How is dilated and other types of cardiomyopathy diagnosed and diagnosed?

Cardiomyopathies are one of the most common causes of sudden death, are sometimes asymptomatic and always have a poor prognosis. There are several types of cardiomyopathies - primary, differing in the form of heart damage (dilated, restrictive and hypertrophic), as well as secondary, caused, for example, by metabolic or endocrine disorders. Also, cardiomyopathies sometimes include takotsubo syndrome (“broken heart syndrome”) and severe myocarditis. At the same time, ischemic cardiomyopathy accounts for, according to some reports, more than half of all cases of heart failure.

What is cardiomyopathy

All diseases of the heart, one way or another, lead to various structural modifications of its tissues and are accompanied by a violation of cardiac functions. Such a modification itself can be a congenital disease (for example, heart defects) or one of the components of a disease of the cardiovascular system in general (for example, hypertension). If the process of muscle modification occurs on its own, then it refers to cardiomyopathies. Thus, cardiomyopathies are conditions in which the heart muscle changes its shape and works abnormally.

Sometimes the ischemic form of damage to the heart tissue is excluded from the list of cardiomyopathies: this is due to the fact that it is more convenient to attribute this type of damage to the heart muscle to coronary heart disease in combination with chronic heart failure, and not to cardiomyopathies that differ in independence.

As a synonym for IC, the diagnosis of "atherosclerotic cardiosclerosis" is often used, in which the first word indicates stenosis (narrowing) of the artery, and the second indicates sclerosis (replacement) of the heart tissues.

1. Hypertrophic form: the wall of the left ventricle (section, or chamber of the heart) becomes thick, the tissue grows, is replaced by fibrous tissue, so that as a result it occupies a significant part of the space inside the ventricle that should be filled with blood, and does not cope with work.
2. Dilated form: the heart wall becomes stretched, the space inside becomes large, and the heart is "bloated" (cardiomegaly).
3. Restrictive form: the tissue of the ventricle becomes rigid (hard, rough, “lazy”), and since it is responsible for extensibility and elasticity when filling with blood and pushing it out, the cardiac blood flow becomes limited (restricted).

The word "ischemic" always indicates vasoconstriction, which leads to impaired circulation. Thus, coronary heart disease is the main background for heart attacks, and cerebral ischemia - for strokes. In ischemic cardiomyopathy, changes in the heart muscle are caused by narrowing of the coronary artery that fills the heart with blood. As a result of this constriction, the blood enters at a different pace, with a different pressure, in a smaller amount, and the muscle lacks oxygen. Sometimes post-infarction damage to the heart is referred to as ischemic cardiomyopathy.

What causes ischemic cardiomyopathy

Ischemic cardiomyopathy can be considered as a condition of the heart after a heart attack (because the resulting tissue death "leaves behind" scars) or a condition that occurs against the background of chronic heart failure.

• diabetic vascular damage and other metabolic disorders;
• atherosclerotic blockage of blood vessels;
• vasospasm;
• taking cardiotoxic drugs;
• chronic radiation sickness and chemotherapy;
• hereditary predisposition both to these diseases and to cardiomyopathies in general.

According to studies, the course of ischemic cardiomyopathy is aggravated against the background of schizophrenia, since neuroleptic drugs are used in the pharmacological management of this disease, which have a toxic effect on the heart as a side effect.

Common predisposition factors may include male gender, older age, being overweight and sedentary, smoking, geographical distance and possibly ethnicity, and, as noted, schizophrenia and other psychiatric illnesses (due to the toxic effects of antipsychotic drugs). requiring many years of use).

Factors that aggravate the course of the disease are chronic or severe stress (which in themselves can cause stress cardiomyopathy, the so-called broken heart syndrome) and concomitant metabolic, endocrine, cardiovascular diseases (arterial hypertension, a tendency to varicose veins), as well as kidney disease, as they lead to an increase in pressure and an increase in the load on the vessels.

How does IC manifest itself?

Ischemic damage to the heart muscle can present with symptoms of chronic heart failure, including:

• angina pectoris - pain in the heart;
• puffiness of the cardiac type;
• shortness of breath (feeling short of breath);
• a state of fatigue and weakness, sometimes sudden exhaustion;
• dizziness;
• strong palpitations or a feeling of fluttering of the heart, arrhythmias;
• weight gain, indicating heart disease and caused by the accumulation of fluid in the abdomen;
• hepatomegaly;
• nocturnal awakening, accompanied by increased sweating and a feeling of fear.

However, often cardiomyopathies are also the cause of sudden death, as they can be asymptomatic. It is these conditions that are the causes of the often occurring "athlete deaths" during exercise.

According to studies, patients with this diagnosis suffer from various sleep disorders. This fact is partly due to the need to take a specific posture during sleep, shortness of breath in the supine position, and pain. In the initial stages of the disease, problems with falling asleep are mainly detected, and as it develops, with the quality of sleep and its duration, the state after awakening.

Diagnostics

Echocardiography or magnetic resonance imaging is used to diagnose cardiomyopathy. The main criterion is a combination of signs of cardiomyopathy (the above-described modifications of the left ventricle: dilatation, restriction or hypertrophy) and a narrowed coronary artery.

1. Dilatation of the left ventricle: EDV index (ventricular volume at rest) more than 110 ml/m2, ESR index more than 80 ml/m2.
2. Ventricular dysfunction: left ventricular ejection fraction according to Simpson less than 45%.
3. Multiple aneurysms.
4. Actually, the narrowing of the coronary artery.

It is important to keep in mind that modern contrast-enhanced MRI techniques make it possible not only to diagnose this condition, but also to form a reliable prognosis: even before surgery, assess possible risks and facilitate the decision on the need for surgical intervention. This is important in connection with the increased mortality from surgery for this disease until recently.

Treatment and prognosis

Since with ischemic damage to the heart muscle irreversible changes in the very structure of the heart occur, which continue to grow, the prognosis for this diagnosis is always unfavorable. This condition increases the risk of death from all causes by several times, often leads to deadly thromboembolism and arrhythmias, increases the load on organs and leads to their hypoxia. According to studies, the three-year survival rate of patients with this diagnosis can be 1/3 (about 35 man out of a hundred).

• coronary bypass;
• installation of an implantable cardioverter-defibrillator or other devices that support the work of the heart;
• heart transplant.

It is ischemic cardiomyopathy that is one of the most common reasons for applying for a heart transplant.

The applied conservative treatment is aimed at revascularization (restoration of vascular tissue) of the myocardium, and includes the use of drugs such as ACE inhibitors, antiarrhythmic drugs, calcium antagonists, nitrates, L-carnitine.

Even with a severe variant of the course of the disease, timely surgical intervention can extend the life of a person with ischemic cardiomyopathy by more than ten years.