What is a heart aneurysm?

What it is?

The heart cells (cardiomyocytes) that have died as a result of hypoxia (after a heart attack) are replaced by scar tissue. It differs significantly from healthy. Having sufficient mechanical strength, the scar does not exhibit elasticity and cannot shrink. Blood passes through the heart under great pressure. The dead part of the heart is not immediately replaced by strong scars, so the weakened tissue in this place stretches and swells under the pressure of blood. This is how a bulge appears in the heart cavity - an aneurysm. Pathological formation can rapidly increase and pose a threat of rupture of the heart tissue.

Aneurysms most often occur in the ventricles, mainly affected by this wall anomaly on the left side. This happens because in this part of the heart the blood pressure is higher than in all the others.

An enlarged heart is a consequence of other pathologies, as a result of which heart tissue is weakened or damaged. An additional factor contributing to the protrusion in the region of the heart is the forced intensified work of the heart.

Varieties of cardiac aneurysms

Heart aneurysms can be different from each other, depending on:

1. Bulging forms.
2. Mode of occurrence.
3. Dimensions of the neoplasm.
4. Location in the region of the heart.
5. The duration of the education period.
6. Structural changes in tissues.

Form

The appearance of the aneurysm will indicate to the doctor how quickly the formation is capable of developing. In accordance with this, diagnostics will be carried out, the method of treatment will be determined.

1. Bag shape. The protrusion is rather voluminous, with a wide base and a large cavity, reminiscent of a hanging bag. The tissue at the site of expansion is subjected to significant stretching. Consequences: increased risk of violation of the integrity of the aneurysm, the risk of stagnation of blood in the "bag" and the development of blood clots.
2. Mushroom shape. The basis of the bulging is narrowed, the cavity area is expanded under the influence of blood. The shape resembles a mushroom. The tension of the walls is significant, the structure of the tissue is damaged. The source of development of aneurysms is small areas of dead tissue or scar formations. Consequences: very high risk of thrombosis and rupture of the heart walls.
3. Diffuse (flat) shape. Such an aneurysm develops from a wide area of ​​the damaged surface, but differs in a small volume. It is practically flat (does not protrude from the heart cavity). Occurs with extensive heart attacks. Neoplasms are localized more often in the region of the anterior wall, from the side of the left ventricle. Consequences: the development of heart failure, arrhythmia, the prospect of increasing the size of the organ.
4. Double aneurysm (one within the other). The most dangerous bulging of the heart wall. One aneurysm develops in the cavity of the other. The first bulge is diffuse or saccular in shape. The wall of this formation is additionally stretched in one of the sections. A new ledge will form there. That is, there is a pathological stratification of the structure of the heart tissue. Consequences: The “aneurysm in the aneurysm” ruptures most often.

Mode of occurrence

1. True aneurysm. It develops in the layers of the heart wall, which is partially replaced by connective tissues.
2. False aneurysm. A cavity is formed between the pericardial tissues and the fibrous adhesion. Stretching of the cardiac cavity does not occur. There is a micro-hole in the wall through which blood flows into the newly formed cavity.
3. Aneurysm in the heart of functional origin. A very rare type of pathology. The protrusion of the muscle layer of the myocardium occurs without changing the myocardium itself. Reason: the area of ​​the heart stops participating in contractile activity due to any pathological disorders.

Aneurysms are also classified by size. This will help the doctor to more accurately predict the further development of the pathology.

1. Small aneurysms. You can notice such an aneurysm of the heart when the organ contracts. The damaged areas are unable to contract.
2. Middle aneurysms. They expand slightly (up to several centimeters). Do not protrude beyond the pericardium.
3. Giant aneurysms. They are large, which means that the shape of the heart is noticeably changed. Some are equal in volume to the cavity of the left ventricle.

Location

Protrusions prefer to develop in the left ventricular cavity. It is this part of the heart that needs oxygen most of all, therefore, during an attack of acute hypoxia, the cells of the left ventricle are the first to die. Rarely, aneurysms are located in the posterior wall or in the septum between the ventricles. More often - in the upper or front part.

An interventricular aneurysm is represented by a displacement of the septum to the right ventricular zone. The consequences of such a deformation include the development of heart failure, since the left ventricle increases, and the right one decreases.

On the right side, the heart is almost not exposed to pathological stretching. Usually, right ventricular enlargement occurs only in the case of injuries sustained in the region of the heart. Another way of developing protrusions in the right ventricle is the consequences of certain operations on the heart muscle: correction of a heart defect obtained at birth (tetrad of Fallot, stenosis of the pulmonary trunk). In the atria, aneurysms are almost never found.

The moment of education

With the help of such a refinement, aneurysms that have arisen after a heart attack are differentiated. To distinguish, determine the amount of time elapsed after the onset of tissue necrosis until the moment of protrusion formation.

• Acute education. The heart is enlarged within the first two weeks. The scar tissue has not yet fully formed. In this case, the aneurysm behaves unpredictably: it can grow rapidly, its rupture is possible, and its shape can also change.
• Subacute aneurysm. Formed a little later (after the 3rd week and before the 8th). At this time, the connective tissue is already strong enough, which reduces the risk of its opening or further growth. Blood clots may form in the aneurysm cavity.
• Chronic aneurysm. The expansion of the heart in diameter is formed almost two months after a heart attack. The scar is already completely compacted, so its stretching cannot be fast and significant. In this case, ruptures of the heart wall are almost not fixed, but the risk of thrombosis and arrhythmia is high.

Bulging structure

If an aneurysm formed after a heart attack, then there will be a large amount of connective tissue in its structure.

When an infection enters the myocardium and damages it, the muscle layer prevails in the structure.

Prediction of the further state of the neoplasm depends on the classification of aneurysms by their composition.

1. Fibrous bulge. Contains in its structure mainly connective tissue, which cannot participate in the contraction of the heart. Under the pressure of blood, it stretches and becomes thin. Occurs in the first time after a heart attack.
2. Fibromuscular bulge. The structure contains muscle tissue and scar tissue. This phenomenon often occurs when a parietal infarction develops. Not all layers of cardiac tissue undergo necrosis.
3. Muscle bulge. It is made up almost entirely of muscle cells. Muscle strain occurs due to a congenital anomaly, impaired blood flow, or impaired transmission of nerve impulses. This part of the heart does not contract with all the others, so the internal pressure on it increases. Muscular aneurysm develops. Pathology is asymptomatic.

Ways of development of aneurysm

Aneurysm, in most cases, occurs in the postinfarction state. Usually the upper part of the left ventricle or the anterior part protrudes, in rare cases the posterior part of this part of the heart swells.

The following conditions can accelerate the formation of a cardiac aneurysm after a heart attack:

• second heart attack;
• accelerated heart rate;
• the appearance of heart failure;
• attacks of high blood pressure;
• violation of recommendations on bed rest.

But a heart attack is not the only way for the development of pathology. There are also other causes of abnormal stretching of the heart tissue.

• Congenital pathology... When a child is in the womb, he can be exposed to various negative influences (nicotine or alcohol poisoning, intrauterine infections, the effect of drugs). These factors influence the formation of the structures of the heart. After birth, when the baby is breathing spontaneously, the pressure in the region of the heart increases, the deformed parts of the heart bulge out. As the baby grows up, pathological phenomena may disappear. But there will always be a risk of developing new aneurysms throughout life.
• Infectious organ damage... With the penetration of the infection into the heart, myocarditis develops. Inflammation covers the walls of the heart muscle, which leads to partial death of cells and their replacement with connective tissue. In such areas, the risk of developing an aneurysm increases.
• Postoperative complications... After operations aimed at eliminating heart defects, complications are possible in children and the elderly. Cardiac sutures may not heal properly, leaving a dense scar, which will serve as a site for the formation of an aneurysm. Another reason: the heart, having survived the operation, contracts in an enhanced mode, this leads to an increase in pressure inside it. The operated areas suffer from this in the first place, the weakened tissue begins to stretch.
• Myocarditis of toxic origin... This is a rather rare reason for the development of an aneurysm. Poisonous substances enter the blood for various reasons. Toxins penetrate the heart and damage its tissues, sometimes necrosis develops. Severe manifestations of allergic reactions also lead to damage to the endocardium (inner lining of the heart). All these factors create conditions for deformation of the heart wall.
• Cardiosclerotic changes of an ideopathic nature... In some cases, the patient is diagnosed with cardiosclerosis of undetected etiology. Cardiomyocytes begin to be replaced by a connective layer, over time this process leads to the formation of an aneurysm.
• Open and closed organ injuries... As a result of an open injury to the heart, a scar (scar) forms at the site of injury. When closed, it is possible to develop false aneurysms or myocarditis, accompanied by cardiosclerosis.
• Irradiation... If the heart has been exposed to strong radiation, cardiosclerosis develops in its cells. This phenomenon can occur during the treatment of a cancerous tumor in the mediastinal region. The rays hitting the heart start the process of slow destruction of the heart cells. An aneurysm can develop over a long period of time.
• Prolonged inflammatory process... Dysfunction of the immune system leads to rheumatism of the heart muscle. The inflammatory process occurs due to the struggle of heart cells with their own antibodies. Prolonged inflammation weakens the heart, myocarditis and cardiosclerotic changes develop.

Symptoms

Pain in the chest does not always accompany the appearance of an aneurysm. The neoplasm does not have nerve receptors, so there can be no pain in this area. Unpleasant sensations arise in healthy tissues due to circulatory disorders.

A feeling of loss of strength indicates the development of heart failure. As a result of this condition, the heart cannot send the required volume of blood to the muscles, therefore, general weakness arises.

The rhythmicity of contractions is disturbed - this is the most typical sign of an aneurysm. Interruptions in heart rate occur from time to time, but do not linger for long. They usually occur due to emotional stress or significant physical exertion.

The pale complexion of the face and body is due to the phenomenon of heart failure. The heart poorly supplies blood to the skin, because of this, they turn pale. Numbness of the limbs, low sensitivity of the skin may be felt.

Palpable heartbeat. A person with an aneurysm constantly feels their heart beating, even in a state of absolute rest. This is due to the increased volume of the left ventricle, it is closer to the ribs, which creates a feeling of increased heartbeat.

Congestion associated with heart failure causes lung function to deteriorate. Oxygen travels more slowly from the lungs, causing shortness of breath.

Coughing fits are very rare in heart aneurysms. The cough appears in the case of large masses when the lungs are compressed. With a deep breath, the pleura in the squeezed lung becomes irritated, and an attack begins with a cough. At the same time, wheezing is absent, sputum is not separated. A cough can occur for the same reason as shortness of breath.

Features of the expansion of the right ventricle of the heart

The cause of this pathology is called cor pulmonale. This phenomenon occurs when a person develops lung disease that makes it difficult to breathe. In this case, the pressure in the artery passing through them increases. This affects the work of the right ventricle, it is overloaded, pumping large volumes of blood. Its cavity expands. Provoking factors:

• Respiratory diseases: the presence of bronchial asthma, chronic bronchitis, tuberculosis, and so on.
• Pathologies of the thoracic part of the body: scoliosis, poliomyelitis.
• Diseases of the vessels localized in the lungs: embolism, arteritis, thrombosis, the effect of the tumor on the vessels.

Signs of an enlarged right ventricle are called:

• dyspnea;
• weakness;
• fainting;
• arrhythmia;
• bloody cough;
• chest pain;
• cold sweat.

In children, congenital malformations may be detected, leading to expansion of the right ventricle. They are accompanied by arrhythmias, cyanosis, shortness of breath, rapid heart rate. Such children grow poorly.

Treatment

Treatment of a heart aneurysm is reduced to surgery. Conservative methods are possible to prevent the development of pathology or to relieve unpleasant symptoms, as well as to reduce the risk of complications.

When there is no indication for emergency surgery, as well as elderly patients who do not tolerate anesthesia, the following drugs are prescribed:

• Beta-blockers - improve the heart rate, reduce the intensity of contractions.
• Drugs from the nitrate group - normalize the patency of the coronary vessels, blood access to the heart is stabilized, which relieves pain.
• Diuretics - are offered to people with hypertension to lower blood pressure and eliminate the risk of rupture of the bulge of the heart muscle.
• Drugs that prevent blood clots - they thin the blood and prevent platelets from joining together.

In the case of the development of dangerous conditions, surgical treatment is prescribed:

• the presence of false aneurysms;
• ruptured aneurysm;
• blood clots;
• an accelerated heart rate that cannot be eliminated with drugs;
• acute heart failure.

During the operation, the surgeon opens the chest, blocks the movement of blood through the heart, the person is connected to a special apparatus that replaces the functions of the heart muscle.

Removal of aneurysm, blood clots, damaged areas of the heart tissue - this is the essence of the operation. At the end of the process, the doctor sutures the heart walls. If necessary, vascular shunting is performed, strengthening the septum between the ventricles. The operation lasts several hours, has a high level of complexity, in some cases, patients die during or after the intervention.

The prognosis for the diagnosis of "heart aneurysm" cannot be called successful. Only surgical intervention can eliminate the threat to life. But even during the operation, deaths or complications are possible. Not all patients are indicated for the use of anesthesia. If it is impossible to carry out surgical treatment, the risk of death increases, and the quality of human life deteriorates.

Conclusions about each case should be made based on the individual characteristics of the organism, the degree of development of the pathology, the patient's age, location, shape, size and duration of aneurysm formation, as well as the presence of additional diseases.