The upper limit of the relative dullness of the heart has been formed. Determination of the border of the heart as a diagnostic method

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The cardiac percussion method makes it possible to detect signs of dilatation of the ventricles and atria, as well as expansion of the vascular bundle. The boundaries of relative and absolute cardiac dullness, vascular bundle, and heart configuration are determined.

Determination of the boundaries of relative dullness of the heart. First, the right, left and upper limits of the relative dullness of the heart are determined. It is known that the right border of the relative dullness of the heart, formed by the RA, is normally located along the right edge of the sternum or 1 cm outward from it; the left border (LV) is located 1-2 cm medially from the left midclavicular line and coincides with the apical impulse; the upper border, formed by the LA appendage or pulmonary trunk, is normally located at the level of the third rib. It should be remembered that the increase in the size of the relative dullness of the heart occurs mainly due to dilatation of individual cavities of the heart; myocardial hypertrophy alone (without dilatation), as a rule, does not change the percussion dimensions of the heart.

Determination of the boundaries of the vascular bundle. The vascular bundle, which includes the aorta, superior vena cava and pulmonary artery, is quite difficult to determine by percussion. Normally, the boundaries of the vascular bundle coincide with the right and left edges of the sternum, its width does not exceed 5-6 cm.

Determining the configuration of the heart. To determine it, the boundaries of the right and left contours of the relative dullness of the heart are additionally identified, percussing on the right in the third intercostal space, and on the left in the third and fourth intercostal spaces. By connecting all the points corresponding to the boundaries of relative dullness, we get an idea of ​​the configuration of the heart. Normally, along the left contour of the heart between the vascular bundle and the LV, an obtuse angle is clearly defined - the “waist of the heart”.

Determination of the boundaries of absolute cardiac dullness. When determining boundaries, the quietest percussion is used. Percussion is performed from the previously found boundaries of relative dullness of the heart towards the area of ​​absolute dullness. The right border of absolute cardiac dullness is normally located along the left edge of the sternum, the left border is 1-2 cm medially from the left border of relative cardiac dullness, and the upper border is at the level of the IV rib.

The most common causes of changes in the boundaries and configuration of the heart are presented in table. 1.

Table 1. Interpretation of cardiac percussion results

The boundaries of the heart are the most important indicator of a person’s health status. After all, all organs and tissues in the body work together, and if a failure occurs in one place, a chain reaction of changes in other organs is triggered. Therefore, it is very important to periodically undergo all necessary examinations for early detection of possible diseases.

The position of the heart is not the same as its boundaries. Speaking about position, we mean the place that the main “motor” of the body occupies relative to others internal organs. Over time, it does not change, which cannot be said about borders.

Such changes may be a consequence of thickening of the myocardial membrane, enlargement of the air sinuses and disproportionate growth of muscle mass of the ventricles and atria. A variety of diseases cause the boundaries of the heart to change. We are talking about narrowing of the passage of the artery of the lungs, pneumonia, tricuspid valve insufficiency, bronchial asthma and etc.

The heart can be compared to a bag of muscles, the valves of which ensure the flow of blood in the right direction: one section receives venous blood, and the other throws out arterial blood. Its structure is completely symmetrical and is formed by two ventricles and two atria. Each of its components performs its own special function, involving numerous arteries, veins and vessels.

And although the heart is located between the right and left sections of the lungs, it is shifted 2/3 to the left. The long axis has an oblique arrangement from top to bottom, from right to left, from back to front, which makes an angle of approximately 40 degrees with the axis of the entire body.

This organ is slightly rotated with the venous half anteriorly, and the left arterial half posteriorly. In front, its “neighbor” is the sternum and the cartilaginous component of the ribs, in the back – the organ for the passage of food and the aorta. The upper part coincides with the cartilages of the third rib, and the right part is localized between the 3rd and 5th ribs. The left one starts from the third rib and continues in the middle between the sternum and the collarbone. The ending reaches the right 5th rib. It must be said that the boundaries of the heart in children differ from those in adults, as does the pulse, blood pressure and other indicators.

Method for assessing heart parameters

The boundaries of the heart and vascular ligaments, as well as their size and location, are determined by percussion, which is the main clinical method. In this case, the doctor performs sequential tapping on the areas of the body part in which the main “engine” of the body is located. The sound produced allows an assessment of the characteristics and nature of the tissue under the examined area.

Data on tissue density is obtained based on the height of percussion noise. Where the density is lower, the sounds have a lower pitch, and vice versa. Low density is characteristic of hollow organs or filled with air bubbles, that is, lungs.

Percussion of the heart determines such a parameter as dullness. This is the area chest, where by tapping the doctor determines the location and boundaries of the body’s heart.

When percussing over the area that is tapped, a dull sound appears, because this organ consists of muscles. However, it is surrounded on both sides by the lungs, and even partially covered, so with these diagnostic activities A dull sound appears above this segment, that is, the boundaries of the relative dullness of the heart are formed, which correspond to the actual size of this organ. In this case, it is customary to distinguish between relative and absolute dullness of the heart, which are assessed by the nature of tapping.

Absolute dullness is diagnosed with quiet percussion. In this case, the doctor makes light taps and determines the area of ​​the heart that is not covered by the lungs. To establish relative dullness, the method of sharp blows is used, which the doctor carries out in the space between the ribs. As a result, a dull sound is heard, which makes it possible to identify the entire part of the body occupied by the heart. In this case, the first criterion, which reveals quiet percussion of the heart area, makes it possible to obtain basic information and make an accurate diagnosis by determining the edges of the heart, and the second, associated with sharp tapping, provides additional data and makes it possible to clarify the diagnosis based on data on the length and diameter, waist and etc.

How is percussion performed?

First, the boundaries of relative dullness of the heart are characterized, an assessment is made of the structure of the organ and its transverse dimensions, then they move on to diagnosing the boundaries of absolute dullness of the heart, ligaments of blood vessels and their parameters. In this case, the doctor is guided by the following rules:

1. He sits down or asks the patient to stand up, and examines severe cases while lying down.
2. Applies finger-finger tapping, which is common in medicine.
3. Applies quiet shocks when examining the boundaries of absolute dullness and quieter ones when diagnosing relative dullness.
4. When diagnosing the boundaries of relative dullness, the tone of the lungs is tapped from clear to dull. In case of absolute dullness - from a clear tone of the lungs to dull.
5. When calibrating percussion noise, the edges are designated according to the outer limit of the pessimeter finger.
6. The pessimeter finger is held parallel to the boundaries being diagnosed.

Assessment of boundaries for relative cardiac dullness

Among the boundaries, the right, left and the one at the top are noted. First, the doctor diagnoses the right border, having previously established the lower limit of the lung from the right flank in the middle of the clavicle. Then they step back one space between the ribs and tap this very line, heading towards the heart and waiting for the pure lung tone to turn into a dull tone. In this case, the percussing finger is placed vertically. Normally, the right border connects with the right edge of the sternum or moves 1 cm outward towards the 4th intercostal space.

The left border of the relative dullness of the heart coincides with the place between the ribs, where the apex beat was previously palpated. In this case, the doctor places the finger vertically outward relative to the push of the apex, but at the same time moving inward. If the apex beat is not audible, percussion of the heart is carried out in the 5th space between the ribs to the right flank from the anterior line of the armpit. In this case, the border is normally localized in the 5th space between the ribs at a distance of 1–1.5 cm inward from the median line of the clavicle.

When diagnosing the left border, an examination is carried out from the left flank from the clavicle below between the parasternal and sternal lines. In this case, the doctor places the pessimeter finger parallel to the edge he is looking for. Normally, it is consistent with the 3rd rib. In this case, great importance is attached to the position of the patient’s body. The lower border of the heart, like all others, moves several centimeters if the patient lies on his side. And in a lying position they are all larger than in a standing position. In addition, this factor is influenced by the phases of cardiac activity, age, gender, individual structural features, and the degree of fullness of the gastrointestinal tract.

Pathologies detected during diagnostic measures

All anomalies are usually deciphered as follows:

1. When the left border is moved to the left and to the lower part from the midline, it is customary to say that left ventricular hyperfunction is evident. An increase in this department can be caused by problems with the bronchopulmonary system, complications after infectious diseases, etc.
2. Expansion of the boundaries of the heart, and all of them, is associated with an increase in fluid in the pericardium, and this is a direct path to heart failure.
3. The growth of boundaries in the area of ​​the vascular ligaments may be a consequence of the expansion of the aorta, since this is the main element that sets the parameters of this part.
4. If the boundaries remain unchanged in different positions of the body, then the question of adhesions of the pericardium and other tissues is raised.
5. Shifting the boundaries to one edge allows you to determine the location of the pathology. This is especially true in the case of pneumothorax.
6. A general decrease in the boundaries of the heart may indicate problems with the respiratory system, in particular, emphysema.
7. If the boundaries simultaneously expand to the right and left, then we can talk about enlargement of the ventricles, provoked by hypertension. The same picture develops in the case of cardiopathy.

Cardiac percussion must be combined with auscultation. In this case, the doctor listens to the sounds of the valves using a phonendoscope. Knowing in which places they should be heard, it is possible to more fully describe the picture of the disease and give a comparative analysis.

When determining the boundaries of relative dullness of the heart, the right boundary is first established, then the left, and then the upper.

To identify right border of relative cardiac dullness along the right midclavicular line, the upper limit of absolute dullness of the liver (or the lower limit of the lung) is established, which is normally located in the VI intercostal space (Fig. 39, a). After this, going up to the IV intercostal space (to get away from hepatic dullness masking cardiac dullness), the pessimeter finger is placed parallel to the desired border and moved towards the heart along the IV intercostal space (Fig. 39, b). A change in percussion sound from clear pulmonary to dull will indicate reaching the limit of relative dullness of the heart. It should be noted that the pessimeter finger should be moved a short distance each time so as not to miss the boundaries of cardiac dullness. The first appearance of dullness indicates that the inner edge of the finger has crossed the border and is already within the location of the heart. The right border is marked along the outer edge of the finger, facing the clear percussion sound. It is formed by the right atrium and is normally located in the IV intercostal space, protruding 1-1.5 cm beyond the right edge of the sternum.

Rice. 39. Determination of the boundaries of relative dullness of the heart:
a - preliminary stage (establishing the upper limit of absolute liver dullness);
b, c, d - definition of the right, left and upper boundaries, respectively;
d - dimensions of the diameter of the relative dullness of the heart.

Before installation left border of relative cardiac dullness it is necessary to determine the apex impulse (see Fig. 38), which serves as a guide. If it cannot be detected, percussion is performed in the 5th intercostal space starting from the anterior axillary line towards the sternum. The plessimeter finger is placed parallel to the desired boundary and, moving it, percussion blows of medium strength are applied until dullness appears. The mark of the left border of relative dullness is placed along the outer edge of the pessimeter finger, facing the clear percussion sound. Normally, it is formed by the left ventricle, is located in the 5th intercostal space at a distance of 1-1.5 cm medially from the left midclavicular line (Fig. 39, c) and coincides with the apical impulse.

When determining upper limit of relative cardiac dullness(Fig. 39, d) a finger-pessimeter is placed near the left edge of the sternum parallel to the ribs and, moving it down along the intercostal spaces, blows of medium force are applied until dullness appears. A mark is placed along the upper edge of the pessimeter finger, facing the clear percussion sound. Upper limit relative dullness of the heart is formed by the contour of the pulmonary artery and the appendage of the left atrium and is normally located on the third rib along the left parasternal line.

Normally, the distance from the right border of relative dullness to the anterior midline is 3-4 cm, and from the left - 8-9 cm. The sum of these distances (11-13 cm) represents the diameter of the relative dullness of the heart (Fig. 39, e) .

The limits of relative cardiac dullness may depend on a number of factors, both extracardiac and cardiac in nature. For example, in people of asthenic physique, due to the low position of the diaphragm, the heart takes a more vertical position (a hanging “drip” heart) and the limits of its relative dullness decrease. The same is observed with prolapse of internal organs. In hypersthenics, due to the opposite reasons (higher position of the diaphragm), the heart accepts horizontal position and the boundaries of its relative dullness, especially the left one, are increasing. During pregnancy, flatulence, and ascites, the limits of relative dullness of the heart also increase.

The shift in the boundaries of the relative dullness of the heart, depending on the size of the heart itself, occurs primarily due to the increase (dilatation) of its cavities and is only to some extent determined by the thickening (hypertrophy) of the myocardium. This can happen in all directions. However, significant expansion of the heart and its cavities is prevented forward by the resistance of the chest wall, and downward by the diaphragm. Therefore, expansion of the heart is possible mainly backwards, upwards and to the sides. But percussion reveals only expansion of the heart to the right, up and to the left.

An increase in the right border of the relative dullness of the heart is most often observed with expansion of the right ventricle and right atrium, which occurs with tricuspid valve insufficiency and narrowing of the mouth of the pulmonary artery. With stenosis of the left atrioventricular orifice, the border shifts not only to the right, but also upward.

A shift of the left border of the relative dullness of the heart to the left occurs with a persistent increase in blood pressure in the systemic circulation, for example with hypertension and symptomatic hypertension, with aortic heart defects (aortic valve insufficiency, aortic stenosis). With aortic defects, in addition to the displacement of the left border of the relative dullness of the heart to the left, it also shifts down to the VI or VII intercostal space (especially with aortic valve insufficiency). A shift of the left border of relative dullness to the left and up is observed with bicuspid valve insufficiency.

Rice. 40. Normal (a), mitral (b) and aortic (c) configurations of the heart.

To determine the configuration of the heart, percussion is performed sequentially in each intercostal space: to the right of IV and above II, to the left of V and above - to II. In this case, the pessimeter finger is positioned, as usual, parallel to the expected dullness. The percussion blow should be of medium strength. The points obtained during percussion are connected to each other and, thus, the configuration of the heart is revealed (Fig. 40, a). It may vary depending on the nature of his pathology. Thus, with mitral heart defects (insufficiency mitral valve, mitral stenosis), the heart acquires a “mitral configuration” (Fig. 40, b). Due to the expansion of the left atrium and left ventricle, the waist of the heart is flattened due to an increase in the size of the left atrium. With aortic defects (aortic valve insufficiency, narrowing of the aortic opening), with pronounced forms of hypertension, the heart, as a result of isolated expansion of the left ventricle, acquires an “aortic configuration” - the appearance of a “boot” or “sitting duck” (Fig. 40, b). In the case of combined and combined defects, all parts of the heart may enlarge. When there is a very sharp displacement of the boundaries of the heart in all directions, it is called “bull”.

Treatment of pathology.

Both the entire heart and its individual chambers can enlarge. This may be a symptom of defects of cardio-vascular system, inflammatory processes or a consequence of excessive load on the myocardium.

The problem is dealt with by a cardiologist and a cardiac surgeon.

Some diseases that cause heart enlargement can be completely cured with medication or surgery, but there are others that can only be completely cured by organ transplantation.

There are two types of enlargement of the entire heart or its individual chambers:

1. Hypertrophy. This is thickening of the walls. Occurs due to the growth of the myocardium (muscular membrane). The left ventricle is most susceptible to this, since it bears the greatest load. Hypertrophy does not always require treatment.
2. Dilation. This is a “stretching” of the chambers of the organ - an increase in their cavity.

Reasons for the increase in heart size

This may be excessive stress on the heart muscle or heart or vascular defects.

Relatively safe causes of cardiac muscle growth

• physical exercise high intensity;
• difficult pregnancy and childbirth.

An enlarged heart is a distinctive feature of people whose bodies are often exposed to aerobic exercise: track and field athletes, hockey players, football players, biathletes, cyclists, skiers, boxers, wrestlers, etc.

Due to intense cardio loads and the need for the organ to pump blood more intensively, the myocardium (muscular membrane) grows, which entails hypertrophy first of the left ventricle, and then of the remaining chambers.

In addition, the cavity of the ventricles is stretched. This is necessary in order to ensure higher performance of the heart - the larger the ventricular cavity, the greater the volume of blood the heart can pump in one contraction.

If there are no symptoms that bother a person, then this feature does not require treatment.

Comparison of ultrasound of the heart of an ordinary person and an athlete

If the heart volume exceeds 1200 cm 3, doctors may prohibit the person from further engaging in professional sports.

In the same way, a large load on the myocardium occurs during pregnancy and childbirth. If there are no other signs of cardiovascular disease, then treatment is not necessary.

Pathological causes of heart enlargement

1. Arterial hypertension.
2. Aortic valve stenosis.
3. Cardiomyopathies.
4. Mitral stenosis.
5. Ventricular septal defect.
6. Ebstein's anomaly.
7. exudative pericarditis.
8. Myocarditis.
9. Amyloidosis.

These diseases require immediate treatment. If the cause of dilatation or hypertrophy is not eliminated in time, heart failure will progress irreversibly.

Characteristics of diseases in which the heart is enlarged

In this section, you will learn in detail about what happens with the pathologies listed above, what symptoms they are accompanied by, and their causes.

Arterial hypertension

This is chronically high blood pressure. Due to vascular spasm, the left ventricle works more actively to pump blood throughout the body. Hypertrophy of its wall occurs.

This pathology has the most favorable prognosis. If you take the antihypertensive medications prescribed by your doctor on time, your heart will return to normal and will not enlarge further.

Ventricular septal defect

A congenital heart defect in which there is a hole in the septum between the left and right ventricles. With pathology, all chambers of the organ become enlarged, especially the left ventricle.

• dyspnea;
• feeling of strong heartbeat;
• heartache;
• cough.

Cardiomyopathies

Enlarged heart – basic clinical sign these diseases.

There are several types of cardiomyopathy:

Types of cardiomyopathies and their descriptions:

Valve defects

Aortic stenosis is a narrowing of the valve lumen between the aorta and the left ventricle. Makes it difficult to eject blood. Provokes left ventricular hypertrophy.

Click on photo to enlarge

Mitral stenosis is a narrowing of the lumen of the valve located between the left ventricle and the left atrium. Left atrial hypertrophy is characteristic.

Click on photo to enlarge

Ebstein's anomaly is an underdevelopment of the tricuspid valve and its displacement into the right ventricle. The right atrium and the upper part of the right ventricle are dilated.

Causes of valve defects:

Symptoms of valve defects:

At a late stage of the disease, there is a blush on the cheeks against the background of pallor of other areas of the skin, a blue tint to the lips, ears and tip of the nose.

• cardiopalmus;
• dyspnea;
• chest pain;
• high temperature (38 or more).

When the disease progresses to chronic form the signs may disappear.

Pericarditis

Exudative pericarditis is an inflammation of the outer lining of the heart (pericardial sac), accompanied by the accumulation of fluid in it. It increases the size of the heart.

• constant shortness of breath;
• cardiopalmus;
• temperature ranging from 37.1 to 38;
• swelling;
• low pressure;
• visible swelling of the chest in the area of ​​the heart.

Amyloidosis

This is a rare disease with unknown causes. With amyloidosis, a specific substance, amyloid, is deposited in the myocardium, as well as in the arteries, liver, kidneys and other organs.

Comparison of cardiac ultrasound of a healthy patient and a patient with amyloidosis

Diagnostics

The size of the heart can be determined using the following methods:

1. Percussion (tapping the surface of the chest with fingers). Allows you to determine the boundaries of the organ during the initial examination.

Further diagnostics may include an ECG, Holter monitoring, and various blood tests.

Treatment

It consists in eliminating the underlying disease, one of the symptoms of which is a big heart.

Forecast

It depends on what exactly caused the enlargement of the heart:

• At arterial hypertension the prognosis is favorable. If you take the medications prescribed by your doctor on time, your heart will soon return to normal and will no longer enlarge.
• In case of ventricular septal defect – relatively favorable. If the operation is not performed in time, there is a risk of developing aortic valve insufficiency, severe arrhythmias, left ventricular dysfunction and sudden death. If the patient is operated on, the heart will no longer bother him.
• For dilated cardiomyopathy – unfavorable. Full recovery occurs only after transplantation. However, it is not always possible to find a donor for a heart transplant. In addition, the risk of postoperative complications is high.
• In hypertrophic cardiomyopathy – relatively unfavorable. With an asymptomatic course of the disease, patients die before the disease is detected. With proper therapy, the risk of death is reduced.
• Metabolic cardiomyopathy has a favorable prognosis. When metabolism is established, complete recovery occurs.
• At aortic stenosis without treatment, life expectancy ranges from 1 to 4 years from the onset of symptoms. If the operation is performed in a timely manner, the prognosis is relatively favorable.
• If mitral stenosis is left untreated, 50% of patients die within 5 years of the first symptoms appearing. After surgery, the prognosis is relatively favorable.
• In case of Ebstein's anomaly, it is relatively favorable. The risk of sudden death is 3–4%.
• For myocarditis – favorable. Complete recovery occurs after 4–8 weeks in 90% of cases, after a year – in 10% of cases.
• For exudative pericarditis – favorable. All operated patients recover.
• In case of amyloidosis – unfavorable. The maximum life expectancy is 5 years from the date of diagnosis.

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The heart is expanded in diameter

Any organ has a certain size and the heart is no exception, in different healthy people they vary within acceptable normal values. The thickness of all the muscular walls of the organ is much more important than its length and width. Anatomically, the human heart consists of four chambers: two atria (right and left) and, respectively, two ventricles. Very often the heart is expanded in diameter due to the altered thickness of the walls of its left side.

You can suspect a change in the boundaries of an organ during an examination:

• Percussion can determine the changed boundaries;
• On auscultation, the apex is heard slightly lower and to the left than at acceptable sizes;
• You can also notice the expansion of the boundaries when assessing the radiograph of the lungs.

Diseases in which there is a change in the boundaries of the heart

There are three groups of diseases, one of the symptoms of which is that the heart is enlarged in diameter:

1. Diseases associated with pathologies of the cardiovascular system:
   • IHD (coronary artery disease);
   • Any degree of hypertension (hypertension);
   • Congenital defects;
   • Development of chronic cardiovascular failure.
2. Extracardiac pathologies:
   • Chronic liver diseases – hepatitis and cirrhosis;
   • Thyroid diseases;
   • Impaired hematopoietic functions;
   • Development of pulmonary failure.
3. Recently, changes in the boundaries of the heart have often been observed due to foreign objects (parts of conductors and stents) located inside venous bypasses and arteries of the heart (coronary). Instruments have been developed to remove foreign bodies using a non-surgical method.

The mechanism of development of expansion of the borders of the heart

The main reason that the heart is expanded in diameter is the stagnation of blood in the ventricles due to its incomplete release during the contraction phase.

The mechanism for the development of this phenomenon is not complicated; during diastole (relaxation phase), each ventricle of the heart is filled with blood; during systole (contraction phase), not the entire amount of incoming blood is pushed into the atria, some remains.

During the next diastole, a new portion enters the ventricle, and the walls of the ventricle gradually stretch, the muscle walls are depleted and ventricular hypertrophy develops, leading to an expansion of the heart in diameter. The majority of clinical cases are left ventricular hypertrophy, indicating the development of pathology associated with impaired functioning of the cardiovascular system.

Expansion of the transverse dimensions of the heart often leads to death, caused by pulmonary embolism.

One of the pathologies affecting the cardiovascular system is.

Until recently, high blood pressure was observed mainly in older people. Currently, this disease is increasingly beginning.

Hypertension is quite common these days and not only elderly people are susceptible to this disease.

What is eccentric left ventricular hypertrophy? This is a widespread pathology of patients suffering from cardiac disorders.

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Don't self-medicate! Be sure to consult a doctor!

Causes of an enlarged heart in an adult, symptoms and diagnostic measures

An enlarged heart can be diagnosed in both an adult and a child. However, we should not forget that such pathology in children differs in its causes, symptoms and treatment.

If during a routine preventive examination of the chest it is determined that the heart is enlarged on fluorography, then there is no need to panic in advance. It is recommended to go for a consultation with a cardiologist and understand the reasons that led to the changes.

The cause of an enlarged heart in an adult is often hypertrophy of the left ventricle of the heart, sometimes the right, or both. In some cases, expansion of both atria is also noted. In this case, the organ is so deformed that it cannot function normally.

Expansion of the boundaries of the heart is called cardiomegaly. Enlargement of the heart chambers is often caused by the accumulation of metabolic products in the heart muscle, which means that true cardiomegaly develops.

Sometimes this phenomenon is detected during excessive physical activity, in pregnant women, and in athletes. In this case, the expansion of the heart is not considered dangerous. More often, during exercise, the lower chambers enlarge, especially the left ventricle, since it is from here that blood is released into the big circle circulation.

The exact etiology of the problem is established after diagnosis.

Important! The pathology detected in a newborn is very dangerous, since about 35% of children with it die in the first three months of life, and 20% develop chronic left ventricular failure.

Causes

• Pregnancy period.
• Heart defects.
• Anemia.
• Renal failure.

• Muscle dystrophy.

Symptoms

• High blood pressure.
• Fast fatiguability.

Enlarged heart in children

Diagnostics

1. Electrocardiography (ECG).
2. Ultrasound of the heart muscle.
3. Computed tomography (CT).

Treatment

The heart is enlarged to the left fluorography

How to detect cardiomegaly?

There are no separate signs of the existence of this disease in humans. All of the symptoms listed below are similar to those of other heart diseases.

• Increased fatigue.
• Shortness of breath during exercise or long walking.
• The appearance of swelling in the legs and body.
• Difficulty in tolerating physical activity.
• Difficulty breathing at night and dry cough.
• Chest pain.
• Headache, tinnitus and increased blood pressure.
• Loss of consciousness (rare).

It is important to note that the disease can be asymptomatic. In this case, only a doctor can determine its presence.

Causes

Most common reasons The reasons for which cardiomegaly appears are chronic diseases, other heart diseases, alcohol or drug poisoning:

• Diabetes. Its combination with high blood pressure doubles the risk of heart organ enlargement.
• Rheumatism. Murmurs and congestion in the heart most often lead to an increase in its size.
• Alcohol. Of course, its impact has a detrimental effect on the functioning of the entire body. But alcohol abuse for more than 10 years is a risk factor.
• Arterial hypertension. It most often occurs in older people and always contributes to cardiomegaly. With this disease, the heart is enlarged to the left as the size of the left ventricle increases.
• Cardiomyopathy. It develops due to a viral infection and alcoholism. With this disease, the organ is slightly enlarged in size.
• Sports. Athletes who participate in sports that require great endurance often have an enlarged heart. This becomes a problem when the heart reaches a pathologically large size, and training regimens are not followed.

How to diagnose and treat the disease?

First of all, the doctor must collect the patient’s medical history: find out about the presence of chronic diseases, previous operations, possible bad habits. After which research is carried out.

Percussion determines the size and boundaries of the organ, which makes it possible to identify which parts of the heart are enlarged, and then judge possible reasons diseases. Conducted in the laboratory biochemical analysis blood, fluorography, ultrasound, computed tomography.

If a doctor determines that the causes of a large heart are chronic or acute diseases, then treatment of these diseases must be carried out. If it is started on time, the organ decreases in size.

If the cause is a heart defect, then you need to consult a cardiac surgeon and, if necessary, undergo surgery. This will allow you to maintain the functionality of this vital organ for a long time. After surgery, symptomatic treatment is prescribed.

It is necessary to slow down the process of heart enlargement in the patient. If a person moves little, does not watch his diet, or has a number of bad habits, to solve the problem he needs to reconsider his lifestyle. This means starting to exercise in moderation and eating foods high in vitamins and microelements.

If treatment is not started promptly, the consequences can be very serious. That is why you should not neglect the recommendations if the doctor prescribes diet, sports or surgery.

For any cause of disease, it is prescribed drug treatment which will last throughout the patient's life. Not every person’s body is able to survive surgery due to age or individual characteristics. As a result, surgical intervention is prescribed only in exceptional cases.

Conclusion

Cardiomegaly is not just a disease, it is an important signal from the body about the presence of additional problems. If the diagnosis showed that the heart is enlarged, it is important to determine the reason why this happened. You cannot take medications based on your own conclusions, or suddenly change your lifestyle or diet. You need to consult a specialist to establish an accurate diagnosis and prescribe treatment methods.

Cardiomegaly or enlarged heart?

Every year, hundreds of thousands of citizens die from cardiovascular pathologies around the world. In most cases, the reason for this is untimely consultation with a doctor and deterioration of cardiac function.

Enlargement of the organ is associated with the development of ventricular hypertrophy, accumulation of metabolic products and neoplastic processes. Cardiomegaly often occurs in healthy people, this includes athletes and pregnant women.

The volume of the heart varies within different limits for each person. If we talk about gender differences, then in men this organ is larger than in women. So on age category From 20 to 30 years, the approximate heart volume will be the following values:

This figure also depends on body weight. A diagnosis of cardiomegaly should be made only after a thorough examination, because in some cases a slightly enlarged heart is the norm, which is strictly individual for each person.

Dilatation of the right or left ventricle: causes

Enlargement of the walls of the right or left ventricle is called hypertrophy. In this case, the functioning of the myocardium is disrupted and, as a result, their functional activity worsens. Depending on the location of the depletion of the heart muscle, different etiologies are distinguished.

Right ventricular hypertrophy

Enlargement of the walls of the right ventricle is most often observed in children with congenital defects of intrauterine development. Also, one of the main reasons is associated with an increase in pressure in the pulmonary circulation and the discharge of blood into the right ventricle. In this case, the load on the right ventricle increases.

In adults, the cause of right ventricular hypertrophy is often diseases that interfere with normal breathing. These include the following pathologies:

• rachiocampsis;
• pulmonary vascular diseases (compression, embolism, thrombosis, etc.);
• bronchial asthma;
• tuberculosis;
• bronchiectasis;
• Chronical bronchitis;
• polio, etc.

Left ventricular hypertrophy

Left ventricular hypertrophy is dangerous sudden stop heart, the cause of myocardial infarction and death. Thickening of the walls of the left ventricle can result from the following cardiac pathologies:

• developing atherosclerosis of the aorta;
• hypertonic disease;
• congenital or acquired heart defects;
• obesity.

To prevent the development of such serious diseases, you must follow preventive measures, which means sticking to healthy lifestyle life and be observed by a doctor in order to promptly diagnose all disorders.

Causes of cardiomegaly

Most often, an enlarged heart in diameter is diagnosed in adults. Predisposing factors that contribute to the expansion of the boundaries of the shadow of the ventricles and atria are quite diverse, in most cases this is associated with cardiovascular pathologies. So, the etiology of the appearance of cardiomegaly includes the following reasons:

• excessive exercise;
• pregnancy;
• idiopathic cardiomyopathy;
• heart defects;
• anemia in severe forms;
• infectious diseases, where the target organ is the heart muscle;
• complications after viral diseases;
• myocardial ischemia or infarction;
• inflammatory processes in heart;
• severe stress loads;
• excessive alcohol consumption, drug addiction, smoking;
• kidney disease and renal failure;
• rheumatic carditis and endocarditis;
• hypertension, etc.

If an enlargement of the heart muscle is detected, the doctor prescribes the necessary diagnostics and treatment.

Clinical manifestations

When the heart expands across the diameter or in other parts, the patient may experience unpleasant symptoms. This includes the following clinical severity:

• increased fatigue;
• shortness of breath at rest or with minor physical exertion;
• increased blood pressure;
• appearance pain in the region of the heart;
• formation of edema in the lower extremities;
• headaches and dizziness;
• short-term loss of consciousness.

Other signs characteristic of a particular cardiac pathology, if present, may also be added.

Treatment

During treatment, it is important to identify the focus, which means to determine the disease or disorder that triggered the occurrence of heart enlargement. As soon as this is diagnosed, treatment is prescribed aimed at eliminating this pathology.

As an auxiliary therapy, medications are prescribed, the purpose of which is to reduce the obstacle to normal blood outflow while simultaneously unloading the increased work of the ventricles. This will prevent the risk of complications such as myocardial infarction, angina, shortness of breath and arrhythmia.

If therapeutic actions are ineffective, the doctor may prescribe surgery to improve blood flow. However, they resort to it only in extreme cases.

1. You should stop using alcoholic drinks which have a toxic effect on the myocardium (heart muscle).
2. In order to prevent the deposition of cholesterol plaques on the walls blood vessels You need to exclude foods high in cholesterol from your daily diet. It is advisable to consume fish, olive, flaxseed, corn and soybean oil at least 2 times a week.
3. To strengthen and maintain the heart muscle in normal working condition, it is useful to include viburnum, cranberries, cabbage, eggplants, peaches, dried apricots, apples, pomegranates, walnuts, melons, etc. in the daily diet.
4. It is necessary to reduce salt intake to at least 2 grams. per day, especially for patients with increased swelling.
5. If obesity is recorded, it is necessary to create a proper balanced diet aimed at eliminating extra pounds.
6. Sleep at least 8 hours, do not become physically and emotionally overtired.
7. Walk outdoors more often.

Enlargement of the heart is not a diagnosis, but only a temporary condition of the heart muscle. With correct and timely actions, you can get rid of this disorder and significantly alleviate your condition.

Causes

Why does the heart enlarge? A number of reasons have been identified that lead to pathology:

• Pregnancy period.
• Diabetes mellitus together with high blood pressure.
• Long-term antibiotic therapy.
• Heart defects.
• Inflammatory processes in the heart area.
• Rheumatism, especially with stagnation of blood.
• Alcohol – it adversely affects the heart muscle and the entire body. If you abuse alcohol for more than 10 years, there is a risk of developing alcoholic cardiomyopathy.
• High blood pressure is more common in older people, and the heart expands to the left as the left ventricle enlarges.
• Cardiomyopathy - formation occurs due to infection in the heart muscle or due to alcohol abuse, and the increase is small.
• Anemia.
• Renal failure.
• Pulmonary hypertension is an enlargement of the right side of the heart.
• Playing sports - athletes often experience an enlargement of the heart muscle, this is considered normal. Dangerous disorders occur when the heart muscle becomes very large and training is irregular.
• Myocardial infarction – most often the entire myocardium enlarges, and an aneurysm often forms.

An enlarged heart is not often observed for the following reasons:

• Muscle dystrophy.
• Loose closure of the tricuspid valve leaflets during ventricular contraction, with an increase in the diameter of the heart muscle on the right.
• Diseases of the endocrine glands.
• Hypertrophic cardiomyopathy - thickening of the walls of the left ventricle and dystrophy of the heart muscle often leads to stagnation of blood, and then to expansion of the heart to the left.
• Infiltrative-restrictive cardiomyopathy is characterized by the presence of inextensible ventricular walls that resist filling with blood.
• Cancerous tumor or metastases going to the heart.
• Bacterial infections in the heart.

Symptoms

Enlargement of the heart muscle appears in relation to individual individual chambers, less often it is observed in all chambers. Pathology usually develops due to additional load on the organ that has to perform more work, than usual. That is, muscle mass is gained with increased blood pumping. This is especially noticeable in inflammatory lung diseases, which lead to oxygen starvation.

It is worth remembering that characteristic features There is no pathology, it is manifested by symptoms of the diseases that led to its development. The following is most often observed:

• Severe shortness of breath even with little physical exertion.
• puffiness lower extremities and other parts of the body.
• Feeling of heaviness on the right side under the ribs.
• Pain in the head, which is accompanied by tinnitus.
• High blood pressure.
• Dry, causeless cough that gets worse when lying down.
• Pain in the retrosternal region on the left.
• Fast fatiguability.
• Dizziness to the point of loss of consciousness (the rarest symptom).

Attention! Often there are cases of asymptomatic progression, then the pathology is discovered by chance during a routine examination.

Enlarged heart in children

An enlarged heart in a child most often occurs due to congenital defects. In medicine, more than 90 defects have been identified, which are characterized by narrowing and insufficiency of the valves, deformations of the heart itself or the vessels feeding it. All of them lead to circulatory disorders.

Separate birth defects cause the death of a child, so it is important to diagnose them as soon as possible (from the first days of life to six months) in order to carry out cardiac surgical treatment. This is done by cardiologists and cardiac surgeons.

In a child, an enlargement of the heart muscle can be caused by diseases such as hypertrophic cardiomyopathy, rheumatism and myocarditis of various origins. Endocarditis and pericarditis in childhood occur much less frequently. In such situations, the increase is not observed immediately after birth, but develops gradually.

Diagnostics

IN modern medicine A large number of diagnostic methods for detecting heart diseases have been developed. Making a diagnosis begins with collecting an anamnesis, which is based on the patient’s complaints and examination. The doctor checks availability chronic diseases, bad habits of the patient, experienced surgical interventions. Next, the following research methods are prescribed:

1. Chest X-ray - the image clearly shows the shadow of the expansion of the heart, and blood stagnation is detected.
2. Electrocardiography (ECG).
3. Echocardiography (EchoCG) determines the physical parameters of the heart muscle, including the size of the chambers, the presence of necrosis and ischemia of the heart.
4. Ultrasound of the heart muscle.
5. Computed tomography (CT).
6. Magnetic resonance imaging (MRI).
7. Immunological and biochemical blood test, which determines the level of hemoglobin, bilirubin, urea, protein and hormones.

Important! The effectiveness of treatment directly depends on the correct diagnosis and cause of the disease. Therefore before. Before treating pathology, the doctor carefully studies the results of tests and instrumental studies.

Treatment

Treatment directly depends on the causes of the disease. All activities are primarily aimed at organizing a healthy lifestyle for the patient and eliminating the cause of the disease. The patient is recommended a special diet that excludes fatty, salty and spicy foods, and giving up bad habits. The doctor prescribes special exercises.

The following medications may be prescribed:

• Medicines from the group of diuretics, which remove excess fluid from the body, thereby easing the load on the heart.
• Anticoagulants are medications that block the formation of blood clots and eliminate the risk of ischemia or alleviate its symptoms.
• Means for normalizing cardiac activity.

Surgical intervention is prescribed only in emergency cases when the patient's life is at risk. The most dangerous and advanced form is considered to be “bull heart”, in this case only a transplant can help.

If disturbances occur against the background of valve pathology, then prosthetics are performed. In case of severe heart rhythm disturbances, a pacemaker is installed under the skin to normalize it.

Important! For prevention and additional therapy, traditional medicine is used.

The heart is the most vulnerable human organ; its performance is affected by many internal and external factors. An enlarged heart indicates that there are certain problems in the body. Therefore, when manifesting unpleasant symptoms It is recommended to immediately seek advice from a cardiologist who will prescribe necessary treatment, otherwise the consequences could be dire.

Causes of an enlarged heart

The weight of an average man’s heart is 332 grams, a woman’s – 253. It is considered normal if the weight of the organ varies within these limits.

As for the sizes, they are usually correlated with a person’s fist. For an organ to function normally, it is very important that all its parts (atria, ventricles) are normal, or rather, the thickness of their walls, length and width as a whole.

What to do if fluorography (x-ray, ultrasound) showed that the heart is enlarged and dilated?

How dangerous is it to literally have a big heart? And as a result of what can the organ become larger? Let's deal with everything in order.

The most important reasons why the heart is larger than normal in a fluorography image include:

In people who engage in heavy physical labor every day, as well as in professional athletes, the heart also works harder: it is forced to beat more often and pump blood faster.

This leads to the fact that there are often more heart muscle cells and they grow. As a result, the weight of the organ and its size increase.

If physical activity in the future is moderate, an enlarged heart for this reason does not pose a health risk.

If a person subjects his body to excessive stress for a long time, then it is possible to develop a pathology such as a hypertrophied heart, which is already fraught with serious complications and even life-threatening.

The reason that the heart is enlarged in size can be diseases of the cardiovascular system (coronary diseases: for example, hypertension, coronary disease) and the heart itself (viral, inflammatory diseases), as well as heart defects.

So, if there is a defect and the organ is unable to function normally in order to properly supply the entire body with blood, the organ can enlarge.

Coronary diseases

Hypertension is the most common cause of heart enlargement.

This is explained by the fact that due to high blood pressure The organ is forced to pump large volumes of blood and work in an intensive mode.

This causes the heart muscles to enlarge and the organ itself to expand.

If a person has ischemia, the heart muscle cells constantly do not receive enough nutrients, as a result of which they degenerate, and connective tissue appears in their place.

The latter, unlike muscle tissue, is not capable of contraction; as a result, the organ cavities become deformed and increase in size.

What to do if an x-ray showed that the organ is enlarged, and the cause of this phenomenon is a disease of the cardiovascular system?

The answer to this question is simple and obvious - treat the root cause and return the organ to normal limits.

If a patient is diagnosed with hypertension, he is usually prescribed pharmaceuticals that lower blood pressure. The latter helps restore the normal size of the organ.

Taking medications for someone with hypertension or ischemic disease, who has been diagnosed with an enlarged heart, should definitely.

The fact is that despite the increased size of the organ, a large heart performs its most important function - pumping blood - much worse, which means that human organs and systems do not receive the nutrients they need - heart failure develops, and the whole body suffers.

That is, returning the organ to its normal size helps prevent heart failure, which in some cases can simply save a person’s life.

Non-coronary diseases

Another fairly common cause of an enlarged heart is inflammatory processes that affect muscle tissue(carditis), primarily rheumatic carditis.

So, if a person has suffered a serious infection such as tonsillitis or scarlet fever, complications (rheumatism) can also affect the most important organ that transports blood.

In this case, the muscle loses its elasticity, and the ventricles are overstretched, as a result of which the size of the organ can increase several times, and its functionality, accordingly, will decrease several times.

In this regard, it is very important timely treatment rheumatic carditis. To date, drugs have been developed to completely eliminate streptococcal infections and prevent overstretching of the heart.

If therapy is not followed, the person may die. In addition, being a carrier of streptococcus, the patient infects others.

Endocarditis – inflammatory disease, affecting the internal cavity of the heart and its valves.

Endocarditis in an advanced stage causes expansion of the organ, loss of muscle elasticity and ability to contract. The disease requires immediate treatment.

Myocarditis is a consequence viral infections, are accompanied by arrhythmia and shortness of breath, and heart failure may occur.

In this regard, a patient with myocarditis needs immediate health care and supportive care.

Chronic alcohol consumption can cause cardiomyopathy and cardiac dystrophy, as a result of which the heart cavities expand and the heartbeat rhythm changes significantly.

Also, in patients with alcoholism, as a rule, there is an increased arterial pressure– another factor contributing to the modification of the heart muscle.

If a person recovers from alcoholism and stops drinking alcohol, and if he has hypertension, takes blood pressure-lowering medications, after some time the organ will restore its normal size.

Thus, if a fluorography image reveals an increase in the size of the heart, you should immediately contact a specialist, find out the cause of the pathological changes and, if necessary, begin therapy: the problem is solvable in most cases.