What is left ventricular dysfunction? Echocardiography: left ventricular diastolic function Left ventricular systolic dysfunction

The likelihood that people with one or another “cardiac” diagnosis will show signs of left ventricular diastolic dysfunction is extremely high; for example, 50 to 90 percent of patients with arterial hypertension suffer from such a disorder.

At first glance, it may seem that malfunctions in a particular part of the myocardium, especially if they do not have pronounced symptoms, do not pose a health hazard. In fact, in the absence of proper treatment, left ventricular diastolic dysfunction can cause serious changes in blood pressure, provoke arrhythmia and other unpleasant consequences. In this regard, doctors strongly recommend that you pay close attention to the condition of the main muscle of the body and, if there is any hint of pathology, consult a specialist. This advice is especially relevant for those who have congenital or acquired heart disease.

Interesting! There is no consensus among medical scientists as to whether impaired left ventricular diastolic function occurs in all heart patients, but it is well established that older people and those suffering from CHF are at greatest risk. It is also known that as the condition worsens, this pathology progresses.

Distinctive features of the violation

In the non-specialized literature, left ventricular diastolic failure is often used as a synonym for diastolic heart failure, although these concepts are not identical. The fact is that in the presence of DHF, a decrease in the elasticity of the left part of the myocardium is always recorded, but often such a problem is only a harbinger of systolic failure.

It is not always the case that a person who has been diagnosed with a decrease in left ventricular diastolic function is ultimately diagnosed, since this also requires the presence of other characteristic features, as well as a slight decrease in ejection fraction. The decision to make a diagnosis is made by the doctor after a thorough examination of the performance of all parts of the myocardium, as well as based on the results of diagnostic procedures.

What causes decreased diastolic function?

There can be quite a lot of reasons why diastolic function is impaired, and in each person the pathology manifests itself differently and can be provoked by both internal disorders and external factors. Among the most common reasons:

• significant narrowing of the aortic lumen due to fusion of the valve leaflets ();
• cardiac ischemia;
• regular increase in blood pressure;
• overweight;
• elderly age.

However, left ventricular diastolic dysfunction also occurs in a number of other cases, for example, in the presence of serious myocardial damage (cardiomyopathy, endocardial disease, etc.), as well as systemic failures caused by amyloidosis, hemochromatosis, hypereosinophilic syndrome, etc. Rarely, however, pathology may develop with effusion constrictive pericarditis and glycogen storage disease.

Possible symptoms and manifestation of dysfunction

Internal and external manifestations of diastolic dysfunction depend on many factors, in particular on the condition of the heart muscle, or more precisely, the elasticity of the walls and the success of relaxation of the main muscle of the body.

If the diastolic function of the left ventricle is impaired for one reason or another, then the filling pressure increases to maintain the indicators of the produced blood volume, which is necessary for the normal functioning of the organs. As a result of the failure, shortness of breath usually occurs, which indicates the presence of congestion in the lungs.

Important! If you do not get rid of excessive pressure to the pulmonary bed, there is a danger that the dysfunction will subsequently develop into right-sided heart failure.

If the pathology is in a moderate phase, then the symptoms appear periodically, and the heart gradually returns to normal, but in severe cases, the rigidity reaches such a great value that the atria cannot compensate for the required volume. Based on the clinical picture and degree of damage, the following types of left ventricular diastolic dysfunction are distinguished:

• Type I - is mainly the result of age-related changes in the structure of the ventricles, manifested in a decrease in the fraction of blood pumping and a general decrease in blood volume with a simultaneous increase in systolic volume. The most serious complication is the development of venous stasis, although secondary pulmonary hypertension is also a danger;
• Type II (restrictive) - accompanied by a serious increase in rigidity, causing a significant pressure gradient between the chambers at the initial stage of diastole, which is accompanied by a change in the nature of the transmitral blood flow.

An integrated approach is the key to effective therapy

How quickly left ventricular diastolic dysfunction can be cured directly depends on the cause and correct diagnosis. Treatment of this pathology is aimed primarily at neutralizing provoking factors, as well as getting rid of the underlying disease of cardio-vascular system, for example, ischemic heart disease or hypertension.

Sometimes, in order to restore the myocardium, surgery to extract the damaged pericardium, although most often therapy is limited to taking medications, namely:

• ACE inhibitors, ARBs;
• beta blockers;
• diuretics;
• calcium channel blockers, etc.

In addition, to maintain normal condition " internal engine“Patients with impaired diastolic function are prescribed a diet with a limited amount of sodium, physical management is recommended (especially if they are overweight), and restrictions are set on the amount of fluid consumed.

In contact with

The human heart consists of several chords that prevent the valve from bending during contraction. Thanks to their presence, the organ can hold blood and push it through the vessels. In some people, in the first weeks of development, an additional chord of the left ventricle is formed. Most often it has a thread-like structure, but in some cases it is based on muscles and tendons. In 90% of cases, this abnormality is found in adolescents aged 13-16 years, but many people with this diagnosis live into old age without problems with the heart. Below we will analyze what it is and how this condition affects well-being.

Reasons for development

An additional chord in the left ventricle most often appears due to a genetic predisposition. It is transmitted in 95% of cases from mother to child. MARS develops in utero, and the catalyst for this process is a failure during formation connective tissue in the cavity of the left ventricle. For this reason, women who have been diagnosed with this need to have their children examined for the presence of this anomaly. Also, the reasons for the development of additional chords may be:

• poor environmental situation in the region;
• physical and nervous overstrain;
• reception alcoholic drinks and smoking.

Varieties of chords

An additional chord in the left ventricle of the heart can be of the following type:

• muscular, fibrous or fibromuscular;
• with longitudinal, transverse, diagonal connecting fibers;
• with single or multiple strands;
• median, basal or apical.

The most dangerous are the transverse chords. They can block blood flow and pose a danger to the human body. In other cases, these MARS are considered harmless and do not cause any burden on the heart.

Symptoms

The additional chord on the heart practically does not manifest itself until a certain age. With a certain structure, it may not appear even at a more mature age. It is believed that the first signs of LVDC can be detected during the active growth of the child, when the skeleton develops faster than the organs. The following symptoms may indicate the presence of MARS:

• fatigue quickly without any heavy load;
• dizziness;
• pain in the region of the heart;
• sudden change of mood;
• racing heartbeat.

A similar symptom complex is given not only by an additional chord in the cavity, but also by other multiple MARS. Therefore, all diagnostic work should be carried out by a doctor with extensive experience. After the active growth stage is completed, the signs of the accessory chord of the left ventricle disappear, but then appear in an adult. But a diagnosis is not made based on the symptoms listed above. The young patient will have to undergo various types of diagnostics.

If, after examination, a child is diagnosed with several extra chords in the heart, then the doctor should refer the patient for additional diagnostics. As you know, connective tissue in the human body is concentrated not only near the heart, but also in muscles and other organs. Therefore, clinical manifestations on their part may occur. If they can be detected, the child is diagnosed with connective tissue dysplasia. This disease is characterized by changes in the skeleton, muscle tissue, the structure of some organs.

Is this anomaly dangerous?

One additional chord in the heart is considered a slight deviation from the norm. Surgery with this type, MARS is not required, so parents and child must remain calm. If there are no disturbances in the blood flow, then surgical and drug treatment there will be no need for illness. As you grow older, it can lead to the development of blood clots and changes in heart rhythm, but it is impossible to predict the appearance of these pathologies.

Diagnostics

The diagnosis is made after an ultrasound of the heart. The patient is first listened to for the presence of systolic murmurs. To make sure that the anomaly is harmless to the child’s body, a classic and stress ECG may be prescribed. The doctor decides which specific diagnostic methods to use after examining the patient.

Treatment

If an additional chord with symptoms of hemodynamics is detected in a child or adult, it is recommended to limit physical activity. Patients are also recommended to take the following medications:

• l-carnitine, ubiquinone to restore metabolic processes in the heart muscle;
• piracetam to remove signs of neurocirculatory dysfunction;
• intravenously B6, B12 and nicotinic acid to improve the condition of the myocardium;
• magnesium and potassium to improve conductivity nerve impulses and prevent arrhythmia.

The development of atrial fibrillation and tachycardia may serve as indications for prompt hospitalization. But most often these diseases appear when there are several chords or one chord is transverse. Then doctors conduct a detailed analysis of the heart and determine a treatment method for the problem that has arisen. Most often, chords that interfere with blood flow are excised or removed with nitrogen.

If an additional chord is found in a child or adult as a result of a routine examination, but does not cause any discomfort, then medications are not taken. Such patients should normalize their daily routine and avoid overexertion and excessive relaxation. You will have to give up intense physical activity in favor of walking in the fresh air.

If a child is involved in a certain sport, then you should not sharply prohibit him from attending the section. You should discuss the possibility of classes with a doctor so that he can adequately assess the patient’s condition. There is no need to isolate a child from society, prohibit him from going out and playing with friends, because... this approach will make him feel inferior.

Prevention of complications

Considering that the disease is genetic in nature, it is impossible to prevent its occurrence. If an additional chord is detected in an adult or child, you must follow the specialist’s recommendations in this regard. To avoid complications, in older age you should monitor the amount of cholesterol consumed and your own weight. Excess body weight creates additional stress on the blood vessels, causing the heart to work harder.

Physical therapy classes are needed for children with an additional chord. They help strengthen the heart muscle, preventing the development of all kinds of pathologies. Most doctors do not advise people with excess chordae to participate in sports at a competitive level. Long swims, practical training at a flying club, and diving can harm people with this anomaly. But sprinting, yoga and bodyweight exercises will make your heart muscle stronger.

The left ventricle is the part of the heart that, when contracting, pumps blood into the aorta. This is the main chamber of the heart, providing blood flow throughout the body. Left ventricular hypertrophy is an increase in mass, thickening of its wall. Often, at the same time, an expansion of the cavity of the left ventricle occurs - its dilatation. Hypertrophy is both an anatomical and electrocardiographic term.
Anatomical hypertrophy of the left ventricle is manifested on the electrocardiogram (ECG) by a number of signs. Doctor functional diagnostics or the cardiologist takes into account the number and severity of such signs. There are several diagnostic criteria, more or less correctly identifying hypertrophy (from 60 to 90% probability). Therefore, not all people with signs of left ventricular hypertrophy on the ECG actually have it. Not all patients with anatomical hypertrophy show it on the ECG. Moreover, the same ECG can be described differently by different doctors if they use different diagnostic criteria in their work.

What diseases does this happen in?

• Left ventricular hypertrophy occurs in young people who are constantly involved in sports. Their heart muscle works intensely during training and naturally increases its mass and volume;
• occurs in diseases associated with difficulty in the exit of blood from the left ventricle into the aorta and with an increase in vascular resistance in the body;
• this ECG sign may be the first symptom of severe heart defects - aortic stenosis and aortic insufficiency. These diseases cause deformation of the valve separating the left ventricle and the aorta. The heart works under a heavy load, but the myocardium copes with it for a long time. A sick person does not feel any discomfort for a long time;
• Left ventricular hypertrophy occurs in a serious disease – hypertrophic cardiomyopathy. This disease is manifested by severe thickening of the walls of the heart. Thickened walls “block” the exit from the left ventricle, and the heart works under load. The disease does not appear immediately; shortness of breath and swelling gradually appear. In advanced cases, this disease may be an indication for heart transplantation.
• This is one of the manifestations of heart damage during arterial hypertension. It can develop even with moderate, but constant increase pressure. It is precisely to stop the progression of left ventricular hypertrophy that recommendations are aimed at constantly taking medications for hypertension, even with normal pressure.
• may appear in older people with severe atherosclerosis of the heart valves. This narrows the opening from the left ventricle into the aorta.

What could this lead to?

If a person has signs of left ventricular hypertrophy on an ECG, but it is not confirmed by echocardiography ( ultrasonography heart) – there is no reason to worry. This ECG feature is probably due to increased body weight or a hypersthenic constitution. The ECG phenomenon of left ventricular hypertrophy itself is not dangerous.

If hypertrophy on the ECG is accompanied by a real increase in muscle mass, in the future this can cause heart failure (shortness of breath, edema) and severe heart rhythm disturbances (ventricular extrasystole, ventricular tachycardia). Athletes should not forget about this when creating a training regimen.

What to do and how to treat

If a person's ECG shows left ventricular hypertrophy, he needs to undergo an ultrasound examination of the heart, or echocardiography (EchoCG). This method will help to accurately determine the cause of the increase in myocardial mass, as well as evaluate heart failure.
If it is not possible to conduct echocardiography, it is recommended to perform radiography of the heart in two projections, sometimes with contrasting of the esophagus.
To exclude heart rhythm disturbances, it is recommended to undergo daily ECG monitoring. To diagnose hypertension during the day, it is necessary to undergo 24-hour blood pressure monitoring.

Left ventricular hypertrophy is irreversible. However, treating the underlying condition helps prevent the condition from progressing. For example, angiotensin-converting enzyme inhibitors (enalapril, captopril and many others) widely used in the treatment of hypertension not only stop the development of hypertrophy, but also cause some regression.

Thus, when detected on ECG signs left ventricular hypertrophy, you should contact a physician or cardiologist for further examination.

You can use our ECG interpretation service →

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Why does a left ventricular aneurysm develop and how to treat it?

Aneurysm of the left ventricle of the heart is a pathology that develops after a myocardial infarction. Typically, the location of the disease is the area in the front or upper part of the heart. This happens due to the thinning of muscle tissue, it no longer has the ability to contract, which means that the process of their protrusion begins under high blood pressure. This pathological condition is a very serious consequence of a heart attack. As a result, the functioning of the hematopoietic system is disrupted. All this leads to the patient requiring surgical intervention by specialized specialists.

Reasons for development

When starting to talk about an aneurysm developing in the left ventricle, experts identify several causes.

The main one among them is rapid wear of the fabric. muscular type"heart" organ, others include the following:

• disruption of the functioning of all wall layers of tissue, the apex of the left ventricle at the time of a heart attack;
• the fact of increased pressure in the area located inside the ventricle;
• neglecting the recommendations of specialists on the organization of physical activity in a heart attack state, that is, exceeding it;
• failures in the process of regeneration of muscle tissue in the post-infarction state, as a result of which a scar appears;
• mechanical injuries;
• a severe form of one or another illness that has developed in the body due to infection;
• receiving a mechanical injury to the heart with a knife or other sharp, piercing, cutting objects;
• receiving a closed injury (usually occurs after a fall from a great height, a car accident);
• rheumatism;
• bacterial endocarditis;
• syphilis infection.

Forms of the disease and symptomatic manifestations

The main forms of the disease are determined by the period of its occurrence.

These include:

• acute - formed during the first two weeks after a heart attack;
• subacute - formed during the first month after a heart attack and is characterized by the formation of a scar with an irregular shape;
• chronic is a rather difficult form to diagnose; it is periodically confused with heart failure, which is acute in nature.

And there is also a division of aneurysm into types according to the form of its manifestations.

This division includes:

1. Mushroom-shaped.
2. Saccular.
3. Diffuse, in other words - flat.
4. Delaminating.

Only a timely examination can give a clear idea of ​​what kind of aneurysm the specialists had to deal with. In such cases, we can talk about prescribing adequate treatment, which the patient must strictly follow.

People who have experienced a left ventricular aneurysm know that this pathological condition is characterized by certain symptomatic manifestations.

These include:

• cardiac arrhythmia;
• painful sensations in the area located behind the sternum;
• shortness of breath, turning into severe attacks of suffocation (usually manifests itself at the time of increased physical exertion);
• the appearance of swelling of organ tissues;
• the occurrence of noise sounds arising in the upper part of the cardiac organ.

If these symptoms occur some time after discharge from the hospital, when the rehabilitation process after a heart attack ends, you should immediately consult a doctor. Otherwise, there may be a threat to the patient’s life, which does not manifest itself if contacted early dates development of a pathological condition.

Diagnosis of the disease and therapeutic measures

Conducted in a timely manner diagnostic procedures- the only correct way to prescribe adequate treatment in the event of an aneurysm. After diagnosis, the severity of the disease is determined, as well as the duration of treatment courses. When a muscle bulges, it is extremely important to clarify three aspects concerning it during the diagnostic examination.

These include:

• location;
• magnitude;
• kind of structural type.

Other research methods necessary for an aneurysm include:

1. Holding laboratory research genetic and urinary material, which makes it possible to identify concomitant diseases that may influence the course of development of the disease.
2. Taking an x-ray of the area chest, which allows you to exclude or detect chest edema in time.
3. Radioisotope ventriculography, which provides complete information not only about the location of the pathology, but also determines the residual contractility of cardiac tissue.
4. Magnetic resonance imaging, which is used in cases where surgical intervention is necessary, because only this procedure allows one to determine how dilated the arterial vascular passages are, as well as their exact location, size and location of the disease.
5. Ultrasound (ultrasound examination), which allows the specialist to clarify information about the bulging zones and places of thinning of the heart muscles.

Considering the fact that the pathological condition is accompanied by a cessation of the normal contraction function of the heart muscles, it can lead to acute heart failure if the doctor’s recommendations are not followed. This can cause rupture of the muscle walls, which - in turn - will cause the patient's immediate death.

• compliance with strict bed rest for a certain period;
• refusal of any physical activity;
• use medicines, helping to reduce blood pressure;
• use medical preparations, preventing the development of blood clots;
• application medications antiarrhythmic action.

However, such therapy does not fully help the patient.

Usually the pathology is eliminated through surgery using modern equipment. If experts offer just such a method of treatment, you should agree, remembering that an aneurysm leads to ruptures of heart tissue, which causes instant death.

Basic preventive measure To prevent the development of the disease, it is necessary to maintain a lifestyle that will not cause the development of a heart attack. This involves maintaining healthy lifestyle life: be sure to adhere to a balanced diet and moderate physical activity.

Few people know that the heart also needs proper rest for its productive work. If proper relaxation of the heart chambers, for example, the left ventricle, does not occur, diastolic dysfunction of the left ventricle develops, and this can lead to more serious disturbances in its functioning. But when does the heart rest, because its work occurs non-stop? What kind of pathology is left ventricular diastolic dysfunction, what are its symptoms? What is the danger? Can this heart disorder be treated? The answers to these questions will be presented in our article.

1 How does the heart rest?

The heart is a unique organ, if only because it works and rests at the same time. The thing is that the chambers of the heart, the atria and the ventricles, contract alternately. At the moment of contraction (systole) of the atria, relaxation (diastole) of the ventricles occurs, and vice versa, when the turn of ventricular systole comes, the atria relax.

So, diastole of the left ventricle is the moment when it is in a relaxed state and is filled with blood, which, with further cardiac contraction of the myocardium, is expelled into the vessels and distributed throughout the body. The work of the heart depends on how fully relaxation or diastole occurs (the volume of blood entering the chambers of the heart, the volume of blood ejected from the heart into the vessels).

2 What is diastolic dysfunction?

Left ventricular diastolic dysfunction is a complex medical term at first glance. But it’s easy to understand it, understanding the anatomy and work of the heart. In Latin dis - violation, functio - activity, function. So, dysfunction is a disruption of function. Diastolic dysfunction is a dysfunction of the left ventricle in the diastole phase, and since relaxation occurs in diastole, a violation of diastolic dysfunction of the left ventricle is associated precisely with a violation of the relaxation of the myocardium of this cardiac chamber. With this pathology, the ventricular myocardium does not relax properly, its filling with blood slows down or does not occur in full.

3 Dysfunction or failure?

The volume of blood entering the lower chambers of the heart decreases, which increases the load on the atria, compensatory filling pressure increases in them, and pulmonary or systemic congestion develops. Impaired diastolic function leads to the development of diastolic failure, but often diastolic heart failure occurs with preserved systolic function of the left ventricle.

In simple words, the earliest pathological manifestation of the ventricles is their dysfunction in diastole, more serious problem against the background of dysfunction - diastolic insufficiency. The latter always includes diastolic dysfunction, but not always with diastolic dysfunction there are symptoms and clinical signs of heart failure.

4 Causes of impaired relaxation of the left ventricle

Violation of the diastolic function of the ventricular myocardium can occur due to an increase in its mass - hypertrophy, or a decrease in the elasticity and compliance of the myocardium. It should be noted that almost all heart diseases affect the function of the left ventricle to one degree or another. Most often, diastolic dysfunction of the left ventricle occurs in diseases such as hypertension, cardiomyopathies, ischemic disease, aortic stenosis, arrhythmias different kind and origin, pericardial disease.

It should be noted that loss of elasticity and increased rigidity of the muscular wall of the ventricles is observed during the natural aging process. Women over sixty are more susceptible to this disorder. high blood pressure leads to an increase in the load on the left ventricle, due to which it increases in size and the myocardium hypertrophies. And the altered myocardium loses the ability to relax normally; such disorders first lead to dysfunction and then to failure.

5 Classification of violation

There are three types of left ventricular dysfunction.

Type I - Type 1 left ventricular diastolic dysfunction is classified as mild in severity. This is the initial stage of pathological changes in the myocardium, its other name is hypertrophic. In the early stages, it is asymptomatic, and this is its insidiousness, since the patient does not suspect problems with the heart and does not seek help. medical care. With type 1 dysfunction, heart failure does not occur, and this type is diagnosed only with the help of echocardiography.

Type II - dysfunction of the second type is characterized as moderate in severity. In type II, due to insufficient relaxation of the left ventricle and a reduced volume of blood ejected from it, the left atrium takes on a compensatory role and begins to work “for two,” which causes an increase in pressure in the left atrium, and subsequently its increase. The second type of dysfunction may be characterized clinical symptoms heart failure and signs of pulmonary congestion.

Type III - or restrictive type dysfunction. This is a severe disorder, which is characterized by a sharp decrease in the compliance of the walls of the ventricle, high pressure in the left atrium, bright clinical picture congestive heart failure. In type III, sudden deterioration of the condition leading to pulmonary edema and cardiac asthma is not uncommon. And these are severe life-threatening conditions that, without proper emergency treatment often lead to death.

6 Symptoms

In the early, initial stages of development of diastolic dysfunction, the patient may have no complaints. It is not uncommon for diastolic dysfunction to be detected as an incidental finding during echocardiography. In later stages, the patient is concerned about the following complaints:

If such symptoms and complaints appear, the patient must undergo comprehensive examination of cardio-vascular system.

7 Diagnostics

Diastolic dysfunction is detected mainly during an instrumental examination method such as echocardiography. With the introduction of this method into the practice of clinical doctors, the diagnosis of diastolic dysfunction began to be made many times more often. EchoCG, as well as Doppler EchoCG, allows us to identify the main disorders that occur during myocardial relaxation, the thickness of its walls, assess the ejection fraction, stiffness and other important criteria that allow us to determine the presence and type of dysfunction. X-rays of the chest organs are also used in diagnosis; highly specific invasive diagnostic methods can be used for certain indications - ventriculography.

8 Treatment

Is it worth treating diastolic dysfunction if there are no symptoms of the disease or clinic? Many patients ask this question. Cardiologists are unanimous in their opinion: yes. Despite the fact that in the early stages there is no clinical manifestations, dysfunction is capable of progression and the formation of heart failure, especially if the patient has a history of other heart and vascular diseases (hypertension, coronary artery disease). Drug therapy includes those groups of drugs that, in cardiological practice, slow down myocardial hypertrophy, improve relaxation and increase the elasticity of the walls of the ventricles. Such drugs include:

1. ACE inhibitors - this group of drugs is effective in both early and late stages of the disease. Representatives of the group: enalapril, perindopril, diroton;
2. AK is a group that helps relax the muscular wall of the heart, causes a decrease in hypertrophy, and dilates the blood vessels of the heart. Calcium antagonists include amlodipine;
3. b-blockers allow you to slow down the heart rate, which causes diastole to lengthen, which has a beneficial effect on the relaxation of the heart. This group of drugs includes bisoprolol, nebivolol, nebilet.

Many people have heard about such a syndrome as heart failure, and everyone understands the seriousness of this disease. But few people know what precedes it.

Left ventricular diastolic dysfunction manifests itself in the form of disturbances in the functioning of the heart, namely problems with filling with blood during muscle relaxation. These disorders often lead to the development of heart failure. It must be said that this problem is not final in its development; indifference to treatment can lead to pulmonary edema, or to cardiac asthma. Today, studying this specificity is the main task of specialists.

Manifestations of DD are nonspecific and often asymptomatic

Violation of the diastolic function of the left ventricle, as a rule, occurs due to loss of elasticity and compliance of the walls of the cardiac organ. It must also be said that this disease can occur without any symptoms. This feature entails a certain problem, which consists in progressive development, due to the impossibility of diagnosis.

Attention! This disease often develops in older people. It is during this period that the system can become weak. In addition, the main category that this disease affects is women.

Reasons for development

The diastolic function of the left ventricle is the ability to fill the ventricle with blood. This does not happen if the walls of the heart organ lose their elasticity. As a rule, this development of events occurs due to hypertrophy of the heart muscle (myocardium), which usually thickens so much that it is unable to perform the necessary functions. Hypertrophy itself is a consequence of the following reasons:

• hypertension;
• cardiomyopathy;
• aortic stenosis;
• pressure on the chambers of the heart, which occurs due to the presence of a disease such as constructive pericarditis;
• pathologies associated with coronary vessels;
• amyloid deposits.

Due to the fact that the entire load falls on the right ventricle, there is a high probability of developing diastolic dysfunction of the two ventricles. It is worth saying that dietary habits play an important role; if a person consumes an excessive dose of table salt, then there is every chance of developing this disease. In addition, overweight people are much more likely to suffer from this disease.

A decrease in left ventricular diastolic function can also occur due to previous diseases, such as:

• myocardial ischemia;
• infectious diseases;
• hypertension;
• tachycardia;
• anemia;
• arrhythmia;
• endocrinological diseases, etc.

Features of the disease

It is not for nothing that they say that the heart is the “motor” of the human body; the importance of its work knows no bounds. You need to know that our heart organ works on the principle of a pump that collects blood from the vessels and throws it into the main aorta. In this regard, there are three main stages of the work of the cardiac organ:

1. the myocardium is in a state of relaxation;
2. conduction of blood flow from the atrium to the ventricle, this occurs due to the pressure difference in these sections;
3. the ventricle fills with blood as a result of corresponding contractions from the atria.

If the pathology is in a moderate phase, then the symptoms appear periodically and the heart gradually returns to normal

Due to the influence of certain factors, the full functioning of this sequence is disrupted, which leads to the development of the disease. It should be said that this disease has its own growth rate, and like all other diseases, over time their form only worsens, this leads to unnecessary problems during the treatment period, as well as to some complications. When the diastolic function of the left ventricle is impaired, it is usually asymptomatic in the first stages of development. In this regard, three main degrees of severity can be distinguished:

As you can see, left ventricular diastolic dysfunction has several stages of development, on which the complexity of treatment directly depends. Even though there are no obvious signs of illness in the body, a routine examination by a specialist should be carried out; this technique will allow you to avoid unnecessary complications.

Features of diagnosis and treatment

Unfortunately, the treatment of this disease does not have one scenario. Based on this, our experts are of the opinion that it is necessary first of all to eliminate the signs of diastolic dysfunction of the left ventricle, which are pronounced. As for diagnosis, it depends on the degree of development of the disease, this means that for earlier stages a certain number of procedures are used, for example, such as:

It is worth saying that diagnosis in the early stages of the disease can prevent undesirable consequences.

ECG is used as an auxiliary diagnostic test

Important! When carrying out therapeutic measures, not only drug therapy is used, but also auxiliary therapy, which completely corrects the lifestyle. Without this complex, the effectiveness of the result is reduced by an order of magnitude.

Drug treatment methods:

1. adrenergic blockers (the heart rate and blood pressure are regulated);
2. diuretics (have a positive effect on eliminating shortness of breath);
3. inhibitors (effect on myocardial elasticity);
4. calcium antagonists (these drugs are preferred if intolerance to adrenergic blockers occurs);
5. nitrates (additional drugs).

Auxiliary methods:

• solving the problem of excess weight;
• use of proper nutrition;
• rejection of bad habits;
• balanced physical activity.

For citation: Vikentyev V.V. Myocardial ischemia and impaired diastolic function of the left ventricle // Breast Cancer. 2000. No. 5. P. 218

Department of Cardiology RMAPO, Moscow

IN last years The attention of many researchers is attracted by the possibility of studying myocardial function in the diastole phase, i.e. diastolic function of the left ventricular myocardium.

Interest in this problem is based on the fact that a number of studies have demonstrated the leading role of impaired diastolic function of the left ventricle in the development of heart failure in many diseases. It is also known that some rhythm disturbances are accompanied by symptoms of diastolic dysfunction. All of the above makes the problem of studying the process of relaxation of the left ventricle very relevant.

The data accumulated to date indicate that the diastolic filling of the left ventricle is determined by many factors, among which the greatest importance is given to the active relaxation of the left ventricular myocardium in the early phase of diastole, the elastic properties of the myocardium itself, in particular, the degree of its rigidity, the pressure that is created in the left atrium at the time of its systole, state mitral valve and associated subvalvular structures. At various diseases heart, pathological changes in the myocardium of the left ventricle itself can lead to disruption of the diastolic function of the left ventricle.

It is customary to distinguish the following periods of diastole: a period of early diastolic filling of the left ventricle, which consists of a fast and slow filling phase, and a period of late diastolic filling of the left ventricle, coinciding with left atrial systole. The volume of blood flow through the mitral valve and its velocity during early diastolic filling is determined by active energy-dependent relaxation of the left ventricular myocardium, chamber stiffness, and the level of left atrial pressure at the beginning of left ventricular diastole. A number of studies have shown that relaxation of the left ventricle in early diastole is an active energy-dependent process controlled by such basic mechanisms as the load of contraction, relaxation, and heterogeneity of load distribution. The period of early diastolic filling of the left ventricle is influenced by the diastolic deformation of the ventricular cavity, as well as intraventricular pressure at the moment of opening of the mitral valve. The combination of the effects of these factors creates the so-called suction function of the left ventricle, which determines the movement of part of the blood volume from the cavity of the left atrium to the cavity of the left ventricle. At the end of rapid filling, the pressure difference between the left chambers decreases, and a slow filling phase begins, during which the gradient between the atrium and the ventricle is small and the blood flow from the atrium to the ventricle is small. By the time left atrial systole occurs, this gradient begins to increase again, which is manifested in a re-acceleration of blood flow through the mitral valve.

During atrial systole, the volume of transmitral blood flow entering the left ventricular cavity depends on the pressure in the left atrium during systole, on the rigidity of the walls of the left ventricle, and the end-diastolic pressure in the ventricular cavity. An additional factor influencing the filling process should also be considered blood viscosity. Normally, the volume and velocity of blood flow through the mitral valve during early diastole significantly exceed these values ​​during atrial systole.

Methodological issues for determining diastolic function

In recent years, with the introduction of Doppler cardiography into widespread practice, it has become possible measuring transmitral blood flow velocities in different periods of diastole non-invasively. It should be noted that a Doppler study of transmitral blood flow can reliably verify only the phase of early fast diastolic filling and the phase of atrial systole, since the L wave, reflecting slow diastolic filling, can be detected on a Dopplerogram only in 25% of cases and, moreover, is very variable in magnitude and duration

In the absence of disturbances in left ventricular diastolic function in healthy young and middle-aged individuals, the peak speed E (E max) and the area under the curve E (velocity integral E, denoted E i) exceed the value of the peak and integral speeds A (A max and A i, respectively). According to various authors, the ratio of the velocities of the periods of early and late diastolic filling of the left ventricle ranges from 1.0 to 2.2 for velocity integrals and from 0.9 to 1.7 for peak velocities. The time of isometric relaxation of the left ventricular myocardium, measured by simultaneous recording of mitral and aortic flows, also largely depends on age, most often it is 74 ± 26 ms.

A number of studies have also shown the relationship between the increase in the contribution of the atrial component of diastolic filling of the left ventricle and the age of the subjects, which is expressed by a decrease in the ratio of the rates of the early and late diastolic filling periods due to an increase in the rates of the atrial systole period and a decrease in the rates of the early diastolic filling period. It should also be noted that the data on phase analysis of diastole in the literature are incomplete and heterogeneous in terminological definition, which requires further study of this issue.

Based on the above, we can conclude that normally the diastolic function of the left ventricle is determined by the following most significant points: diastolic deformation of the left ventricle, pressure in its cavity at the time of opening of the mitral valve, rigidity of the walls of the left ventricle, preservation of the structures of the mitral complex and the rheological properties of the blood itself.

Impaired diastolic function in myocardial ischemia

In the presence of chronic ischemia myocardium, the rigidity or rigidity of its walls increases. In particular, a number of researchers have convincingly shown the existence of a close correlation between the diastolic properties of the heart and the maximum oxygen consumption of the myocardium at rest and during exercise.

At the current level of development of this issue The pathogenetic mechanism of impaired diastolic relaxation of the left ventricle is as follows: insufficient oxygen supply to the myocardium leads to a deficiency of high-energy compounds, which in turn leads to a slowdown in the process of early diastolic relaxation of the left ventricle.

These changes affect the process of filling the ventricular chamber in early diastole: due to a slower than usual decrease in pressure in the left ventricular chamber, the moment when the pressure levels between the ventricle and atrium are comparable is reached later. This leads to an increase in the duration of the period of isometric relaxation of the left ventricular myocardium. Once the mitral valve opens, the pressure gradient between the ventricle and atrium is less than normal and, therefore, early diastolic filling flow is reduced. A kind of compensation is provided during atrial systole, when the volume of blood required for adequate filling of the left ventricle enters during active contraction of the atrium chamber. Thus, the atrial contribution to the formation of the stroke volume of the chamber increases. The above hemodynamic changes are attributed to the early type of ventricular diastole disorder, in which there is no significant increase in pressure in the chamber of the left atrium, and, accordingly, changes in the hemodynamics of the pulmonary circulation and signs of congestive heart failure are not observed.

The explanation of the pathogenetic aspects of the influence of ischemia in patients with impaired diastolic function of the restrictive type looks much more complicated. For the formation of this type of diastole disorder, the following main points are necessary: ​​high end-diastolic pressure in the cavity of the left ventricle, formed by the significant rigidity of its myocardium, high pressure in the cavity of the left atrium, ensuring adequate filling of the ventricle in early diastole, decreased systolic function of the left atrium. Most authors in this regard point to the rather rare occurrence of a restrictive type of diastole disorder in patients with coronary artery disease, since high myocardial stiffness is often associated with its organic damage, for example, with restrictive cardiomyopathy, infiltrative cardiopathy. Patients with coronary heart disease are characterized by the presence of focal myocardial pathology and the formation of high myocardial stiffness due to prolonged, chronic ischemia and the development of fibrosis.

Thus, today it is quite obvious that myocardial ischemia has a negative effect on the process of diastolic filling of the left ventricle. Therefore, it is advisable to also touch upon the issues of diagnosing impaired diastolic function in the category of patients under consideration.

Diagnostics

Along with invasive research methods (ventriculography) and radionuclide methods (radionuclide ventriculography), it has become increasingly important in recent years. Doppler cardiography . It is generally accepted today to distinguish 2 types of dysfunction of the diastolic function of the left ventricle according to Doppler cardiography.

1st type , in which, as a result of a violation of the early phase of ventricular diastole, the speed and volume of blood flow through the mitral orifice in the early phase of diastole (E peak) decrease and the volume and speed of blood flow increase during atrial systole (A peak), while an increase in the time of isometric relaxation of the left myocardium is noted ventricle (VIRM) and prolongation of deceleration time (DTT) of flow E.

Type 2, designated pseudonormal , or restrictive, which assumes the presence of significant rigidity of the ventricular myocardium, which leads to an increase in diastolic pressure in the ventricular chamber, and then in the atrium, and the pressure in the atrium chamber can significantly exceed the pressure in the ventricular cavity by the time the latter begins diastole, which ensures the presence of significant pressure gradient between chambers at the beginning of diastole; at the same time, the nature of the transmitral blood flow changes: the E peak increases and the A peak decreases, and the previously indicated time intervals (VIRM and VZ) are shortened.

A number of authors suggest dividing disorders of left ventricular diastolic function into 3 types: early, pseudonormal and restrictive . Thus, E. Braunwald proposes to differentiate the pseudonormal type of disorder from the normal and restrictive type based on the duration of the slowdown of the E peak of early filling, which, as is known, is shortened in pseudonormal and restrictive types of diastole disorder. The validity of this approach is questionable in light of the presence in the literature of data on a significant influence on the duration of diastole time intervals of heart rate at the time of the study.

Other authors point out the possibility of differentiating between the pseudonormal type of disorder and the norm by assessing flows in the pulmonary veins. With the pseudonormal type, there is an increase in pressure in the left atrium, which affects the filling nature of the left atrium.

The role and place of color Doppler M-modal echocardiography in the differential diagnosis between the above types of left ventricular filling is not entirely clear today. A number of authors believe that this technique helps to distinguish the pseudonormal type of filling from the restrictive and normal ones, while at the same time the question remains open about the degree and nature of the influence on the accuracy of measurements in this mode of factors such as heart rate, blood viscosity, and the state of the left atrium myocardium etc. It seems that color Doppler mapping in this situation does not have any fundamental advantages over a conventional Dopplerogram, because with M-modal scanning of a color Doppler image, the time intervals described above are also measured, which means that the influence of all the previously mentioned limiting factors is also preserved .

It is important to study segmental diastolic function using the Doppler tissue imaging method with M-modal scanning. The use of this method makes it possible to evaluate not only general state diastolic function, but also the nature of relaxation of individual segments, which is especially important when assessing the effect of myocardial ischemia on these parameters at rest and during stress tests.

Clinical significance of left ventricular diastolic dysfunction and the possibility of drug intervention

IHD is one of the most common causes the occurrence of diastolic dysfunction of the left ventricle due to disruption of early diastolic relaxation against the background of acute or chronic ischemia, increased myocardial stiffness at the site of the post-infarction scar and the formation of connective tissue against the background of chronic ischemia. Besides, an increase in the stiffness of hypertrophied intact myocardium in patients with coronary artery disease may be associated with ischemia against the background of coronary insufficiency due to stenosis of the artery supplying blood to this area of ​​the myocardium, and as a result of relative coronary insufficiency, which often occurs with hypertrophy. It is also known that diastolic dysfunction can occur without impairment of left ventricular systolic function. But impaired diastolic function, even in isolated form, leads to a significant deterioration in central hemodynamics and may contribute to the onset or progression of pre-existing systolic heart failure.

Prognosis for patients ischemic disease hearts that have diastolic dysfunction are more unfavorable, which makes the problem of its drug correction urgent.

Few studies have been devoted to the issues of drug therapy for impaired diastolic function in patients with coronary artery disease. In addition, to date there is no large study on this issue. In recent years, the scientific literature has published mainly experimental work on animals devoted to studying the influence of antianginal drugs of various groups , and ACE inhibitors (enalapril - SOLVD - investigators) on the process of diastolic relaxation of the myocardium. Based on the results of these studies The greatest effectiveness was observed with the use of calcium antagonists, beta-blockers, and ACE inhibitors . For example, E. Omerovic et al. (1999) demonstrated the positive effect of a selective b 1 blocker metoprolol on the state of systolic and diastolic function of the left ventricle during myocardial infarction.

There are also separate clinical works devoted to this issue. A. Tsoukas et al. (1999), studying the influence combination therapy with diuretics and ACE inhibitors on the state of central hemodynamics in patients with a restrictive type of transmitral blood flow and a reduced left ventricular ejection fraction (<40%), отметили положительное влияние указанной комбинации препаратов у 25% пациентов.

Elimination of diastolic dysfunction in the presence of myocardial ischemia is largely determined by the adequacy of individually selected antianginal therapy or surgical myocardial revascularization . For this purpose, they are most often used calcium antagonists (in particular amlodipine), b-blockers, nitrates.

The data of C. Stanescu et al. are also interesting. (published in the proceedings of the 21st Congress of the European Association of Cardiology in 1999) on the frequency of prescription of various groups of drugs in patients with heart failure of various etiologies (coronary artery disease - 35%, hypertension - 24%, valvular heart disease - 8%, cardiomyopathies - 3 %, other reasons - 17%). According to these authors, of 1360 patients hospitalized for heart failure, diastolic heart failure was diagnosed in 38% of cases. After an echocardiographic study, the frequency of prescription of various drugs in these patients was as follows: diuretics - 57%, calcium antagonists - 44%, b-blockers - 31%, ACE inhibitors - 25%, cardiac glycosides - 16%. While before echocardiographic examination and determination of the presence of diastolic form of heart failure, the frequency of prescription of the above drugs in these patients was as follows: diuretics - 53%, calcium antagonists - 16%, b-blockers - 10%, ACE inhibitors - 28%, cardiac glycosides - 44%. Thus, after the echocardiographic study, calcium antagonists were prescribed 3 times more often, and cardiac glycosides - less often than before the study.

In conclusion, it is advisable to note that the problem of correcting diastolic dysfunction in coronary patients is far from being resolved. Some issues regarding the diagnosis of diastolic dysfunction remain controversial, and there is no consensus regarding drug therapy. It seems that many aspects of this problem will be resolved when the results of large studies appear on the effect of therapy on the state of diastolic function in coronary patients.