Causes, symptoms and treatment of diffuse cardiosclerosis

What is it

Let's start with the definition. Diffuse cardiosclerosis is a lesion of the heart muscle, in which there are multiple (almost evenly distributed) sections of myocardial degeneration into connective tissue. The development of sclerosis occurs in places where cardiomyocytes die massively. The heart begins to resemble the appearance of a honeycomb, where lesions alternate with healthy areas, which gradually decrease.

The prevalence of pathology is 55-90 cases per 1000 people aged 50 and older. In practice, there are many more such patients. In addition to this variant of heart damage, focal cardiosclerosis is distinguished.

Causes

There is a whole spectrum of pathologies that can lead to degenerative changes in the heart. These include:

1. Cardiac ischemia. Atherosclerosis, the imposition of thrombotic masses on the walls of the arteries feeding the myocardium, or prolonged angiospasm (caused by the pathology of the central nervous system) lead to a narrowing of the lumen of the coronary bed and a decrease in the delivery of blood with oxygen to the heart. The discrepancy between the supply of nutrients to the muscular organ and its needs provokes hypoxia of certain areas with their subsequent death. This is how diffuse small-focal cardiosclerosis develops.
2. Myocardial infarction. In rare situations, acute disturbance of blood supply to an organ through the coronary bed is widespread (2 or more walls are involved), which is manifested by the death of a large number of cells.
3. Infectious and inflammatory diseases. The most common representative of this group is myocarditis, which develops against the background of ARVI or viral hepatitis, helminthic invasions, migration of bacterial agents (staphylococcus, streptococcus, mycobacterium tuberculosis).
4. Systemic metabolic disorders. Systematic physical overstrain, poisoning with cardiotoxic poisons (lead, cobalt, glycosides), acute renal or hepatic failure lead to metabolic pathologies in the myocardium and the appearance of foci of connective tissue accumulation.

There are also rarer reasons. For example, cardiosclerosis against the background of collagenosis (Morphan or Ehlers-Danlos syndrome, mucopolysaccharidosis) or fibroelastosis. Their course is always unpredictable, since it has practically not been studied.

The contributing factors are:

• inactive lifestyle (office work, lack of physical activity);
• inaccuracies in the diet (consumption of animal fats, lack of vegetables and fruits in the diet);
• overweight (BMI over 25) and obesity (body mass index over 30);
• the presence of bad habits (systematic alcohol abuse, smoking);
• burdened heredity (the presence of associated clinical conditions in close relatives, manifested before the age of 45);
• age (over 50 years old);
• male gender.

The larger the set of risk factors, the higher the likelihood of developing pathology. You also have many of them. Is not it? This means that it is time to think about your health.

Symptoms

Cardiosclerosis of the heart has a polymorphic clinical picture, which depends on the section of the muscular organ involved in the pathological process.

Moderately severe diffuse cardiosclerosis is usually asymptomatic.

More massive lesions are manifested by the following symptoms:

From the side of the heart

Pathology of the rhythm and conduction of the heart (atrial fibrillation, extrasystole, AV blockade of any degree, impulse conduction disturbances along the Purkinje fibers and His bundle). The more fibers are affected by dystrophy, the brighter the pathology of contractility.

Patients experience interruptions in the work of an organ or heartbeat, periods of severe weakness, dizziness. Fainting sometimes develops.

Left ventricular heart failure

First of all, it is manifested by pulmonary edema. Patients are worried about shortness of breath (up to 40-60 respiratory movements per minute), wet cough with streaks of blood, general weakness and malaise, pale skin color, acrocyanosis (bluish tint of the distal extremities and nasolabial triangle). If you find that you have at least some of these symptoms, see your doctor immediately.

Inadequacy of the right heart

Stagnation of blood in the systemic circulation leads to multiple accumulation of fluid in the tissues of the lower extremities, liver and spleen, in the body cavities with the formation of hydrothorax, hydropericardium, ascites. Total edema is extremely rare - anasarka, from which quick death can occur.

The involvement of the valve apparatus of the heart in the pathological process leads to the destruction of the valves, tendon fibers and papillary muscles. Mitral dysfunction and aortic stenosis are especially common, the presence of which significantly aggravates the clinical picture of heart failure. Such diseases are an indication for valve replacement, which is extremely difficult to achieve in modern healthcare.

There are also signs of the underlying pathology, which led to cicatricial degeneration of the heart tissue.

For example, for ischemic heart disease (stable exertional angina) against the background of atherosclerosis, the following are characteristic:

• pain and shortness of breath behind the breastbone with slight physical and psycho-emotional stress or at rest;
• general weakness;
• increased fatigue.

Remember, prevention helps to avoid many of the symptoms listed above. The course of ischemic heart disease with severe clinical symptoms is always accompanied by cardiosclerosis. My personal experience as a doctor shows that in patients who prevent attacks, lesions of the cardiac conduction system and such a formidable complication as myocardial infarction are less common.

Complications

It should be understood that a long course of cardiosclerosis leads to an aggravation of the manifestations of heart failure and the compensatory development of cardiomyopathies (hypertrophy and dilatation of various parts of the heart).

The totality of all diseases can be complicated by conditions such as:

1. Formation of an aneurysm. Thinned walls expand under the action of intracavitary pressure, rupture may occur with the outflow of blood into the pericardium. Tamponade is the cause of death in 99% of cases.
2. Paroxysmal tachycardia - a formidable complication of such a pathology as small focal diffuse cardiosclerosis. The heart rate reaches 140 or more per minute. The patient's condition varies greatly: from mild dizziness to cardiogenic shock and hypoxic coma.
3. Acute heart failure - disruption of the compensatory mechanisms of the myocardium. All organs experience oxygen starvation, foci of dystrophy and necrosis are formed. If you do not provide help quickly, the condition is fatal.
4. AV blockade. They occur when the atrioventricular node is affected. The ventricles and atria of the heart begin to contract irregularly, stable hemodynamics is not provided.

Diagnostics

An integral part of my work before making a diagnosis is a thorough study of the patient's medical history (for the presence of atherosclerosis, coronary heart disease, myocardial infarction, inflammatory lesions or arrhythmias). My cardiac patients always have at least one of the above listed deviations.

I then do a physical exam that includes:

• percussion of the heart area in order to identify the displacement of the boundaries (indicate hypertrophy and dilatation of the chambers);
• auscultation of the heart valves (defects, hypertension in the pulmonary circulation can be detected);
• palpation of the main arteries (abdominal aorta, brachiocephalic vessels, large conductors of arterial blood in the extremities);
• assessment of the patient's appearance (for example, pallor and cyanosis of the skin is a clear sign of heart failure).

Along the way, the state of other systems is assessed (hepatomegaly, ascites, hydrothorax, hydropericardium, etc.).

The second stage of diagnostics is the appointment of a complex of laboratory and instrumental studies:

1. Echo-KG - ultrasound imaging of the heart. The lesions look like segments of hypo- and akinesia.
2. Chest x-ray. With hypertrophy and dilatation of the organ chambers, the borders of cardiac dullness expand, the cardiothoracic index is 50-80%.
3. Scintigraphy or coronography - methods for assessing the stability of coronary hemodynamics.
4. Biochemical blood test. Special attention is paid to the lipid profile, the deviations of which are risk factors for atherosclerosis (decrease in HDL, increase in total cholesterol, LDL, TAG). The state of the liver (ALT, AST, bilirubin) and kidneys (urea, creatinine) is also assessed.
5. General blood analysis. The study registers inflammatory processes of a bacterial (increased ESR, neutrophilic leukocytosis) or viral (lymphocytosis, leukopenia, accelerated erythrocyte sedimentation rate) nature.

I would like to draw special attention to electrocardiography. Experience shows that even functional diagnosticians are not always able to recognize specific cardiosclerosis.

In the presence of cicatricial changes in the heart wall, there are the following deviations:

• flattened or negative T wave;
• decrease in the amplitude of the QRS complex;
• depression or elevation of the ST segment.

Now I want to present the classic ECG pictures for cardiomyopathies and blockages (often accompanying cardiosclerosis), which it is quite possible to check independently using a regular ruler:

Holter monitoring has proven itself well. A special device is installed for a day or more and continuously records the ECG and blood pressure level. In my memory, each subject has rhythm disturbances (for example, 3-4 extrasystoles per day), but only frequent episodes of inadequate contractions are a sign of illness.

Treatment

Cardiosclerosis is an irreversible pathology that modern medicine cannot cure. Therapy is aimed exclusively at reducing the activity of the disease, eliminating etiological factors and maximizing compensation for disturbed vital functions.

Non-drug

Careful adherence to a diet is necessary, which involves:

• a decrease in the diet of table salt (up to 2 g / day) and liquid (up to 1,500 ml / day);
• refusal from fried, spicy foods, animal fats;
• eating a large amount of fresh fruits and vegetables (at least 400 g daily).

Regular feasible physical activity after consulting a doctor is a natural way to keep the body's muscles in good shape and prevent vascular complications. Physical therapy, aerobic exercise, and frequent walks in parks or coniferous forests are recommended.

Drug therapy

Taking medications is aimed at eliminating and preventing various pathologies from the heart and blood vessels (hypertension, rhythm disturbances, edema, etc.).

With arterial hypertension, the following are shown:

1. Beta blockers ("Metoprolol", "Betaloc ZOK", "Nebilong"). They effectively reduce blood pressure and are a measure to prevent high heart rate arrhythmias.
2. Diuretics ("Furosemide", "Hydrochlorothiazide", "Veroshiron", "Lasix"). Reduce blood pressure by removing excess fluid from the body, helping to eliminate edema.
3. Calcium channel blockers ("Amlodipine", "Nifedepine", "Diltiazem") - prevent the occurrence of cardiac arrhythmias, significantly reduce the total peripheral resistance of the vascular walls.
4. Angiotensin 2 receptor antagonists and angiotensin-converting enzyme inhibitors ("Valsartan", "Captopril", "Enalapril"). Reduce afterload on the heart by reducing vascular tone.

The selection of antihypertensive drugs taking into account the spectrum of vascular pathologies is an extremely difficult task for any clinician. Often, the pressure will only stabilize after a few adjustments to the treatment. On a personal example, such combinations have been tested as Betaloc (b-blocker) and Diroton (ACE inhibitor) in patients with hypertension of 2-3 degrees and atrial fibrillation or Hydrochlorothiazide with Enalapril in patients whose conditions are accompanied by edema syndrome.

Patients are often prescribed antihypoxants (Preductal), anticoagulants (Xarelto) to improve brain function and prevent vascular catastrophes.

In case of systemic pathologies of connective tissue, cardiosclerosis should be treated by an immunologist, occupational pathologist and other narrow specialists. The presence of myocarditis is the reason for the appointment of rational antibiotic therapy and temporary intake of cardiac glycosides. Frequent attacks of angina pectoris lead to the use of nitrates ("Nitroglycerin", "Nitrospray").

Surgery

In case of obstruction of the coronary bed, which cannot be compensated for with medication, balloon dilatation of blood vessels and coronary artery bypass grafting are performed. The presence of aneurysms is the reason for their surgical excision. In case of arrhythmias and blockages from the side of the conducting system, pacemakers and cardioverters are installed, which, in the event of a critical violation, will save lives.

Prophylaxis

Cardiosclerosis and all of its types do not imply primary prevention.

Secondary measures include:

• adherence to all doctor's recommendations and lifelong medication intake;
• organization of work and rest regime (no overload);
• regular low-intensity physical activity;
• adherence to a diet;
• rejection of bad habits;
• prompt referral to specialists with the progression of clinical symptoms.

As regrettable as it may sound, in reality, only 20-30% of patients with cardiological profile comply with all recommendations.Why is that? The experience of working as a doctor has shown that their life expectancy is markedly reduced compared to patients who consider adherence to the doctor's prescriptions a waste of time.