Cardiac ischemia and its treatment. Ischemic heart disease or ischemia of the heart muscle Ventricular myocardium similar ischemic changes

The ECG can diagnose most heart pathologies. The reasons for their appearance are due to concomitant diseases and the characteristics of the patient's lifestyle.

What does this mean if myocardial changes were found on the ECG? In most cases, the patient needs conservative treatment and lifestyle correction.

Electrocardiogram (ECG) - one of the most informative, simple and accessible cardiological research. It analyzes the characteristics of the electrical charge that stimulates the contractions of the heart muscle.

Dynamic recording of charge characteristics is carried out on several muscle sites. The electrocardiograph reads information from electrodes placed on the ankles, wrists and chest skin in the area of \u200b\u200bthe heart projection and converts them into graphs.

Norm and deviations - possible causes

Normally, the electrical activity of the areas of the myocardium, which is recorded by the ECG, should be uniform. This means that the intracellular biochemical exchange in heart cells occurs without pathologies and allows the heart muscle to produce mechanical energy for contractions.

If the balance in the internal environment of the body is disturbed various reasons – the following characteristics are recorded on the ECG:

• diffuse changes myocardium;
• focal changes in the myocardium.

The reasons for such changes in the myocardium on the ECG can be both harmless states, not threatening the life and health of the subject, and serious dystrophic pathologies requiring urgent medical attention.

One of these serious pathologies is myocarditis, or. Regardless of its etiology, areas of inflammation can be located both in the form of foci and diffusely throughout the heart tissue.

Myocarditis reasons:

• as a consequence of scarlet fever, tonsillitis, chronic tonsillitis;
• complications typhus, scarlet fever;
• consequences of viral diseases: influenza, rubella, measles;
• autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.

One of the reasons for changes in muscle tissue can be cardiodystrophy - a metabolic disorder in heart cells without damage to the coronary arteries. Lack of nutrition of cells leads to a change in their normal life, impaired contractility.

Causes of cardiac dystrophy:

• The ingestion of toxic metabolic products into the blood due to severe impaired renal and liver function;
• Endocrine diseases: hyperthyroidism, diabetes mellitus, adrenal tumor, and, as a result, excess hormones or metabolic disorders;
• Constant psycho-emotional stress, stress, chronic overwork, starvation, unbalanced diet with nutritional deficiencies;
• Children have a combination of increased loads with a sedentary lifestyle, vegetative-vascular dystonia;
• Lack of hemoglobin (anemia) and its consequences - oxygen starvation of myocardial cells;
• Heavy infectious diseases in acute and chronic form: flu, tuberculosis, malaria;
• Dehydration of the body;
• Avitaminosis;
• Alcohol intoxication, occupational hazards.

Definition by cardiogram

With diffuse lesions heart deviations from the normal picture are noted in all leads. They look like numerous areas with impaired conduction of electrical impulses.

This is expressed on the cardiogram as a decrease in the T waves, which are responsible for. With focal lesions, such deviations are recorded in one or two leads. These deviations are plotted as negative T waves in the leads.

If focal changes are represented, for example, by scars remaining in the connective tissue, they look on the cardiogram as electrically inert areas.

Diagnostics

Decoding of electrocardiogram data takes 5-15 minutes... Her data can reveal:

• The size and depth of the ischemic lesion;
• Localization of myocardial infarction, how long ago it happened in the patient;
• Electrolyte metabolism disorders;
• Enlargement of cardiac cavities;
• Thickening of the walls of the heart muscle;
• Intracardiac conduction disorders;
• Heart rhythm disorders;
• Toxic myocardial damage.

Features of diagnosis for various pathologies of the myocardium:

• myocarditis- on the data of the cardiogram, a decrease in the teeth in all leads, a violation of the heart rhythm, the result of a general blood test shows the presence of an inflammatory process in the body;
• myocardial dystrophy– eCG indicators are identical to the data obtained with myocarditis, this diagnosis can only be differentiated using data laboratory research (blood biochemistry);
• myocardial ischemia - data on the ECG show changes in the amplitude, polarity and shape of the T wave, in those leads that are associated with the ischemic zone;
• acute heart attack myocardium - horizontal displacement of the ST segment upward from the isoline, trough-shaped displacement of this segment;
• cardiac muscle necrosis - irreversible death of myocardial cells is reflected on the ECG graph as a pathological Q wave;
• transmural necrosis - this irreversible damage to the wall of the heart muscle throughout its thickness is expressed in the cardiogram data, as the disappearance of the R wave and the acquisition of the QS type by the ventricular complex.

When hypertensive crisis, decompensated heart failure, electrolyte disturbances or suspected acute myocardial infarction - a coronary scar appears on the ECG graph.

When making a diagnosis, additionally you should pay attention to the symptoms of concomitant diseases... It can be pain in the heart with myocardial ischemia, swelling of the legs and arms with, signs of heart failure as a result of a heart attack on the legs, hand tremors, sudden weight loss and exophthalmos with hyperthyroidism, weakness and dizziness with anemia.

The combination of such symptoms with diffuse changes detected on the ECG requires an in-depth survey.

What diseases do they accompany

Pathological changes in the myocardium, identified on the ECG, may be accompanied by impaired blood supply to the heart muscle, repolarization processes, inflammatory processes and other metabolic changes.

A patient with diffuse changes may show the following symptoms:

• dyspnea,
• chest pain
• increased fatigue,
• cyanosis (blanching) of the skin,
• heart palpitations (tachycardia).

Such manifestations most often become the reason for conducting an electrocardiogram. In medical practice, there are many examples when myocardial pathologies did not cause tangible changes in the well-being of patients and were detected during preventive examinations.

Diseases accompanied by changes in the heart muscle:

• Myocardial dystrophy- violation of biochemical metabolic processes in the heart;
• Allergic, toxic, infectious myocarditis- inflammation of the myocardium of various etiology;
• Myocardiosclerosis- replacement of heart muscle cells connective tissueas a consequence of inflammation or metabolic diseases;
• Violations water-salt exchange;
• Hypertrophyparts of the heart muscle.

To differentiate them, additional examinations are required.

Additional diagnostic tests

Cardiogram data, despite their informative value, cannot be the basis for making an accurate diagnosis. In order to fully assess the degree of myocardial changes, additional diagnostic measures are prescribed by a cardiologist:

• - the level of hemoglobin and such indicators of the inflammatory process as the level of leukocytes in the blood and (erythrocyte sedimentation) are assessed;
• Blood biochemistry analysis - the indicators of the content of protein, cholesterol, glucose are estimated to analyze the work of the kidneys, liver;
• General clinical analysis urine - indicators of kidney function are assessed;
• Ultrasoundif you suspect a pathology internal organs - according to indications;
• ECG indicators;
• Carrying out Stress ECG;
• Heart ultrasound (echocardiography) - the state of the heart is assessed to find out the cause of myocardial pathology: expansion (dilation), hypertrophy of the heart muscle, signs of a decrease in myocardial contractility, impaired motor activity.

After analyzing the history and data of laboratory and instrumental examination, the cardiologist determines the method of treating changes.

Treatment for focal and diffuse disorders

In the treatment of myocardial pathologies are used various groups of drugs:

If conservative treatment does not lead to significant improvements in the patient's condition with myocardial disease, he is given an operation to implant a myocardial pacemaker.

Besides remedies the patient is advised to change his lifestyle and establish a balanced diet. For a patient with such pathological manifestations, it is unacceptable physical exercise, drinking and smoking. He is shown physiotherapy exercises and feasible work.

The main provisions of the dietary nutrition:

• Salt and excess fluid intake is limited to a minimum;
• Spicy and fatty foods are not recommended;
• The menu should include vegetables, fruits, lean fish and meat, dairy products.

Myocardial changes detected on the ECG, require additional laboratory and instrumental examination... If necessary, a cardiologist will prescribe treatment in a hospital or outpatient... Timely measures taken will help to avoid serious complications.

Preventively, within the framework of a national project, she underwent an examination at a local hospital, including an EKG. The results scared me. Moderate deviations of atrial depolarization. Signs of moderate hypoxia of the ventricular myocardium. Ischemic changes in the ventricular myocardium are possible. Sinus rhythm. Normal pos. EOS. Signs of overload or early signs of LV hypertrophy.

Is everything so serious, what can be done, can it be influenced excess weight BMI 27.2?

Such definitions are described in the manuals, perhaps the doctor was simply not experienced enough. Again, exactly such changes on the ECG in a person of 80 years old would not raise doubts. But for 30 years they are implausible. So most likely there is nothing wrong and there is no ischemia either. But it would be nice to scan the ECG and send it to us.

Myocardial ischemia: causes, symptoms, diagnosis, treatment

Myocardial ischemia is the basis of ischemic heart disease (CHD) - the most common pathology of cardio-vascular system in people. According to statistics, at least half of elderly men and a third of women suffer from it, and mortality from various forms of ischemia reaches 30%.

The disease has no geographic boundaries, is common in both developing and developed countries with a high level of medicine. Long time IHD can be asymptomatic, only occasionally making itself felt by unpleasant sensations in the heart.

Painless myocardial ischemia is of great importance. The disease does not manifest itself in any way for many years, but it can cause extensive heart attack and sudden death. According to some reports, this form of pathology affects up to 20% practically healthy peoplebut with risk factors.

Causes and types of heart ischemia

The reasons that lead to ischemic changes in the heart muscle have not been heard except by the lazy one. Among the main risk factors are:

• Elderly age;
• Male gender;
• Hereditary predisposition (familial dyslipidemia);
• Smoking;
• Comorbidities such as diabetes, hypertension, obesity;
• Lipid spectrum disorders;
• Hypodynamia.

Elderly patients are the main contingent of cardiology departments. This is not accidental, because with age, dystrophic processes occur in the vessels, metabolic disorders are aggravated, and concomitant pathology joins. It should be noted that in recent years ischemia has been showing clear signs of "rejuvenation", especially among residents of large cities.

Women, due to hormonal characteristics, are less susceptible to ischemia of the heart, since estrogens have a kind of protective effect, however, by about 70 years, when persistent menopause occurs, their incidence rates are equated to those of men. The lack of estrogen predetermines the earlier development of atherosclerosis and, accordingly, ischemic heart damage in men.

Violation of fat metabolism causes the deposition of lipid formations on the walls of the arteries, which impede blood flow and lead to oxygen starvation of the heart tissues. These phenomena are significantly aggravated by general obesity and diabetes mellitus... Hypertension with crises contributes to damage to the inner lining of the arteries and the circular deposition of fat in them, which causes a significant deficit in blood flow.

These factors lead to the appearance of direct causes of lack of oxygen in the heart: atherosclerosis, vasospasm, thrombus formation.

causes of impaired coronary blood flow and subsequent myocardial ischemia

Varieties of myocardial ischemia according to the International Classification of Diseases are as follows:

Angina is the most frequent form ischemia of the heart, which is diagnosed in most elderly people who do not even present complaints (asymptomatic form). The absence of pain should not be soothing, especially in persons with concomitant diseases predisposing to atherosclerosis and susceptible to risk factors.

A heart attack is myocardial necrosis, when an acute lack of oxygen leads to the death of cardiomyocytes, a violation of cardiac activity with a high risk of death. Heart attack is one of the most severe and irreversible manifestations of ischemia. After the healing of the necrosis focus, a dense scar remains at the site of injury (postinfarction cardiosclerosis).

With a significant amount of necrotization, they speak of a large-focal infarction, often it penetrates the entire thickness of the heart muscle (transmural infarction). Small foci of necrosis can be found under the membranes of the heart. Subepicardial ischemia occurs under the outer shell (epicardium), subendocardial ischemia - inside, under the endocardium.

forms of myocardial necrosis (infarction) due to ischemia and their reflection on the ECG

All forms of ischemia sooner or later lead to depletion of compensatory mechanisms, structural changes and a steadily increasing heart failure. Such patients have a high risk of thromboembolic complications with damage to the brain, kidneys, and extremities. Thrombi especially often appear with subendocardial ischemia, when the inner layer of the heart is involved.

A special form of the disease is the so-called transient, or painless, mute, ischemia of the heart muscle. It occurs in about half of patients with coronary artery disease, does not give any symptoms, however, changes in myocardial cells still occur and they can be identified, for example, using an ECG.

Transient ischemia of the heart is significantly more common among hypertensive patients, smokers, patients with congestive heart failure. Without exception, all patients with a mute form of pathology have a lesion of the great vessels of the heart, multiple severe atherosclerosis, a large length of narrowing areas. It is still not clear why painless ischemia occurs with significant vascular damage, but perhaps this is due to the good development of collateral blood flow.

What happens in the heart during ischemia?

The main symptom of ischemic heart disease is considered to be pain syndrome, which occurs both in the chronic course of the disease, and in its acute forms. The appearance of pain is based on irritation of nerve receptors by metabolic products that are formed under conditions of hypoxia. The heart works continuously, pumping colossal volumes of blood, so the costs of oxygen and nutrients are very high.

Blood to the heart muscle enters through the coronary vessels, and collateral blood flow to the heart is limited, therefore, when the arteries are damaged, the myocardium always suffers. Atherosclerotic plaque, thrombus, sudden vasospasm create an obstacle to blood flow, as a result of which muscle cells do not receive the blood they supply, pain and characteristic structural changes in the myocardium appear.

In cases of chronic myocardial ischemia, usually with atherosclerosis, the heart muscle "starves" constantly, against this background, the stimulation of fibroblast cells that form connective tissue fibers occurs, and cardiosclerosis develops. The involvement of conductive nerve bundles contributes to arrhythmias.

Vascular catastrophes in thrombosis, plaque rupture, spasm are accompanied by complete and sudden cessation of blood flow through the vessels, blood does not reach the heart muscle, and acute myocardial ischemia "pours out" into a heart attack - necrosis of the heart muscle. Often, against the background of long-term chronic ischemia, sharp forms diseases.

Ischemic changes are usually recorded in the left side of the heart, as it experiences a much greater load than the right parts. The myocardium is thicker here, and good blood flow is needed to provide oxygen. Ischemia of the wall of the left ventricle usually forms the basis of ischemic heart disease, here the main events "unfold" in necrosis of the heart muscle.

Manifestations of myocardial ischemia

Clinical signs of cardiac ischemia depend on the degree of arterial damage and the course of the pathology. The most common type of ischemia is exertional angina, when pain occurs at the time of physical exertion. For example, a patient climbed the stairs, ran, and the result is chest pain.

The symptoms of angina pectoris are:

• Pain in the region of the heart, behind the sternum, extending into the left arm, interscapular region, increasing or appearing with physical exertion;
• Shortness of breath with fast walking, emotional overload.

If these symptoms last up to half an hour, are relieved by taking nitroglycerin, occur during exertion, then they talk about exertional angina. When complaints appear spontaneously, at rest, we are talking about rest angina. Worsening pain, decreased resistance to stress, poor drug effects can be a sign of progressive angina.

Myocardial infarction is a very severe form of ischemia, which is manifested by burning, severe chest pain due to necrosis of cardiomyocytes. The patient is restless, there is a fear of death, possibly psychomotor agitation, shortness of breath, cyanosis of the skin, interruptions in the rhythm of heart contractions are possible. In some cases, necrosis is not quite typical - with pain in the abdomen, completely without pain.

Another manifestation of cardiac ischemia can be arrhythmia - atrial fibrillation, intracardiac conduction disturbances in the form of blockages, tachycardia. In this case, patients feel interruptions in the activity of the heart, heart palpitations or a feeling of fading.

The most dangerous variant of coronary heart disease is sudden cardiac death, which can occur against the background of an attack of angina pectoris, necrosis, arrhythmia. The patient loses consciousness, heart and breathing stops. This condition requires immediate resuscitation measures.

In advanced stages of ischemia of the heart, signs of heart failure increase, cyanosis of the skin and mucous membranes appears, edema first on the limbs, then fluid accumulates in the body cavities (chest, abdominal, pericardial). The patient complains of weakness, severe shortness of breath, is forced to take a half-sitting or sitting position.

Diagnosis and treatment of myocardial ischemia

Diagnosis of coronary heart disease is based on clarification of complaints, features of the course of the disease, the relationship of symptoms with exercise. The doctor listens to the lungs, where wheezing often appears due to congestion, palpation of the liver may show its increase in chronic heart failure. Auscultation of the heart makes it possible to diagnose the presence of additional murmurs, rhythm disturbances.

There are no reliable signs that make it possible to make a diagnosis during the examination, therefore, laboratory and instrumental tests are additionally carried out. The patient is prescribed biochemical analysis blood with a study of the lipid spectrum, it is mandatory to conduct an ECG, including with exercise (bicycle ergometry, treadmill). A large amount of information can be obtained from Holter monitoring.

On ECG signs ischemia is considered a decrease or elevation of the ST segment more than 1 mm. Registration of arrhythmias, blockades of impulse conduction is possible. A large-focal infarction is characterized by the presence of a deep Q wave, changes in the T wave in the form of a sharp rise in the most acute stage, it is negative in the acute and subacute period.

various forms of ischemia on the ECG

For laboratory confirmation of heart attack, a number of studies are carried out. So, general analysis blood will show an increase in ESR, leukocytosis, which indicate an inflammatory response to necrosis. Analysis of protein fractions makes it possible to establish an increase in some of them (ALT, AST, CPK, troponins, myoglobin, etc.). It is worth noting that such informative indicators as the level of troponins, myoglobin, cardiac fractions of CPK are determined by far not in all institutions due to the lack of equipment, therefore, patients resort to the help of private clinics, and sometimes even remain without analysis.

To clarify the state of the coronary arteries, coronary angiography, contrast-enhanced CT, MSCT, scintigraphy are performed, which are especially necessary for painless ischemia.

Treatment of cardiac ischemia depends on the form of the disease, the patient's condition, and concomitant pathology. When different types IHD is different, but its principles still remain unchanged.

The main directions of therapy for cardiac ischemia:

• Limitation of physical and emotional stress while maintaining sufficient physical activity (walking, feasible gymnastics);
• A diet aimed at normalizing fat and carbohydrate metabolism (the same as in atherosclerosis - restricting animal fats, carbohydrates, the predominance of fruits, vegetables, dairy products, fish in the diet); decrease in body weight with obesity by reducing the calorie content of food and its volume;
• Drug therapy, including diuretics, beta-blockers, calcium antagonists, nitrates for pain attacks, antiplatelet agents.

Drug therapy is the most important and mandatory component of the treatment of myocardial ischemia. Scroll medicines is selected individually, and the patient must strictly follow all the recommendations of the cardiologist.

All patients with ischemic heart disease take antiplatelet agents. The high efficiency of acetylsalicylic acid in small doses has been proven, on the basis of which drugs that are safe for long-term use have been created (thrombosis, aspirin cardio, cardiomagnyl). In some cases, anticoagulants are prescribed (warfarin), in case of myocardial infarction, heparin is administered.

Beta-blockers are also considered the main group of agents in the treatment of myocardial ischemia. They reduce the frequency of heart contractions and its need for oxygen, prolong the life of patients. The most common are metoprolol, bisoprolol, carvedilol.

Given the violation of the lipid spectrum, statins and fibrates are prescribed, which reduce the amount of atherogenic cholesterol fractions (LDL, VLDL) and increase anti-atherogenic (HDL). Lovastatin, simvastatin, clofibrate, fenofibrate are used.

Nitrates (nitroglycerin) are effective in relieving pain attacks. They are used in tablets or injectable forms... A side effect is a decrease blood pressure, dizziness and fainting, so hypotensive patients should be extremely careful.

Diuretics are necessary for the elimination of fluid that creates unnecessary stress on the myocardium. Loop (furosemide), thiazide (indapamide) diuretics are used.

ACE inhibitors are included in most treatment regimens for myocardial ischemia, since they not only maintain blood pressure at normal levels, but also relieve arterial spasm. Prescribed lisinopril, capropril, enap.

For arrhythmias, antiarrhythmic drugs are indicated. In cases of tachycardia, beta-blockers will be effective, in other forms - amiodarone, cordarone.

With severe coronary artery disease, when drug treatment does not lead to the desired result, they resort to surgical correction of vascular changes. Endovascular techniques are used (balloon angioplasty, stenting), as well as more radical surgery - coronary artery bypass grafting.

The prognosis for heart ischemia is always serious, most of patients become disabled, there is still a high risk of complications and death. Given the widespread prevalence of ischemia itself, and the factors leading to its appearance, as well as high level disability among patients, the problem does not lose its relevance, and the attention of specialists is focused on finding new effective ways treatment and prevention of an insidious disease.

Myocardial changes on the ECG - what does it mean for the diagnosis

The ECG can diagnose most heart pathologies. The reasons for their appearance are due to concomitant diseases and the characteristics of the patient's lifestyle.

What does this mean if myocardial changes were found on the ECG? In most cases, the patient requires conservative treatment and lifestyle correction.

Description of the procedure

The electrocardiogram (ECG) is one of the most informative, simple and affordable cardiac studies. It analyzes the characteristics of the electrical charge that stimulates the contractions of the heart muscle.

Dynamic recording of charge characteristics is carried out on several muscle sites. The electrocardiograph reads information from electrodes placed on the ankles, wrists and chest skin in the area of \u200b\u200bthe heart projection and converts them into graphs.

Norm and deviations - possible causes

Normally, the electrical activity of the areas of the myocardium, which is recorded by the ECG, should be uniform. This means that intracellular biochemical exchange in heart cells occurs without pathologies and allows the heart muscle to produce mechanical energy for contractions.

If the balance in the internal environment of the body is disturbed for various reasons, the following characteristics are recorded on the ECG:

• diffuse changes in the myocardium;
• focal changes in the myocardium.

The reasons for such changes in the myocardium on the ECG can be both harmless conditions that do not threaten the life and health of the subject, and serious dystrophic pathologies that require urgent medical attention.

• rheumatism as a consequence of scarlet fever, tonsillitis, chronic tonsillitis;
• complications of typhus, scarlet fever;
• consequences of viral diseases: influenza, rubella, measles;
• autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.

One of the reasons for changes in muscle tissue can be cardiodystrophy - a metabolic disorder in heart cells without damage to the coronary arteries. Lack of nutrition of cells leads to a change in their normal life, impaired contractility.

• The ingestion of toxic metabolic products into the blood due to severe impaired renal and liver function;
• Endocrine diseases: hyperthyroidism, diabetes mellitus, adrenal tumor, and, as a result, excess hormones or metabolic disorders;
• Constant psycho-emotional stress, stress, chronic overwork, starvation, unbalanced diet with nutritional deficiencies;
• Children have a combination of increased loads with a sedentary lifestyle, vegetative-vascular dystonia;
• Lack of hemoglobin (anemia) and its consequences - oxygen starvation of myocardial cells;
• Severe infectious diseases in acute and chronic form: influenza, tuberculosis, malaria;
• Dehydration of the body;
• Avitaminosis;
• Alcohol intoxication, occupational hazards.

Definition by cardiogram

With diffuse lesions of the heart, deviations from the normal picture are noted in all leads. They look like numerous areas with impaired conduction of electrical impulses.

This is expressed on the cardiogram as a decrease in the T waves, which are responsible for repolarization of the ventricles. With focal lesions, such deviations are recorded in one or two leads. These deviations are plotted as negative T waves in the leads.

If focal changes are represented, for example, by scars remaining in the connective tissue after a heart attack, they appear on the cardiogram as electrically inert areas.

Diagnostics

Deciphering electrocardiogram data takes 5-15 minutes. Her data can reveal:

• The size and depth of the ischemic lesion;
• Localization of myocardial infarction, how long ago it happened in the patient;
• Electrolyte metabolism disorders;
• Enlargement of cardiac cavities;
• Thickening of the walls of the heart muscle;
• Intracardiac conduction disorders;
• Heart rhythm disorders;
• Toxic myocardial damage.

Features of diagnosis for various pathologies of the myocardium:

• myocarditis - the cardiogram data clearly shows a decrease in teeth in all leads, a violation of the heart rhythm, the result of a general blood test shows the presence of an inflammatory process in the body;
• myocardial dystrophy - ECG indicators are identical to those obtained with myocarditis, this diagnosis can only be differentiated using laboratory data (blood biochemistry);
• myocardial ischemia - ECG data show changes in the amplitude, polarity and shape of the T wave, in those leads that are associated with the ischemic zone;
• acute myocardial infarction - horizontal displacement of the ST segment upward from the isoline, trough-shaped displacement of this segment;
• cardiac muscle necrosis - irreversible death of myocardial cells is reflected in the ECG graph as a pathological Q wave;
• transmural necrosis is an irreversible damage to the wall of the heart muscle throughout its thickness, expressed in the cardiogram data, as the disappearance of the R wave and the acquisition of the QS type by the ventricular complex.

When making a diagnosis, you should additionally pay attention to the symptoms of concomitant diseases. It can be pain in the heart during myocardial ischemia, edema of the legs and arms with cardiosclerotic changes, signs of heart failure as a result of a heart attack on the legs, tremors of the hands, dramatic weight loss and exophthalmos with hyperthyroidism, weakness and dizziness with anemia.

The combination of such symptoms with diffuse changes detected on the ECG requires an in-depth examination.

What diseases do they accompany

Pathological changes in the myocardium, identified on the ECG, may be accompanied by impaired blood supply to the heart muscle, repolarization processes, inflammatory processes and other metabolic changes.

A patient with diffuse changes may show the following symptoms:

• dyspnea,
• chest pain
• increased fatigue,
• cyanosis (blanching) of the skin,
• heart palpitations (tachycardia).

Diseases accompanied by changes in the heart muscle:

• Myocardial dystrophy - violation of biochemical metabolic processes in the heart;
• Allergic, toxic, infectious myocarditis - inflammation of the myocardium of various etiology;
• Myocardiosclerosis - replacement of heart muscle cells with connective tissue, as a consequence of inflammation or metabolic diseases;
• Water-salt metabolism disorders;
• Hypertrophy of parts of the heart muscle.

To differentiate them, additional examinations are required.

Additional diagnostic tests

Cardiogram data, despite their informativeness, cannot be the basis for an accurate diagnosis. In order to fully assess the degree of changes in the myocardium, additional diagnostic measures are prescribed by the cardiologist:

• General clinical blood test - the level of hemoglobin and such indicators of the inflammatory process as the level of leukocytes in the blood and ESR (erythrocyte sedimentation) are assessed;
• Analysis for blood biochemistry - the indicators of the content of protein, cholesterol, glucose are estimated to analyze the work of the kidneys, liver;
• General clinical urine analysis - indicators of kidney function are assessed;
• Ultrasound in case of suspected pathology of internal organs - according to indications;
• Daily monitoring of ECG indicators;
• Exercise ECG;
• Ultrasound of the heart (echocardiography) - the state of the heart is assessed to determine the cause of myocardial pathology: expansion (dilation), hypertrophy of the heart muscle, signs of a decrease in myocardial contractility, impairment of its motor activity.

Treatment for focal and diffuse disorders

In the treatment of myocardial pathologies, various groups of drugs are used:

• Corticosteroid hormones - as an anti-allergic agent;
• Cardiac glycosides - for the treatment of diffuse changes in the myocardium, manifestations of heart failure (ATP, Cocarboxylase);

Diuretics - for the prevention of edema;

Means for improving metabolism (Panangin, Magnerot, Asparkam);

Antioxidants (Mexidol, Actovegin) - to eliminate the negative effect of lipid oxidation products;

Antibiotics - for anti-inflammatory therapy;

Drugs for the treatment of concomitant diseases;

Vitamin preparations.

If conservative treatment does not lead to significant improvements in the patient's condition with myocardial diseases, he undergoes an operation to implant a myocardial pacemaker.

The main provisions of dietary nutrition:

• Salt and excess fluid intake is limited to a minimum;
• Spicy and fatty foods are not recommended;
• The menu should include vegetables, fruits, lean fish and meat, dairy products.

Changes in the myocardium detected on the ECG require additional laboratory and instrumental examination. If necessary, a cardiologist will prescribe treatment in a hospital or on an outpatient basis. Timely measures taken will help to avoid serious complications.

Myocardial ischemia of the heart muscle

According to statistics, more than half of elderly men and about a third of women suffer from various heart diseases. Myocardial ischemia is one of the most common pathologies, it is widespread both in highly developed countries and in those where the level of medicine leaves much to be desired.

The particular danger of this disease lies in the fact that it can proceed in a latent form for years, only occasionally manifesting itself as unpleasant sensations in the region of the heart, and subsequently causes a massive heart attack and sudden death.

So, let's figure out what it is - myocardial ischemia, and what types of pathology are there.

Heart damage in myocardial ischemia

Typically, the disease is classified as follows:

• Angina pectoris is the most common form of ischemia. It is usually asymptomatic, it is diagnosed mainly in elderly people. People with prerequisites for atherosclerosis are especially susceptible to this pathology.
• Myocardial infarction is one of the most severe and irreversible manifestations of ischemia. This condition is a necrosis of areas of the myocardium due to an acute lack of oxygen, and is often the cause of death. But even with successful healing of the necrotic focus, a scar will still remain in its place (postinfarction cardiosclerosis).
• Cardiac arrhythmias are disruptions in the normal functioning of the heart, in which it stops contracting with the proper frequency.
• Sudden coronary death.
• Postinfarction cardiosclerosis.
• Heart failure.

In any case, myocardial ischemia causes the gradual development of pathological changes in the heart. Such patients are especially at risk of blood clots in the vessels of the limbs, kidneys or brain.

A special form of pathology is transient ischemia of the heart muscle. This disease occurs in approximately 1/2 of the patients suffering from ischemic heart disease, while it does not manifest itself at all externally - deviations can be detected only with the help of instrumental examination. Most often, this pathology develops in smokers, hypertensive patients and patients with congestive heart failure.

The main symptom by which one can suspect ischemic heart disease is pain that occurs in both chronic and acute forms of pathology.

The heart is an organ that works without interruption, pumping a huge amount of blood through the body, and expending a large amount of nutrients and oxygen. And suddenly arising vascular spasms, blood clots and atherosclerotic plaques interfere with normal blood circulation, resulting in pain and pathological changes.

Ischemia of the left ventricular myocardium is usually the basis of all ischemic heart diseases, since the left side of the organ has a much greater load than the right one, and for its normal supply of oxygen, invariably good blood circulation is needed.

Causes

The causes of myocardial ischemia can be very diverse, but among the main provocateurs it is customary to single out the elderly age of patients, belonging to male sex, genetic predisposition, diabetes mellitus, obesity, smoking, hypertension, hypodynamia and metabolic disorders.

Smoking as one of the causes of heart ischemia

Of course, people of venerable age are the main patients of cardiology departments, since over the years in the body metabolic processes deteriorate, various diseases, begin dystrophic changes in the vessels. Although recently there has been a clear tendency for cardiac pathologies to rejuvenate, especially among residents of megacities.

In the female body, estrogens play a certain protective role, therefore, in the fair sex, myocardial ischemia occurs much less often than in men. However, around the age of 70, when the period of persistent menopause begins, the chances of getting sick are equal for both sexes.

Obesity entails a huge number of pathologies, since it causes the deposition of lipid formations on the arterial walls, as a result of which blood circulation is impeded and hypoxia (oxygen starvation) of the heart tissues begins. The situation is further aggravated by the presence of diabetes mellitus in a patient.

All of these factors provoke the emergence of the main causes of lack of oxygen - vasospasm, blood clots, atherosclerosis.

Symptoms

Symptoms of myocardial ischemia largely depend on the type of disease and the degree of arterial lesion. The most common type of disease is the so-called exertional angina, when pain in the region of the heart appears after any physical effort.

Signs of angina pectoris are:

• Pain in the chest region, which radiates to the left arm and the area between the shoulder blades, and appears or intensifies during physical exertion.
• Shortness of breath with emotional strain or brisk walking.

If the listed signs and symptoms occur only at moments of exertion, last no more than half an hour and are removed with nitroglycerin, they speak of exertional angina. In the case when pain occurs without apparent reason, we can talk about the so-called rest angina. If the pain tends to intensify from case to case, the effect of medication is gradually lost and resistance to physical exertion decreases, they speak of a progressive form of pathology.

Pain in the heart is the main symptom of ischemia

Myocardial infarction is an extremely severe ischemic manifestation that makes itself felt very severe pain in the retrosternal region. A person becomes restless, he has shortness of breath, the skin becomes cyanotic, there is a fear of death and psychomotor agitation. In rare cases, the patient begins to have a stomach ache, and there are no direct manifestations of a heart attack.

A very dangerous variant of ischemia is sudden cardiac death, which occurs against the background of cardiac arrhythmia, an attack of angina pectoris or necrosis. This condition requires urgent resuscitation measures.

Diagnostics

Diagnosis of myocardial ischemia is carried out by examining and interviewing the patient, listening to the heart and lungs, on the basis of which the doctor may suspect the diagnosis. To confirm or refute it, the patient is assigned a number of additional studies: electrocardiogram in a calm state and with stress, biochemical blood test, Holter monitoring.

To clarify the diagnosis, examinations such as coronary angiography, MSCT, contrast-enhanced CT and scintigraphy are also performed. Unfortunately, due to the lack of the necessary equipment, some of the studies are not available in all medical institutions, therefore, for their implementation, patients are forced to go to private clinics.

ECG procedure to clarify the diagnosis of myocardial ischemia

Treatment

Treatment of myocardial ischemia is prescribed individually for each patient, and depends on the severity of the pathology, the patient's condition, the presence or absence of concomitant diseases. At the same time, the basic principles of therapy in all cases remain unchanged.

First of all, the treatment of ischemic diseases involves:

• Moderate physical activity (exercise, walking) and the exclusion of excessive overload.
• Compliance with a special diet (the same as prescribed for atherosclerosis), aimed at improving metabolism. If the body weight is significantly higher than the norm, it must be reduced by reducing the amount of food and reducing its calorie content.
• Medication therapy, medications for which are prescribed by the doctor individually.

All patients, without exception, are prescribed antiplatelet agents - acetylsalicylic acid, on the basis of which they are created, shows excellent results in the fight against pathology. If necessary, the doctor additionally prescribes the use of anticoagulants. With a heart attack, heparin is required.

Beta-blockers are considered very important drugs, which allow to regulate the heart rate and reduce the need for oxygen, thereby increasing the life expectancy of patients.

Fibrates and statins help to reduce the content of atherogenic cholesterol fractions, while increasing the number of antiatherogenic ones.

Nitroglycerin is very effective in relieving pain symptoms. It is used both in tablet form and in injections. However, this drug must be used with extreme caution in hypotensive patients, since it side effects can become a sharp drop in pressure, fainting and dizziness.

To remove excess fluid, which creates a load on the myocardium, diuretics are used - thiazide, diuretic and loop drugs.

Almost all treatment regimens for ischemic diseases include ACE inhibitors, since they relieve vascular spasms and normalize blood pressure, stabilizing its values.

If the patient has a cardiac arrhythmia, he is prescribed antiarrhythmic drugs. For tachycardia, beta-blockers will be required, for other forms, cordarone or amiodarone.

In the event that the arteries are very severely affected, and drug therapy does not have the desired effect, surgical correction is carried out. Both more gentle techniques (stenting or balloon angioplasty) and radical (coronary artery bypass grafting) are used.

Ischemic heart disease always has an extremely serious prognosis. The overwhelming majority of people as a result of this pathology acquire disability, the risk of complications and even death is extremely high. Due to the widespread prevalence of the disease, experts make every possible effort to find the best way treatment of pathology and its successful prevention.

Minor deviations from the norm in the structure of the heart can be detected in every second person. They are the result of various pathological processes, especially of an inflammatory nature. In a child, a similar problem often occurs during puberty, and in older people, due to age changes of cardio-vascular system. They are revealed mainly by accident during a routine examination. Knowingly worry about the presence of moderate changes in the myocardium, not knowing what it is, is not worth it. They usually do not affect the body in any way and do not appear, but a person will have to be fully examined to determine the causative factor and change their lifestyle.

Pathological abnormalities in the structure of the heart mainly occur in its lower part (in the left ventricle). If they are not particularly pronounced, are not a consequence of cardiological pathology and do not progress, then often the clinical picture is absent. On an ECG (electrocardiogram), such changes do not always appear. It is possible to identify them mainly with a more detailed examination.

More pronounced diffuse changes are manifested by characteristic cardiac symptoms. You can see their list below:

• pain in the chest (angina pectoris), provoked by ischemia of the heart;
• a feeling of shortness of breath and the appearance of edema - characteristic of cardiosclerosis;
• dizziness and signs of asthenia (weakness) occur with anemia.

Patients often show symptoms of chronic heart failure after experiencing myocardial infarction. In more rare cases, the cause is dysfunction. thyroid gland... She begins to produce significantly more than the required amount of hormones, which leads to the following symptoms:

• tremors (tremors) of the limbs;
• weight loss;
• bulging (forward displacement) of the eyes, characteristic of exophthalmos.

The resulting symptoms gradually progress. The patient's quality of life will decrease until the appearance of shortness of breath after any physical activity, due to which the ability to work significantly decreases. If moderate changes in the left ventricular myocardium manifested themselves against the background of heart failure, then over time, a person may lose the ability to independently carry out daily activities. To prevent such complications, it is necessary to be fully examined in order to identify the cause of the pathological abnormalities in the structure of the heart. Treatment will be aimed at eliminating it and alleviating the general condition.

Varieties of pathological changes

Changes in the structure of the heart muscle are divided into several types, depending on the factor that influenced their development.

Genesis (cause of development) and localization of the listed types of deviations are different. By size, they are divided into diffuse and focal changes in the myocardium. The first type is diagnosed most often. It is characterized by the defeat of all parts of the heart. Focal deviations are isolated areas. In both cases, the altered sites are gradually replaced by connective tissue that does not transmit electrical impulses. It will no longer be possible to reverse the process at this stage.

Causes of abnormalities in the structure of the myocardium

In each case, there are reasons for the occurrence of deviations in the structure of the myocardium. They have a detrimental effect on the heart and blood vessels. Inflammatory changes appear in the patient due to myocarditis. The disease is of an infectious nature and aseptic, that is, caused without the help of microorganisms. Diffusely located lesions develop due to the influence of such factors:

• Rheumatism affecting connective tissues. The cause of the development of pathology is ingestion streptococcal infection... It occurs after tonsillitis, tonsillitis, scarlet fever and other similar diseases.
• Typhus, caused by the bacteria rickettsia. It is characterized by damage to the nervous and cardiovascular systems.
• Viral infections, which are characterized by complications of the heart muscle. Measles, rubella and influenza are especially common.
• Autoimmune disruptions caused by lupus erythematosus and rheumatoid arthritis, provoking complications in the heart muscle.

Cicatricial abnormalities in the structure of the myocardium are manifested mainly for the following reasons:

• The prolonged course of cardiac ischemia leads to an increase in the activity of fibroblastates. They provoke the proliferation of connective tissue.
• A heart attack appears as a scar. If its extensive form has been experienced, then necrosis affects the volumetric area of \u200b\u200bthe myocardium.
• Postponed operations on the heart muscle leave a trace in the form of a piece of connective tissue at the site of intervention.

Dystrophy of the tissues of the heart muscle is manifested mainly due to the failure of metabolic processes in cardiomyocytes of a non-inflammatory nature. The changes are aggravated gradually against the background of the development of other pathologies.

Heart cells lack vital elements for normal functioning, due to which they are depleted and arrhythmias occur. In medicine, myocardial dystrophy is also called cardiac dystrophy. The most current list of reasons for its occurrence is as follows:

• Constant failures in the work of the liver and kidneys lead to the development of failure of these organs. Toxic substances begin to accumulate in the blood, due to which the metabolic processes throughout the body.
• Diseases of the endocrine organs (pancreas and thyroid glands, adrenal glands) provoke excessive production of hormones. They affect the entire body, especially the cardiovascular system.

• Anemia is manifested due to an acute deficiency of hemoglobin in the blood. Lack of this iron-containing protein often causes myocardial dystrophy.
• Various irritating factors (stress, overwork, overeating or dieting) gradually provoke depletion of the heart muscle.
• AT childhood the problem arises due to a combination of psycho-emotional overload and insufficient physical activity. In a child, these factors provoke the development of vegetative-vascular dystonia, which disrupts the normal regulation of the heart due to disruptions in the autonomous department. nervous system.
• Diseases caused by infections (tuberculosis, flu, malaria) can drain the body and adversely affect all its systems.
• Fever and its inherent dehydration overload the heart and blood vessels and provoke degeneration due to a lack of nutrients.
• Acute intoxication caused by alcohol, medicines and chemicals, or chronic, caused by poor ecology or at work, lead to depletion of the body.

The most commonplace and common cause of heart dystrophy is a lack of nutrients in the body due to an improperly composed diet. Sometimes it is provoked by the following diseases:

• atherosclerosis;
• ischemia;
• hypertonic disease;
• arrhythmia;
• myocardial hypertrophy.

Metabolic abnormalities are triggered by malfunctions at the cellular level. They are manifested by impaired metabolism of potassium and sodium in cardiomyocytes, as a result of which the heart does not receive the required energy for full contraction and relaxation. If the changes that have arisen are not serious and arise due to overwork, obesity, stress and hormonal surges (during pregnancy, during puberty), then we are talking about a nonspecific lesion. They are also provoked by malfunctions in the metabolism of cardiomyocytes. Severe metabolic disorders in heart cells are manifested due to the influence of the following factors:

• hypertension;
• cardiomyopathy;
• acute rheumatic fever;
• cardiosclerosis;
• angina pectoris.

It is considered a completely natural phenomenon if the left ventricle of the heart is slightly altered in children or elderly people. In the first case, the problem lies in the restructuring of the body associated with active growth and an imperfect metabolic process. In aged patients, deviations in the structure of the myocardium are permissible due to aging and wear and tear of all tissues.

Diagnostic and treatment methods

Treatment by a cardiologist is made only on the basis of the results of the examination. If the patient does not have a dangerous cardiac pathology, then the doctor may advise taking vitamin complexes, especially in autumn and winter, to control the pressure level and correct the lifestyle. If there is suspicion of the secondary nature of myocardial changes, that is, development under the influence of other diseases, the following diagnostic methods will be prescribed:

• Blood donation to determine the amount of hemoglobin, check the level of leukocytes and erythrocyte sedimentation rate.
• Study of the composition of urine to assess the condition of the kidneys.
• Performing a biochemical blood test to determine the level of protein, sugar and cholesterol.
• Daily ECG monitoring with and without exercise to assess the condition of the heart.
• Performance ultrasound examination (Ultrasound) of internal organs for the presence of abnormalities in their structure.
• Examination of the heart muscle using an echocardiograph to visualize its sections and determine the cause of myocardial changes.
• Using electrocardiography (ECG) to detect any abnormalities in the heart rhythm, as well as in its conduction and structure.

Having received all the necessary data, the doctor will assess the patient's condition. If the reason is not only in the heart, then he will advise you to consult with other specialists (endocrinologist, gastroenterologist, hematologist) to draw up complex treatment... An important advantage of a timely started course of therapy is a high chance of eliminating pathological changes. In fact, in 90% of cases, myocardial cells are able to recover completely.

Even if modern methods diagnostics could not help identify the cause of the problem, then treatment is aimed at achieving the following goals:

• stop the clinical picture of heart failure;
• to secure cardiomyocytes and restore their functions;
• normalize metabolic processes in the heart.

The following groups of drugs are commonly used in the treatment of heart failure:

• Cardiac glycosides ("Strofantin", "Digitoxin") increase vascular tone, eliminate arrhythmias, shorten the contraction phase of the heart muscle and improve its nutrition.

• Antiarrhythmic drugs ("Amiodarone", "Dofetilide") block beta and alpha-adrenergic receptors, improve myocardial nutrition and have a coronary dilating effect.
• Diuretics (Lasix, Britomar) reduce venous return to the heart and remove excess moisture from the body, lowering blood pressure.

To stimulate metabolic processes, doctors prescribe the following drugs based on nutrients:

• "Cocarboxylase" (coenzyme);
• Doppelgerts Active, Asparkam (magnesium, potassium);
• "B-Complex", "Neurobion" (vitamins of group B);
• "Preductal", "Mexidol" (antioxidants);
• "Riboxin" (metabolic agent).

As an addition to the main treatment regimen, the following drugs may be required:

• hypotensive;
• sedatives;
• hormonal (with endocrine disruptions);
• antiallergic;
• antibacterial.

Folk remedies are often introduced into the treatment regimen for myocardial changes, as they saturate the body essential substances and calm the nervous system. Decoctions on the following herbs are most relevant:

• hawthorn;
• melissa;
• motherwort;
• peppermint;
• cranberry;
• pion;
• rosehip.

Compliance with a healthy lifestyle

Comprehensive treatment of any pathology consists not only in taking medications, but also in a properly selected diet. In the presence of moderate changes in the myocardium, it is recommended to adhere to the following rules:

• overeating or starving is not recommended;
• the daily amount of salt consumed should not exceed 5 g;
• it is imperative to add vegetables and fruits to your diet;
• the daily menu should contain only low-fat varieties of fish and meat;
• you need to eat 4-5 times a day, and the last meal should be taken 3-4 hours before bedtime;
• it is advisable to completely abandon fatty foods;
• it is recommended to cook steamed or by boiling.

The rules will help normalize metabolic processes in cardiomyocytes healthy way lives, which are given below:

• sleep at least 6-8 hours a day;
• to refuse from bad habits;
• try to avoid stressful situations;
• exercise at a moderate pace without overload.

Forecast

Moderate changes in the structure of the heart muscle are not a pathology. They are a consequence of the influence of other diseases, therefore, with the timely elimination of the cause, the process can be reversed without harm to health. The prognosis will improve if you follow all the doctor's recommendations and do not allow the condition to worsen, since cardiomyocytes will take time to full recovery... In mild cases, it is possible to cure without drug therapy.

Less optimistic prognosis with a combination of moderate changes with signs of heart failure. The process can be completely reversed if the muscle tissues of the myocardium have not yet been replaced by connective tissues that do not transmit electrical signals. Doctors usually prescribe medications that improve metabolic processes and give recommendations for correcting nutrition and rest.

Serious diffuse changes cause development dangerous forms heart failure and cardiosclerosis. It is impossible to eliminate them completely. Treatment consists in attempts to stop the pathological process and improve the patient's quality of life.

Moderate changes in the myocardium are among the common pathological abnormalities in the structure of the heart muscle. In most cases, they do not lead to anything and do not appear. The problem is found mainly during a routine inspection. As a means of treatment, the doctor prescribes drugs that improve metabolic processes in cardiomyocytes and stabilize the work of the heart. If the case is neglected, then it is not possible to completely reverse the changes and the patient will have to take medications for life.

Myocardial ischemia is a pathological condition consisting in a lack of oxygen to the heart, which is manifested by angina pectoris, heart attack, and various changes in the rhythm of contractions. Ischemia is based on atherosclerosis, thrombus formation or spasm of the heart arteries.

Myocardial ischemia forms the basis - the most common pathology of the cardiovascular system in humans. According to statistics, at least half of elderly men and a third of women suffer from it, and mortality from various forms of ischemia reaches 30%.

The disease has no geographic boundaries, is common in both developing and developed countries with a high level of medicine. For a long time, IHD can be asymptomatic, only occasionally making itself felt by unpleasant sensations in the region of the heart.

Painless myocardial ischemia is of great importance. The disease does not manifest itself in any way for many years, but it can cause extensive heart attack and sudden death. According to some reports, this form of pathology affects up to 20% of practically healthy people, but with risk factors.

Causes and types of heart ischemia

The reasons that lead to ischemic changes in the heart muscle have not been heard except by the lazy one. Among the main risk factors are:

• Elderly age;
• Male gender;
• Hereditary predisposition (familial dyslipidemia);
• Smoking;
• Comorbidity such as being overweight
• Hypodynamia.

Elderly patients are the main contingent of cardiology departments. This is not accidental, because with age, dystrophic processes occur in the vessels, metabolic disorders are aggravated, and concomitant pathology joins. It should be noted that in recent years ischemia has been showing clear signs of "rejuvenation", especially among residents of large cities.

Women, due to hormonal characteristics, are less prone to heart ischemia, since estrogens have a kind of protective effect, however, by about 70 years old, when persistent menopause occurs, their incidence rates are equated to those of men. The lack of estrogen predetermines the earlier development of atherosclerosis and, accordingly, ischemic heart damage in men.

Violation of fat metabolism causes the deposition of lipid formations on the walls of the arteries, which impede blood flow and lead to oxygen starvation of the heart tissues. These phenomena are significantly aggravated by general obesity and diabetes mellitus. Hypertension with crises contributes to damage to the inner lining of the arteries and the circular deposition of fat in them, which causes a significant deficit in blood flow.

The listed factors lead to the appearance of direct causes of lack of oxygen in the heart:, vasospasm,.

causes of impaired coronary blood flow and subsequent myocardial ischemia

Varieties of myocardial ischemia according to the International Classification of Diseases are as follows:

1. Sudden coronary death.
2. due to a previous heart attack.

Angina pectoris - the most common form of ischemia of the heart, which is diagnosed in the majority of elderly people who do not even present complaints (asymptomatic form). The absence of pain should not be soothing, especially in persons with concomitant diseases predisposing to atherosclerosis and susceptible to risk factors.

Heart attack - this is myocardial necrosis, when an acute lack of oxygen leads to the death of cardiomyocytes, impaired cardiac activity with a high risk of death. A heart attack is one of the most severe and irreversible manifestations of ischemia. After the healing of the necrosis focus, a dense scar remains at the site of injury (postinfarction cardiosclerosis).

With a significant amount of necrotization, they speak of a large-focal infarction, often it penetrates the entire thickness of the heart muscle (transmural infarction). Small foci of necrosis can be found under the membranes of the heart. Subepicardial ischemia occurs under the outer shell (epicardium), subendocardial ischemia - inside, under the endocardium.

forms of myocardial necrosis (infarction) due to ischemia and their reflection on the ECG

All forms of ischemia sooner or later lead to depletion of compensatory mechanisms, structural changes and a steadily increasing heart failure. Such patients have a high risk of damage to the brain, kidneys, and extremities. Thrombi especially often appear with subendocardial ischemia, when the inner layer of the heart is involved.

A special form of the disease is the so-called transient, or painless, mute, ischemia of the heart muscle. It occurs in about half of patients with coronary artery disease, does not give any symptoms, however, changes in myocardial cells still occur and they can be detected, for example, using an ECG.

Transient ischemia of the heart is significantly more common among hypertensive patients, smokers, patients with congestive heart failure. Without exception, all patients with a mute form of pathology have a lesion of the great vessels of the heart, multiple severe atherosclerosis, a large length of narrowing areas. It is still not clear why painless ischemia occurs with significant vascular damage, but perhaps this is due to the good development of collateral blood flow.

What happens in the heart during ischemia?

The main symptom of ischemic heart disease is considered to be pain syndrome, which occurs both in the chronic course of the disease, and in its acute forms. The appearance of pain is based on irritation of nerve receptors by metabolic products that are formed under conditions of hypoxia. The heart works continuously, pumping colossal volumes of blood, so the costs of oxygen and nutrients are very high.

Blood to the heart muscle enters through the coronary vessels, and collateral blood flow to the heart is limited, therefore, when the arteries are damaged, the myocardium always suffers. Atherosclerotic plaque, thrombus, sudden vasospasm create an obstacle to blood flow, as a result of which muscle cells do not receive the blood they supply, pain and characteristic structural changes in the myocardium appear.

In cases of chronic myocardial ischemia, usually with atherosclerosis, the heart muscle "starves" constantly, against this background, the stimulation of fibroblast cells that form connective tissue fibers occurs, and develops cardiosclerosis... The involvement of conductive nerve bundles promotes arrhythmias.

Vascular catastrophes in thrombosis, plaque rupture, spasm are accompanied by complete and sudden cessation of blood flow through the vessels, blood does not reach the heart muscle, and acute myocardial ischemia "pours out" into a heart attack - necrosis of the heart muscle. Often, against the background of long-term chronic ischemia, acute forms of the disease occur.

Ischemic changes are usually recorded in the left side of the heart, since it is experiencing a much greater load than the right parts. The myocardium is thicker here, and good blood flow is needed to provide oxygen. Ischemia of the wall of the left ventricle usually forms the basis of ischemic heart disease, here the main events "unfold" in necrosis of the heart muscle.

Manifestations of myocardial ischemia

Clinical signs of cardiac ischemia depend on the degree of arterial damage and the course of the pathology. The most common type of ischemia is exertional anginawhen pain appears at the time of physical effort. For example, a patient climbed the stairs, ran, and the result is chest pain.

Angina symptoms consider:

• Pain in the region of the heart, behind the sternum, extending into the left arm, interscapular region, increasing or appearing with physical exertion;
• Shortness of breath with fast walking, emotional overload.

If these symptoms last up to half an hour, are relieved by taking nitroglycerin, occur during exertion, then they talk about angina pectoris stresses... When complaints appear spontaneously, at rest we are talking about rest angina... Worsening pain, decreased resistance to stress, poor drug effects may be a sign progressive angina.

Myocardial infarction - a very severe form of ischemia, which is manifested by burning, severe chest pain due to necrosis of cardiomyocytes. The patient is restless, there is a fear of death, possibly psychomotor agitation, shortness of breath, cyanosis of the skin, interruptions in the rhythm of heart contractions are possible. In some cases, necrosis is not quite typical - with pain in the abdomen, completely without pain.

Another manifestation of ischemia of the heart can be -, disturbances of intracardiac conduction in the form of blockades, tachycardia. In this case, patients experience interruptions in the activity of the heart, a strong heartbeat or a feeling of fading.

The most dangerous variant of coronary heart disease is sudden cardiac death, which can occur against the background of an attack of angina pectoris, necrosis, arrhythmia. The patient loses consciousness, heart and breathing stops. This condition requires immediate resuscitation measures.

In the advanced stages of heart ischemia, signs of heart failure increase, cyanosis of the skin and mucous membranes appears, edema first on the limbs, then fluid accumulates in the body cavities (chest, abdominal, pericardial). The patient complains of weakness, severe shortness of breath, is forced to take a half-sitting or sitting position.

Diagnosis and treatment of myocardial ischemia

Diagnosis of coronary heart disease is based on clarification of complaints, features of the course of the disease, the relationship of symptoms with exercise. The doctor listens to the lungs, where wheezing often appears due to congestion, palpation of the liver may show its increase in chronic heart failure. Auscultation of the heart makes it possible to diagnose the presence of additional murmurs, rhythm disturbances.

There are no reliable signs that make it possible to make a diagnosis during the examination, therefore, laboratory and instrumental tests are additionally carried out. The patient is prescribed blood chemistry with the study of the lipid spectrum, it is mandatory to carry out, including - with exercise (bicycle ergometry, treadmill). A large amount of information can be obtained at.

ECG signs of ischemia are considered to be a decrease or elevation of the ST segment more than 1 mm. Registration of arrhythmias, blockade of impulse conduction is possible. A large-focal infarction is characterized by the presence of a deep Q wave, changes in the T wave in the form of a sharp rise in the acute stage, it is negative in the acute and subacute period.

For laboratory confirmation of heart attack, a number of studies are carried out. So, general blood analysis will show an increase in ESR, leukocytosis, which indicate an inflammatory response to necrosis. Protein analysis factions allows you to set the increase of some of them (troponins, etc.). It is worth noting that such informative indicators as the level of troponins, myoglobin, cardiac fractions of CPK are determined by far not in all institutions due to the lack of equipment, therefore, patients resort to the help of private clinics, and sometimes even remain without analysis.

To clarify the state of the coronary arteries, , CT with contrast, MSCT, especially necessary for painless ischemia.

Treatment of cardiac ischemia depends on the form of the disease, the patient's condition, and concomitant pathology. With different types of coronary artery disease, it differs, but its principles still remain unchanged.

The main directions of therapy for cardiac ischemia:

• Limitation of physical and emotional stress while maintaining sufficient physical activity (walking, feasible gymnastics);
• A diet aimed at normalizing fat and carbohydrate metabolism (the same as in atherosclerosis - restricting animal fats, carbohydrates, the predominance of fruits, vegetables, dairy products, fish in the diet); decrease in body weight with obesity by reducing the calorie content of food and its volume;
• Drug therapy, including diuretics, beta-blockers, calcium antagonists, nitrates for pain attacks, antiplatelet agents.

Drug therapy is the most important and mandatory component of the treatment of myocardial ischemia. The list of medicines is selected individually, and the patient must strictly follow all the recommendations of the cardiologist.

The prognosis for cardiac ischemia is always serious, most patients become disabled, the risk of complications and death is still high... Considering the widespread prevalence of ischemia itself, and the factors leading to its appearance, as well as the high level of disability among patients, the problem does not lose its relevance, and the attention of specialists is focused on finding new effective ways to treat and prevent an insidious disease.

The human heart muscle is a unique complex of cells that are capable of transforming the energy received as a result of biochemical processes into mechanical energy that causes the heart to contract. This type of activity depends on many factors that contribute to intracellular metabolism in the myocardium. Therefore, any shifts in the constancy of the internal environment of the body can be reflected in the disruption of the vital activity of the heart cells, whether it be heart disease, hormonal disorders in the body, or a condition after an infectious disease.

Diffuse changes in the myocardium are not a disease, but a syndrome, upon detection of which the doctor should determine what caused - serious illness or minor metabolic disorders. The appearance of such signs is due to the fact that part of the cells during biochemical shifts begin to work and contract not quite correctly, as a result of which the electrical activity of the heart muscle areas recorded on the ECG will not be uniform. In other words, diffuse changes in the myocardium are accumulations of altered cells through which the conduction of electrical impulses is impaired.

Disorders of cell activity can be not only diffuse, that is, covering areas in all parts of the heart, but also focal, for example, when small or large scars are formed in the myocardium. Scars are represented by connective tissue that cannot conduct impulses and is electrically inert, which is what the doctor sees on the cardiogram.

Why do myocardial changes occur?

The reason for such deviations on the cardiogram can be both harmless and quite serious, posing a threat to human life. In order to find out more precisely what exactly causes diffuse or focal changes in the myocardium, it is necessary to carefully examine the patient. Pathological changes in the myocardium can be caused by various processes, and therefore several subgroups are distinguished among them.

The causes of inflammatory changes are - infectious or aseptic (without the participation of microorganisms) inflammation of the heart muscle. As a rule, areas of inflammation are diffusely located, but they can also occur in the form of foci.

Myocarditis. The photo on the right is a cross-section of the heart. Arrows indicate diffuse inflammatory processes in the heart tissue in myocarditis

Myocarditis of varying severity occurs in diseases such as:

• Acute, caused hemolytic streptococci due to the transferred sore throat, scarlet fever or chronic tonsillitis,
• Diphtheria, typhus,
• Influenza, measles, rubella, Coxsackie viruses, etc.
• Autoimmune diseases, for example, rheumatoid arthritis with heart damage, etc.

Dystrophic changes in the myocardium are characterized by metabolic and function disorders in the heart cells, caused by non-inflammatory and non-coronary (not caused by coronary artery disease) diseases. Literally, this means that myocardial cells lack nutrients for their vital activity, which leads to their non-uniform contraction. This state is called in another way. This condition can occur in the following cases:

1. Severe violations of the liver and kidneys with the development of failure of these organs, as a result of which toxic metabolic products accumulate in the blood,
2. Diseases of the endocrine organs - adrenal tumor, thyroid hyperfunction, as a result of which an excess of hormones or insufficient absorption of glucose by heart cells leads to a violation of intracellular metabolism,
3. Constant stress, exhausting physical activity, malnutrition and starvation, chronic overwork,
4. In children, in addition to the previous reason, increased emotional and mental stress in the absence of sufficient mobility can lead to changes in the myocardium, as a result of which dysregulation of the heart by the nervous system develops,
5. - a decrease in hemoglobin in the blood and, as a result, oxygen starvation of myocardial cells,
6. Acute and chronic infectious diseases (influenza, malaria, tuberculosis),
7. Fever and dehydration
8. Lack of vitamins in food,
9. Acute and chronic intoxication - alcoholism, professional poisoning chemicals and etc.

Metabolic changes in the myocardium are caused by impaired repolarization processes in muscle cells. Depolarization and repolarization are subtle mechanisms of exchange of potassium and sodium ions inside each cell, the generated energy during which is converted into energy necessary for the cell to contract and relax. When the electrolyte composition is disturbed in the blood and in the heart muscle, a change in the metabolism of muscle cells occurs. Sometimes such violations in the conclusion of the ECG are formulated as nonspecific changes in the myocardium.

In addition to conditions that can provoke myocardial dystrophy, this can be caused by coronary arteries and,. That is, those conditions in which the heart receives insufficient nutrients and microelements. We can say that impaired repolarization processes and moderate changes in the myocardium mean that this is not so much coronary heart disease as the first bell for the patient that the blood supply to the heart muscle is impaired, and in the near future he is likely to develop myocardial ischemia.

Insignificant and moderate changes in the left ventricular myocardium in childhood are considered absolutely normal due to imperfect exchange substances and in the elderly due to the aging process of all internal organs.

Cicatricial changes in the myocardium indicate that in the heart muscle previously inflammatory process or had myocardial infarction with necrosis (death) of heart cells. Cicatricial changes after myocarditis, also called, as a rule, diffuse, and after - focal. The differences between these terms are that cardiosclerosis is a diagnosis reflecting the disease, and cicatricial changes in the myocardium are the pathomorphological basis of the disease, reflected on the cardiogram. Postinfarction cardiosclerosis is more often represented by a focal scar, and can be large or small focal, and located along one or more walls of the left ventricle - the lower (posterior) wall, its anterior or lateral sections.

Can there be symptoms with diffuse changes in the myocardium?

As a rule, in the absence of cardiological pathology, changes on the ECG do not manifest themselves clinically and are only an accidental finding during examination. However, the patient should undergo further follow-up as directed by a physician to ensure that he does not have initial signs any disease and, if necessary, initiate timely treatment.

By themselves, no diffuse changes in the myocardium clinical signs do not possess, especially when it comes to minor or moderate changes... Nevertheless, pronounced changes the heart muscle in most cases indicates some kind of cardiological or other disease, therefore, symptoms may appear from the underlying disease. These include pain in the heart caused by myocardial ischemia; and edema with cardiosclerosis; signs of chronic heart failure after a previous myocardial infarction; trembling limbs, weight loss and displacement eyeballs anteriorly (exophthalmos) with hyperfunction of the thyroid gland; pallor, dizziness and weakness with anemia, etc.

In this regard, a patient with diffuse changes in the myocardium must remember that if he has unpleasant symptoms, he should consult a doctor as soon as possible to find out the cause of this condition.

What kind of examination may be needed?

In each specific case, only a doctor, during an internal examination of a patient, can decide whether there is a need for further examination. So, for example, with minor diffuse changes in the myocardium in adult patients without signs of a serious illness, the doctor may limit himself to recommendations for correcting blood pressure levels, maintaining a healthy lifestyle and taking vitamins.

If there is a suspicion of a disease that caused changes in the myocardium, additional diagnostic methods may be prescribed:

Treatment

Therapy of absolutely any disease begins with a lifestyle correction and the foundations of a balanced diet. When it comes to dystrophic or metabolic changes in the myocardium of minor and moderate severity, sleep, proper rest and diet are essential.

For a sufficient supply of energy substrates to the heart muscle, it is necessary to receive balanced and healthy food 4-6 times a day.

Low-fat meats and poultry are welcomed in the diet, which is most important for anemia, sea and red fish, red caviar, fruits and vegetables, especially peaches, apricots, bananas, carrots, potatoes, spinach, nuts. Also useful is the daily consumption of dairy products, grains and cereals. Confectionery and chocolate, fatty meats and poultry are limited. Salty, fatty, fried, spicy and spicy foods, alcohol, coffee, carbonated drinks are excluded.

To improve metabolism (metabolism) in cardiac tissues, drugs such as:

1. Panangin, asparkam, magnerot, magne B6 - contain potassium and magnesium, which are necessary for the correct contractions of the myocardium,
2. Actovegin, Mexidol - antioxidants, eliminate the negative effect of lipid peroxidation products (LPO) in myocardial cells,
3. Vitamins A, C, E, group B are irreplaceable participants in intracellular metabolism.

If severe diffuse changes in the myocardium are caused by a disease, treatment is required. For example, replenishment of hemoglobin deficiency with iron-containing drugs, correction of thyroid function, antihypertensive drugs for arterial hypertension, antibiotic therapy and prednisolone for myocarditis, diuretics and cardiac glycosides for heart failure caused by cardiosclerosis, etc.