Miokardiodistrofiya – the secondary damage of a myocardium caused by metabolic violations and leading to dystrophy and dysfunction of a cardiac muscle. Miokardiodistrofiya is followed by a kardialgiya, interruptions of a warm rhythm, moderate tachycardia, bystry fatigue, dizziness, short wind. Diagnostics of a miokardiodistrofiya is based on data of the anamnesis and clinic, an electrocardiography, phonocardiography, X-ray analysis, echocardiography, MRT, stsintigrafiya, biochemical blood test, etc. Treatment of a miokardiodistrofiya assumes performing pathogenetic therapy of a kardiotrofikama and symptomatic therapy by antiarrhytmic, antigipertenzivny medicines, warm glycosides etc.
The term "miokardiodistrofiya" (secondary cardiomyopathy, myocardium dystrophy) in cardiology unite group of the not inflammatory and not degenerate damages of a myocardium which are followed by the expressed disorder of exchange processes and considerable decrease in sokratitelny ability of a cardiac muscle. Miokardiodistrofiya is always the secondary process including dismetabolichesky, electrolytic, fermental, neurohumoral and vegetative violations. Miokardiodistrofiya is characterized by dystrophy of miotsit and structures of the carrying-out system of heart that leads to violation of the main functions of a cardiac muscle – a sokratimost, excitability, automatism, conductivity.
Miokardiodistrofiya, especially at the initial stages, has, as a rule, reversible character that distinguishes her from the degenerate changes of a myocardium arising at hemochromatosis and an amiloidoza of heart.
Can lead the most various external and internal factors breaking course of a metabolism and energy in a myocardium to a miokardiodistrofiya. Miokardiodistrofiya can develop under the influence of sharp and chronic exogenous intoxications (alcoholic, medicinal, industrial, etc.), physical agents (radiation, vibration, overheating). Quite often the miokardiodistrofiya accompanies the course of endocrine and exchange violations (a thyrotoxicosis, a hypothyroidism, a giperparatireoz, diabetes, obesity, avitaminosis, Cushing's syndrome, a pathological climax), system diseases (kollagenoz, neuromuscular dystrophy), infections (chronic tonsillitis, etc.), diseases of a gastrointestinal tract (cirrhosis, pancreatitis, a malabsorption syndrome).
The miokardiodistrofiya reasons newborns and children of early age can have a perinatal encephalopathy, pre-natal infections, a syndrome of disadaptation of cardiovascular system against the background of a hypoxia. At athletes the miokardiodistrofiya can result from an excessive physical overstrain (pathological sports heart).
Various adverse factors cause disorder of electrolytic, proteinaceous, power exchange in kardiomiotsita, accumulation of pathological metabolites. Changes of biochemical processes in a myocardium lead to violation of sokratitelny function of muscle fibers, various violations of a rhythm and conductivity, heart failure. At elimination of an etiologichesky factor trophic processes in miotsita can be restored completely. However at a long adverse effect there is a death of a part of kardiomiotsit and their replacement with connecting fabric – the cardiosclerosis is formed.
Clinical forms of a miokardiodistrofiya
Miokardiodistrofiya at anemias
Violations in a myocardium develop at reduction of hemoglobin to 90-80 g/l. On this background the gemichesky hypoxia which is followed by power deficiency in a myocardium develops. The Anemichesky miokardiodistrofiya can arise at iron deficiency and hemolytic anemia, at sharp and chronic blood loss, the DVS-syndrome.
As clinical manifestations of a miokardiodistrofiya at anemia serve pallor of integuments, dizziness, short wind, tachycardia, strengthening of a pulsation of carotids. The Perkutorny research reveals the expansion of borders of heart testifying to a myocardium hypertrophy. Auskultativno loud tones of heart, systolic noise over heart and vessels, "noise of a top" on cervical vessels are found. Heart failure develops at long anemia and inadequate treatment.
Miokardiodistrofiya at a thyrotoxicosis
Under the influence of excess amount of tireoidny hormones in a cardiac muscle synthesis of adenosine triphosphoric acid (ATP) and a kreatinfosfat (KF) decreases that is followed by power, and then and proteinaceous deficiency. At the same time, tireoidny hormones stimulate activity of sympathetic nervous system, causing increase in ChSS, minute volume of blood, speed of a blood-groove, OTsK. In such conditions change of intracardial haemo dynamics cannot be supported energetically that as a result leads to development of a miokardiodistrofiya.
In clinic of a miokardiodistrofiya at a thyrotoxicosis arrhythmias (sinusovy tachycardia, premature ventricular contraction, paroksizmalny tachycardia, vibrating arrhythmia) prevail. The long thyrotoxicosis causes chronic insufficiency of blood circulation, mainly on right ventricular type which is shown by pains in heart, hypostases, a gepatomegaliya. Sometimes at a thyrotoxicosis miokardiodistrofiya symptoms in this connection patients address, first of all, the cardiologist, and already dominate then get to the endocrinologist.
Miokardiodistrofiya at a hypothyroidism
The deficiency of tireoidny hormones leading to decrease of the activity of metabolism in a myocardium forms a pathogenetic basis of a miokardiodistrofiya at a hypothyroidism. At the same time increase in permeability of vessels is resulted by a liquid delay in miotsita that is followed by development of dismetabolichesky and electrolytic violations (increase in content of sodium and reduction of potassium).
Alcoholic and toxic miokardiodistrofiya
It is considered that daily reception of 80-100 ml of ethyl alcohol for 10 years leads to an alcoholic miokardiodistrofiya. However at hereditary deficiency of a number of the enzymes splitting ethanol stresses, frequent viral infections the miokardiodistrofiya can develop also in shorter terms – for 2-3 years even at the use of smaller amounts of alcohol. The alcoholic miokardiodistrofiya occurs mainly at men of 20 — 50 years.
The toxic miokardiodistrofiya occurs at the persons receiving long therapy by immunodepressants (cytostatics, glucocorticosteroids), NPVP, some antibiotics, tranquilizers and also at poisonings with chloroform, phosphorus, arsenic, carbon monoxide etc. Such options of a miokardiodistrofiya can proceed in kardialgichesky (painful), sharp arhythmic, combined and stagnant forms.
The Kardialgichesky form of a miokardiodistrofiya is characterized by the pressing or aching thorax pains, passing feeling of heat or a chill of extremities, perspiration. Patients are disturbed by the general weakness, bystry fatigue, decrease in physical endurance, headaches.
The arhythmic form of a miokardiodistrofiya is followed by tachycardia, violations of a rhythm and conductivity of heart (sinusovy takhi-or bradycardia, premature ventricular contraction, blockade of legs of a bunch of Gis), sometimes - attacks of fibrillation and trembling of auricles. At the combined form of a miokardiodistrofiya arrhythmias and kardialgiya are noted. Manifestations of a stagnant miokardiodistrofiya are caused by heart failure and include short wind at a tension, cough, attacks of cardiac asthma, hypostases standing, a hydropericardium, , a gepatomegaliya, ascites.
Damages of a myocardium at tonsillitis arise at 30 — 60% of patients. The Tonzillogenny miokardiodistrofiya usually develops after a series of the postponed quinsies proceeding with high fever and intoxication. In clinic of a tonzillogenny miokardiodistrofiya complaints to pains in heart of intensive character, the expressed weakness, spasmodic pulse, short wind, focal or diffusion perspiration prevail, subfebrilitt, artralgiya.
Miokardiodistrofiya of a physical overstrain
Develops at the athletes who are carrying out physical activities which exceed their individual opportunities. In this case damage of a myocardium can be promoted by the hidden chronic centers of an infection in an organism - sinusitis, tonsillitis, adneksit and so forth; lack of good rest between trainings etc. Concerning pathogenesis of a miokardiodistrofiya of physical tension it is put forward a number of theories: hypoxemic, neurodystrophic, steroid and electrolytic.
This option of a miokardiodistrofiya is generally shown by symptoms of the general character: weakness, slackness, bystry fatigue, oppressed mood, decrease in interest in sport. There can be heartbeat, a pricking in heart, interruptions.
Develops owing to disgormonalny processes at women at the age of 45 – 50 years. The climacteric miokardiodistrofiya is shown by the pains in the heart pressing, pricking or the aching character irradiating in the left hand. Kardialgiya amplify in connection with "inflows", are followed by feeling of heat, tachycardia, the increased perspiration. Heart failure at a climacteric miokardiodistrofiya can develop at the available accompanying arterial hypertension.
Diagnostics of a miokardiodistrofiya
At patients with a miokardiodistrofiya in the anamnesis diseases or pathological states which are followed by a fabric hypoxemic syndrome and violation of metabolic processes usually come to light. The objective research of heart finds irregular pulse, muting of warm tones, easing of the I tone on a top, systolic noise.
At an electrocardiography various arrhythmias, violations of processes of repolarization of a myocardium, decrease in sokratitelny function of a myocardium are registered. Conducting load and pharmacological tests at a miokardiodistrofiya, as a rule, yields negative results. The phonocardiography finds changes of a ratio of duration of an electric and mechanical systole, emergence of a galopny rhythm and systolic noise on the basis and a top, muting of tones of heart. By means of an echocardiography expansion of cameras of heart, change of structure of a myocardium, absence of organic pathology is defined.
The miopatichesky configuration of heart revealed at a thorax X-ray analysis, demonstrates deep damage of a myocardium. Stsintigrafiya allows to estimate metabolism and perfusion of a myocardium, to reveal focal and diffusion defects of accumulation as, the numbers of the functioning kardiomiotsit indicating decrease.
Resort to a biopsy of a cardiac muscle in doubtful cases, at not informational content of noninvasive researches. The differential diagnosis of a miokardiodistrofiya is carried out with IBS, myocardites, an atherosclerotic cardiosclerosis, pulmonary heart, heart diseases.
Treatment of a miokardiodistrofiya
Complex therapy of a miokardiodistrofiya consists of treatment of the main disease, pathogenetic (metabolic) and symptomatic therapy. In this regard medical tactics at a miokardiodistrofiya is defined not only by the cardiologist, but also narrow experts – the hematologist, the otolaryngologist, the endocrinologist, the rheumatologist, the gynecologist-endocrinologist, the sports doctor. The sparing physical mode, an exception of harmful professional effects, contact with chemicals, alcohol intake and smoking is recommended to patients.
Metabolic therapy of a miokardiodistrofiya assumes purpose of vitamins of group B, the cocarboxylase, ATP, medicines of potassium and magnesium, inosine, anabolic steroids and other medicines improving metabolic processes and food of a cardiac muscle.
At heart failure diuretics, warm glycosides are shown; at arrhythmias – antiarhythmic means. At a climacteric miokardiodistrofiya ZGT, sedative and hypotensive medicines is appointed. Etiotropny therapy of a tonzillogenny miokardiodistrofiya demands intensive treatment of tonsillitis up to a tonzillektomiya.
Forecast and prevention of a miokardiodistrofiya
Reversibility of changes of a myocardium at a miokardiodistrofiya depends on timeliness and adequacy of treatment of the main disease. An outcome it is long the proceeding miokardiodistrofiya also heart failure serves .
The prevention of a miokardiodistrofiya is based on elimination of the current diseases, the accounting of age and physical training at sports activities, refusal of alcohol, an exception of professional vrednost, good nutrition, obligatory sanitation of the centers of an infection. Repeated medicamentous courses of kardiotrofny therapy 2–3 times a year are recommended.