Myocardial cardiosclerosis: a description of the pathology, diagnosis, treatment

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 (MVP) is I20.0-I20.9. The disease is characterized by inflammation of the muscle layer of the heart, which can develop for a number of reasons.

Cardiosclerosis is a pathological change in the myocardium when its cells (cardiomyocytes) are replaced by connective tissue. In this case, scars form. The combination of these 2 pathologies gives the diagnosis of myocardial sclerosis. A shorter synonym for this disease is myocardiosclerosis.

The vessels here are not affected, unlike atherosclerosis. According to the ICD, myocardial cardiosclerosis is not assigned to atherosclerosis, although it is in the section of coronary heart diseases.

Heart walls and myocarditis

The wall of the heart muscle consists of 3 layers: endocardium, myocardium and pericardium, or epicardium. The myocardium has conductivity, i.e., its tissue is functional and can conduct electrical impulses, it is elastic and can contract.

Myocarditis is an inflammation accompanied by pathological 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 aneurysm.

It should be noted that this diagnosis is not entirely correct. Why? Cell replacement goes to fibrous tissue, while there are no sclerotic changes. 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 - postmyocarditis cardiosclerosis.

Myocardial cardiosclerosis can develop in different scenarios. It depends on the area of ​​the replaced tissues, i.e. fibrosis. Today, the exact reasons for why some people may develop pathology, while others do not, have been established.

Causes of the disease

Post-myocardial cardiosclerosis is always a secondary disease. Most often, it becomes a consequence of myocarditis. The reasons are the following factors:

1. Infections - infection with the Coxsackie A and B viruses, influenza, diphtheria, scarlet fever, hepatitis, adenovirus, herpes, CMV, ECHO, HIV, Epstein-Barr.
2. Bacterial infections, especially beta hemolytic streptococcus gr. A. They have a special affinity for the tissues of the heart - leading to rheumatism.
3. Allergies.
4. Toxic damage - abuse of antidepressants.
5. Thyrotoxicosis.
6. Idiopathic myocarditis.

A heart attack, ischemia, myocardial dystrophy (occurs with anemia, hypoxia, etc.) can lead to the disease. According to ICD-10, the code for myocardial cardiosclerosis with rhythm disturbance is I20.0-I20.9.

Change mechanism

The process of replacing cardiomyocytes with fibrous tissue is irreversible. With it, the contractility of the heart is gradually disrupted. This leads to the fact that the muscle of the heart ceases to be elastic and elastic - to replace the scarring, the chambers of the heart begin to expand gradually. The load on the heart increases, he already has an effort to push blood through a large circle of blood circulation. This becomes possible only through myocardial hypertrophy.

In this case, the scars form rather slowly, because adaptation mechanisms are connected that help the heart withstand the increased load. The connective tissue cannot contract, and if there are few cardiomyocytes, they take on all the burden and begin to actively hypertrophy. The left ventricle enlarges. This stage is called myocardial cardiosclerosis without heart failure. The patient has no complaints at this time.

At some stage, this reserve is exhausted, and the contractility of the heart is again at risk. The result is the development of heart failure. In addition, cicatricial changes may concern the valves, where their insufficiency or narrowing of the valves develops.

The larger the lesion 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 prognosis, but only in the absence of cardiac arrhythmias. Arrhythmias in themselves very wear out the heart and cause its insufficiency.

With diffuse lesions, a complete replacement of the muscle with a scar forms. 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 with rhythm disturbance occurs.

The main symptoms of cardiosclerosis

Small foci of scarring and moderate diffuse lesions have no symptoms. More often this is characteristic of young people who have suffered from cardiac pathology for the first time.

Suspicion of the development of myocardiosclerosis can occur with:

• constant stitching pain in the chest;
• a cough that echoes in the chest;
• tachycardia attacks that are not associated with emotions and stress;
• daytime drowsiness, fatigue, weakness in the morning;
• shortness of breath
• dizziness with darkening in the eyes.

Manifestations and symptoms of myocardial cardiosclerosis can be divided into two groups: heart failure (usually chronic); rhythm disturbances. Persistent arrhythmias cause ineffective heart contractions, which is accompanied by the following symptoms: aching cardialgia, interruptions and bouts of heart 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 heart failure occur:

1. Inspiratory dyspnea (difficulty breathing).
2. In severe cases, orthopnea occurs - the patient is forced to sit, resting his hands on the bed, to reduce shortness of breath.
3. Weakness and constant increased fatigue, lethargy.
4. Swelling - they begin with the feet, then gradually rise higher. Always symmetrical. Reaching the level of the belt, they can be combined with ascites.
5. An increase in heart rate and a decrease in pressure - the heart cannot “pump out” the required volume and speeds up its work.

Rhythm disturbances

Myocardial cardiosclerosis with cardiac arrhythmias, depending on the lesion site, can produce different types of arrhythmias. For example, by the type of bigeminia, a pathological impulse is formed after each normal stroke (1: 1 ratio). CHF itself with post-myocarditis cardiosclerosis is also capable of causing arrhythmia. Expanded atria begin to erratically contract - flicker. The pressure is normal or reduced. Subjectively, rhythm disturbances are felt as interruptions in the work of the heart - a feeling of freezing and fluttering in the chest.

Possible complications

The most dangerous complications of postmyocardial cardiosclerosis are increasing CHF, thinning and swelling 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 fibrillation and ventricles. With the progression of these conditions, pulmonary, cerebral edema, and the development of renal failure can occur. Aneurysm often leads to rupture of the heart.

Diagnostic measures

Diagnostic Methods:

1. ECG - changes in the electrocardiogram are nonspecific. They will show cicatricial changes and arrhythmia, but the etiology of the processes cannot be detected.
2. Holter ECG is a 24-hour monitoring. It allows you to record episodic rhythm disturbances. This is a more informative technique.
3. ECHO-KG - allows you to assess the degree of expansion of the chambers of the heart, to determine the localization of areas of sclerosis, weakening contractility and the presence of aneurysm. The study allows to determine myocardial hypertrophy, valve dysfunction.
4. X-ray of the chest - can determine the expansion of the borders of the heart and congestion in the lungs.
5. Myocardial scintigraphy is a radionuclide method of research, which allows you to fully examine the muscle, to identify the magnitude of the lesions. The essence of the method is that healthy tissues can capture certain radionuclides with varying degrees of intensity and accumulate them, which is reflected in the device. In areas of fibrosis, capture does not occur.
6. General blood test - may indicate some diseases that caused this condition.
7. MRI - allows you to assess the prevalence of the process.

Treatment tactics

Therapy of myocardiosclerosis is aimed at slowing the development of scars and improving heart function. The main 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 hormones are recommended.

Antioxidants are always prescribed. They improve metabolic processes in the myocardium - Kratal, Mexiprim, Cytochrome, Kudesan, potassium and magnesium salts (Panangin, Magnikum, Kalipoz), Riboxin, Preductal, " Thiotriazolin "," Elkar ".

Symptomatic treatment of heart failure includes the use of:

• cardiac glycosides - "Strofantin", "Digoxin";
• diuretics - "Lasix", "Indapamide";
• beta-blockers - Metoprolol, Atenolol, Concor, Carvedilol;
• ACE inhibitors - Enap, Lisinopril;
• calcium antagonists - "Diltiazem", "Corinfar retard."
• antiarrhythmic drugs - "Lidocaine", "Etatsizin", "Cordaron".

With conduction blockages, Isadrin and Atropine are prescribed. Acceptance of these drugs becomes permanent.

In the presence of an aneurysm, surgical reinforcement of the wall or resection of the protrusion, palliative surgery, is used.

With bradyarrhythmias, radiofrequency ablation or the installation of a pacemaker is indicated.

Rapidly progressing heart failure is the basis for a heart transplant. This completely saves the patient from 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 treatment of the patient, he already shows signs of initial cardiosclerosis, vitamins and restorative drugs are used in the treatment. Also widely used are antioxidants and antihypoxants - Mildronate, Preductal, Mexidol and Actovegin. They do not allow under-oxidized metabolic products to accumulate in the blood, which destructively affect the remaining normal muscle cells and enrich the heart muscle with oxygen.

What are the forecasts?

Unsymptomatic forms of myocarditis cardiosclerosis have a favorable prognosis. The myocardium adapts over time to the presence of fibrosis.

Preventive actions

Prevention includes the prevention of myocarditis:

• Timely treatment and full infections.
• Getting rid of chronic foci of inflammation (caries, tonsillitis, sinusitis, etc.).

Cardiosclerosis and the Army

Are they enlisted in the army with myocardial cardiosclerosis? The Regulation on Military Medical Examination contains a list of diseases, which reads as follows: cardiosclerosis with persistent disturbance of the rhythm of the heart or heart failure 2 FC is required for exemption from conscription. A persistent violation of the rhythm of the heart is considered to be arrhythmia lasting more than 7 days. It requires antiarrhythmic therapy.