When it comes to heart disease, they are most often associated with atherosclerosis, cholesterol, stress and old age. But there are other types of similar pathologies that are more characteristic of a young age and are not related to these factors. The ICD-10 code for myocardial cardiosclerosis (PMC) is I20.0-I20.9. The disease is characterized by inflammation of the muscular layer of the heart, which can develop for a variety of reasons.
Cardiosclerosis is a pathological change in the myocardium when its cells (cardiomyocytes) are replaced by connective tissue. This creates scars. The combination of these 2 pathologies gives the diagnosis of myocardial sclerosis. A more concise synonym for this disease is myocardiosclerosis.
Vessels here are not affected, unlike atherosclerosis. According to the ICD, myocardial cardiosclerosis is not classified as atherosclerosis, although it is insection of coronary heart disease.
The walls of the heart and myocarditis
The wall of the heart muscle consists of 3 layers: endocardium, myocardium and pericardium, or epicardium. The myocardium is conductive, i.e. its tissue is functional and can conduct electrical impulses, it is elastic and can contract.
Myocarditis is an inflammation accompanied by pathomorphological changes in the thickness of the myocardium at the molecular level. It can be infectious, allergic or rheumatic. The outcome of any of them, with improper treatment or its absence, is the replacement of functioning cells with fibrous tissue. This condition is called myocardial cardiosclerosis and can lead to a number of complications: arrhythmias, heart failure, heart aneurysms.
It should be noted that this diagnosis is not entirely correct. Why? Cell replacement goes to fibrous tissue, while there are no sclerotic changes yet. It would be more correct to call the process myocardial fibrosis.
In sclerosis, changes are already associated with the development of the above factors. In medical sources, a more complete name is used - postmyocardial cardiosclerosis.
Myocardial cardiosclerosis can develop according to different scenarios. It depends on the area of replaced tissues, i.e. fibrosis. Today, the exact reasons why some people may develop pathology, while others do not, have not been established.
Causes of disease development
Postmyocardial cardiosclerosis is always secondarydisease. Most often it becomes a consequence of myocarditis. The reasons are the following factors:
- Infections - Coxsackie A and B, influenza, diphtheria, scarlet fever, hepatitis, adenovirus, herpes, CMV, ECHO, HIV, Epstein-Barr.
- Bacterial infections, especially beta-hemolytic streptococci gr. A. They have a special affinity for the tissues of the heart - they lead to rheumatism.
- Allergies.
- Toxic damage - antidepressant abuse.
- Thyrotoxicosis.
- Idiopathic myocarditis.
Mechanism for change
The process of replacing cardiomycytes with fibrous tissue is irreversible. With it, the contractility of the heart is gradually disturbed. This leads to the fact that the heart muscle ceases to be elastic and resilient - to replace the scars, the heart chambers begin to gradually expand. The load on the heart increases, it has to push the blood through the systemic circulation with an effort. This becomes possible only through myocardial hypertrophy.
In this case, scars are formed rather slowly, because adaptation mechanisms are activated to help the heart withstand the increased load. The connective tissue cannot contract, and if there are few cardiomyocytes, they take the brunt andbegin to actively hypertrophy. The left ventricle is enlarged. This stage is called myocardial cardiosclerosis without heart failure. The patient has no complaints at this time yet.
At some stage, this reserve is exhausted, and the contractility of the heart is again under threat. The result is the development of heart failure. In addition, cicatricial changes may affect the valves, where their insufficiency or narrowing of the valves develops.
The larger the affected area, the faster heart failure develops. As a result, it becomes chronic (CHF).
Types of myocardial sclerosis
Depending on the extent of the lesion, sclerosis is focal and diffuse. In the first case, both single and multiple foci of fibrosis in the myocardium are noted, only some parts of the muscle are affected. The focal form is more common. A single focus of myocardial sclerosis is the most favorable in the prognosis, but only in the absence of cardiac arrhythmias. The arrhythmias themselves wear out the heart and cause it to fail.
With a diffuse lesion, a complete replacement of the muscle with a scar is formed. The focal type of pathology can be asymptomatic, but only until its scars sit on the conducting sections or near the sinus node. In these cases, arrhythmia becomes inevitable - myocardial cardiosclerosis occurs with rhythm disturbance.
Main symptoms of cardiosclerosis
Small scarring and moderationdiffuse lesions have no symptoms. More often this is typical for young people who fell ill with heart disease for the first time.
Suspicion of the development of myocardiosclerosis may occur when:
- constant stabbing chest pain;
- cough echoing in chest;
- attacks of tachycardia not associated with emotions and stress;
- daytime sleepiness, fatigue, weakness in the morning;
- dyspnea;
- dizzy with dark eyes.
Manifestations and symptoms of myocardial cardiosclerosis can be divided into two groups: heart failure (usually chronic); rhythm disturbances. Sustained arrhythmias cause inefficient heart contractions, which is accompanied by the following symptoms: aching cardialgia, interruptions and bouts of palpitations, fainting with dizziness.
Heart failure
While the expansion of the heart is moderate, the patient has no complaints. With a pronounced loss of myocardial strength, symptoms of CHF occur:
- Inspiratory shortness of breath (difficulty inhaling).
- In severe cases, orthopnea occurs - the patient is forced to sit, resting his hands on the bed, to reduce shortness of breath.
- Weakness and constant fatigue, lethargy.
- Edema - they start from the feet, then gradually rise higher. Always symmetrical. Reaching the level of the belt, they can be combined with ascites.
- Increase in heart rate and decrease in pressure - the heart cannot "pump out" the required volume and speeds up its work.
Rhythm disturbances
Myocardial cardiosclerosis with cardiac arrhythmia, depending on the affected area, can give different types of arrhythmias. For example, according to the type of bigeminia, a pathological impulse is formed after each normal blow (1: 1 ratio). CHF itself in postmyocarditis cardiosclerosis can also cause arrhythmias. The dilated atria begin to contract chaotically - to flicker. The pressure is normal or low. Subjectively, rhythm disturbances are felt as interruptions in the work of the heart - a feeling of fading and fluttering in the chest.
Possible Complications
The most dangerous complications of postmyocardial cardiosclerosis are increasing CHF, thinning and bulging of the affected areas of the myocardium (aneurysm), arrhythmias in the form of flutter and flicker. Fibrous tissue in the myocardium violates not only muscle contractility, but also all other main physiological properties of cells - excitability, conductivity and automatism. This causes various forms of arrhythmias, from tachycardia to atrial and ventricular fibrillation. With the progression of these conditions, swelling of the lungs, brain, and development of renal failure may occur. Aneurysms often lead to rupture of the heart.
Diagnostic measures
Diagnostic methods:
- ECG - changes in the electrocardiogram are nonspecific. They will show cicatricial changes and arrhythmia, but the etiology of the processes cannot be identified.
- cardiac ECG byHolter is a daily monitoring. It allows you to fix episodic rhythm disturbances. This is a more informative technique.
- ECHO-KG - allows you to assess the degree of expansion of the chambers of the heart, determine the localization of areas of sclerosis, weakening of contractility and the presence of an aneurysm. The study allows you to determine myocardial hypertrophy, valve dysfunction.
- Chest x-ray - can detect heart enlargement and lung congestion.
- Myocardial scintigraphy is a radionuclide research method that allows you to fully examine the muscle, to identify the size of the lesions. The essence of the method is that he althy tissues can capture certain radionuclides with varying degrees of intensity and accumulate them, which is reflected in the device. Entrapment does not occur in areas of fibrosis.
- Complete blood count - may indicate some diseases that caused this condition.
- MRI - allows you to assess the prevalence of the process.
Treatment tactics
Therapy for myocardiosclerosis is aimed at slowing down the development of scars and improving the functioning of the heart. The main thing should be the identification and elimination of causal factors.
If the cause is an infection, antibiotic therapy is used. Autoimmune diseases require complex treatment of the underlying pathology.
For allergic etiology, antihistamines and hormonal agents are recommended.
Antioxidants are always prescribed. They improve metabolic processes in the myocardium- "Kratal", "Mexiprim", "Cytochrome", "Kudesan", potassium and magnesium s alts ("Panangin", "Magnicum", "Kalipoz"), "Riboxin", "Preductal", "Thiotriazolin", "Elkar".
Symptomatic treatment of CHF includes the use of:
- cardiac glycosides - "Strophanthin", "Digoxin";
- diuretic drugs - "Lasix", "Indapamide";
- beta-blockers - Metoprolol, Atenolol, Concor, Carvedilol;
- ACE inhibitors - "Enap", "Lisinopril";
- calcium antagonists - Diltiazem, Corinfar-retard.
- antiarrhythmic drugs - "Lidocaine", "Etatsizin", "Kordaron".
In case of conduction blockade, "Izadrin" and "Atropine" are prescribed. Taking these drugs becomes permanent.
In the presence of an aneurysm, surgical strengthening of the wall or resection of the protrusion is used - palliative surgery.
For bradyarrhythmias, radiofrequency ablation or pacemaker placement is indicated.
Rapidly progressing CHF is the basis for a heart transplant. This completely relieves the patient of all heart problems.
In the treatment of acute myocarditis, non-steroidal anti-inflammatory drugs and hormones are used: "Nimesulide", "Aspirin" and steroid hormones -"Prednisolone", "Dexamethasone".
NSAIDs and steroids minimize inflammation in the myocardium.
If at the first visit of the patient, he already has signs of initial cardiosclerosis, vitamins and restorative drugs are used in the treatment. Antioxidants and antihypoxants are also widely used - "Mildronate", "Preductal", "Mexidol" and "Actovegin". They do not allow incompletely oxidized metabolic products to accumulate in the blood, which have a destructive effect on the remaining normal muscle cells and enrich the heart muscle with oxygen.
What are the forecasts?
Asymptomatic forms of myocardial cardiosclerosis have a favorable prognosis. The myocardium adapts over time to the presence of fibrosis.
Prevention measures
Prevention includes prevention of myocarditis:
- Timely treatment and full coverage of infections.
- Getting rid of chronic foci of inflammation (caries, tonsillitis, sinusitis, etc.).
Cardiosclerosis and the army
Do they take in the army with myocardial cardiosclerosis? The Regulation on the military medical examination contains a list of diseases, which reads as follows: for exemption from conscription, cardiosclerosis with persistent cardiac arrhythmias or heart failure FC 2 is required. Arrhythmia lasting more than 7 days is considered a persistent heart rhythm disorder. She requires antiarrhythmic therapy.
