Holetsistokardialny syndrome – the simptomokompleks which is characterized by change of normal warm activity against the background of dysfunction of a gall bladder or biliary tract. The disease is shown by a kardialgiya, arrhythmia and violation of conductivity of heart which arise at peak of bilious (hepatic) colic or an exacerbation of cholecystitis. Diagnostics is based on data of fizikalny survey, ultrasonography of heart, gall bladder and channels, the ECG, blood test. The basis of conservative therapy is made by dietary food, purpose of spazmolitichesky and bile-expelling medicines. Expeditious treatment assumes carrying out a laparoscopic or open holetsistektomiya.
Holetsistokardialny syndrome (holetsistitny heart, a holetsistokoronarny syndrome, bilious a syndrome) - set of the metabolic and functional violations of activity of a myocardium resulting from negative impact on a cardiac muscle of pathological processes in biliarny system. Prevalence of a disease at chronic beskamenny cholecystitis makes 25–57%, at cholelithiasis - 15%. Variability of statistics is connected with difficulty in recognition and performing differential diagnosis of pathology. The disease occurs at women by 3 times more often than at men. Average age of patients makes 35-55 years.
Reasons of a holetsistokardialny syndrome
The disease develops against the background of pathological processes in a gall bladder and biliary tract: sharp and chronic beskamenny or kalkulezny cholecystitis, a stenosis of final department of a holedokh as a result of a stenoziruyushchy papillit, new growths of a faterov of a nipple, etc. the Holetsistokardialny syndrome occurs at the persons having in the anamnesis coronary heart disease, chronic heart failure, arrhythmias, a hypertension. Bilious colic or the attack of cholecystitis which is followed by intensive pain can serve as the catalyst of development of a syndrome.
Pathogenetic aspects of a holetsistokardialny syndrome are a dispute subject among scientists of the whole world. In modern gastroenterology there are several interconnected and equivalent theories of development of a disease:
- Reflex. According to this theory, inflammatory diseases of zhelchevydelitelny system exert pathological impact on the autonomic nervous system (parasympathetic, sympathetic), causing reflex violation of a rhythm, a spasm of arteries of heart other.
- Metabolic. As a result of frequent exacerbations of cholecystitis and cholelithiasis the metabolism is broken (electrolytes, carbohydrates, lipids, proteins, etc.). Change of exchange processes is led to oppression of metabolic reactions in a myocardium.
- Infectious and toxic. The bacterial toxins which are emitted at an exacerbation of pathology of biliarny system (a holangit, cholecystitis, ZhKB) possess kardiotropny action. In the conditions of violation of a homeostasis and the expressed intoxication dystrophic changes of a myocardium of toxic genesis develop.
Symptoms of a holetsistokardialny syndrome
Most often clinical manifestations arise after alcohol intake, errors in food, strong psychoemotional pressure. The symptomatology of a disease has different degree of expressiveness. Most often the syndrome demonstrates the acute pristupoobrazny, squeezing or pricking pain in heart, irradiirushchy in the left podreberye, a shovel, a shoulder. Painful feelings arise at the height of an exacerbation of cholecystitis or cholelithiasis. The aching, squeezing pains to the left of a breast can be the only display of pathology of zhelchevydelitelny system.
There is a bezbolevy shape of holetsistitny heart at which the main symptom is violation of a warm rhythm (fibrillation of auricles, premature ventricular contraction, AV-blockade). Arrhythmia at a holetsistokardialny syndrome is connected with the beginning of bilious colic and will practically not respond to treatment antiarrhytmic medicines. The disease is often combined with tachycardia, increase HELL, short wind. From biliarny system the expressed pains in the right podreberye, violation of a chair, nausea, vomiting with bile, temperature increase of a body are noted. At obstruction by a concrement of a gleam of a biliarny channel yellowness of integuments and a skler joins the main symptoms.
Consequences of a holetsistokardialny syndrome are connected with complications of the diseases which caused this pathology. The intensive attack of a kardialgiya can lead to development of cardiogenic shock, consciousness loss, a lethal outcome. Various violations of a rhythm in the absence of treatment against the background of the available pathology of heart cause fatal arrhythmias (fibrillation and trembling of ventricles) up to an asistoliya. The reflex spasm of coronal vessels can be complicated by development of a sharp coronary syndrome, and long ischemia of a cardiac muscle - a myocardial infarction. From bile-excreting system the perforation of a gall bladder a concrement with development of peritonitis and sepsis is possible. At accession of an infection there is an empiyema of a gall bladder.
Lack of patognomonichny signs, stertost of a clinical picture causes considerable difficulties at verification of the diagnosis. Search of an optimum algorithm of diagnostics is of interest to doctors of various specialties (therapists, gastroenterologists, surgeons, etc.). For establishment of the exact diagnosis appoint a complex research of cardiovascular and bile-excreting systems:
- Survey of the expert. Most often the patient sees a doctor of narrow specialization (the cardiologist, the gastroenterologist) depending on character of the prevailing symptoms. The expert finds out the anamnesis of life and a disease, carries out fizikalny survey, pays attention to communication between the beginning of an attack of kardialny pains or arrhythmias and an exacerbation of cholecystitis or bilious colic.
- Diagnostics of bile-excreting system. For a research of a biliarny path carry out ultrasonography of a gall bladder and biliary tract. In the presence of cholelithiasis carry out an endoscopic retrograde holangiopankreatografiya (ERHPG). In disputable and hard cases apply a magnetic and resonant holangiografiya.
- Research of cardiovascular system. For an exception of pathology of heart carry out the ECG on which premature ventricular contraction, violation of conductivity on legs of a bunch of Gis, atrioventricular blockade of various degree, inversion of a tooth of T can be found. In certain cases carry out daily holterovsky monitoring of the ECG. EHO-KG allows to exclude organic damages of heart (defects, a myocardial infarction, etc.)
- Blood test. At an exacerbation of cholecystitis in blood the quantity of leukocytes, bilirubin level increases, SOE accelerates. For an exception of a myocardial infarction determine the KFK, KFK-MV level, a troponin, LDG, LDG-1.
Differential diagnostics of a holetsistokardialny syndrome is carried out with pathology of cardiovascular system: coronary heart disease, arrhythmias of other genesis, myocardial infarction. At a bezbolevy form with prevalence of an astenonevrotichesky syndrome the disease should be distinguished from vegeto-vascular dystonia. In differential diagnostics the beginning of kardialny pains, their duration and communication with the advent of complaints from a gall bladder and biliarny channels is of great importance.
Treatment of a holetsistokardialny syndrome
Medical tactics depends on a condition of the patient, expressiveness of cardiological symptoms and a type of pathology of bile-excreting system. Now consider two main options of treatment of a disease:
- Conservative. It is shown at beskamenny cholecystitis with rare (1-2 times a year) aggravations, in the presence of concrements in a bubble no more than 10 mm in size with preservation of its function and passability of a puzyrny channel. Conservative therapy is applied at a serious somatic condition of the patient before improvement of health. The strict diet limiting consumption of greasy, fried food, alcoholic and carbonated drinks is shown to all patients. Appoint medicines of ursodezoksikholevy acid which influence concrements, gradually dissolving them. At the small sizes of stones carry out a noninvasive shock and wave lithotripsy.
- Quick. It is applied at inefficiency of conservative therapy, the big sizes of a concrement and the adverse course of cholecystitis. Surgical manipulations represent open or laparoscopic removal of a gall bladder. At the expressed decompensation of warm activity expeditious treatment is carried out in two stages. In the beginning carry out a one-stage decompression and sanitation of a gall bladder. Then, after knocking over of a pain syndrome and stabilization of a condition of the patient, carry out a holetsistektomiya.
Forecast and prevention
The forecast of a holetsistokardialny syndrome depends on expressiveness of cardiological manifestations and weight of diseases of a biliarny path. At timely knocking over of cardiac pathology, removal of an inflammation and carrying out operation the forecast favorable. The complications which developed as a result of diagnostic mistakes can bring to adverse, and sometimes and to a lethal outcome. Prevention of a disease consists in careful inspection of patients with pathology of bile-excreting system. The patient needs to keep to a diet and to accept the medicines appointed by the doctor, without allowing development of hepatic colic and the aggravations which are followed by an intensive pain syndrome.