on a lobby of a wall of a thorax and amplifying at each warm reduction.
On the ECG at aneurism of heart symptoms of a transmuralny myocardial infarction which, however, do not change stadiyno are registered, and keep the "stiffened" character throughout a long time. allows to visualize an aneurism cavity, to measure its sizes, to estimate a configuration and to diagnose ventricle cavity thrombosis. With the help stress-EhoKG and PET of heart comes to light viability of a myocardium in a zone of chronic aneurism of heart.
The X-ray analysis of bodies of a thorax finds a kardiomegaliya, the stagnation phenomena in a small circle of blood circulation. The X-ray contrast ventrikulografiya, MRT and MSKT of heart are highly specific methods of topichesky diagnosis of aneurism, determination of its sizes, detection of thrombosis of her cavity.
According to indications sick with aneurism of heart sounding of cavities of heart, coronary angiography, EFI is carried out. Aneurism of heart needs to be differentiated from a tselomichesky cyst of a pericardium, mitralny heart disease, sredosteniye tumors.
Treatment of aneurism of heart
In the preoperative period the patient with aneurism of heart appoints warm glycosides, anticoagulants (heparin hypodermically), hypotensive means, a kislorodoterapiya, an oksigenobaroterapiya. Surgical treatment of sharp and subsharp aneurism of heart is shown in connection with bystry progressing of heart failure and threat of a rupture of an anevrizmatichesky bag. At chronic aneurism of heart operation is made for prevention of risk of tromboembolichesky complications and for the purpose of a myocardium revaskulyarization.
As palliative intervention resort to strengthening of a wall of aneurism by means of polymeric materials. To radical operations the resection of aneurism of a ventricle or an auricle (if necessary – treat with the subsequent reconstruction of a wall of a myocardium a patch), a septoplastika on Sacks (at aneurism of an interventricular partition).
At false or post-traumatic aneurism of heart the ushivaniye of a warm wall is made. In need of additional revaskulyariziruyushchy intervention in one stage carry out an aneurism resection in combination with AKSh. After a resection and plasticity of aneurism of heart development of a syndrome of small emission, a repeated myocardial infarction, arrhythmias (paroksizmalny tachycardia, vibrating arrhythmia), insolvency of seams and bleeding, respiratory insufficiency, a renal failure, a thrombembolia of vessels of a brain is possible.
Forecast and prevention of aneurism of heart
Without surgical treatment course of aneurism of heart adverse: most of patients with postinfarction aneurisms perish within 2-3 years after development of a disease. It is rather good-quality uncomplicated flat chronic aneurisms of heart proceed; the meshkovidny and fungoid aneurisms which are often complicated by intracardial thrombosis have the worst forecast. Accession of heart failure is an adverse predictive sign.
Prevention of aneurism of heart and its complications consists in timely diagnosis of a myocardial infarction, adequate treatment and rehabilitation of patients, gradual expansion of the motive mode, control of violation of a rhythm and a tromboobrazovaniye.