What is a heart aneurysm? Aneurysm is a local persistent expansion of a blood vessel or heart cavity. It is believed that the cause of the development of pathology is atherosclerosis. Or the disease occurs due to myocardial infarction. Below we will examine in more detail what a heart aneurysm is, what are the causes of its development and treatment methods.
general information
Aneurysm is a rather dangerous disease. It is important to diagnose it in time, however, many patients who have an aneurysm can have a long time and not suspect the presence of this ailment.
Among patients, only 70% recorded a successful treatment outcome. Other patients die or become disabled due to rupture of the vessel. It is important that diagnosis and treatment be carried out before hemorrhage. As a rule, the diagnosis of the disease is carried out using CT angiography, as well as cerebral angiography.
During a CT scan of the brain, it is possible to detect intracerebral as well as subarachnoid hemorrhage. However, CT very often does not show the presence of blood in small quantities. In such cases, labial puncture helps, with the ability to detect even a small SAK (subarachnoid hemorrhage). A complication of SAH is the narrowing of not only arteries, but also hydrocephalus.
In some patients, aneurysms are detected by chance, most often during a study of the carotid arteries in the diagnosis of other diseases. With the growth of aneurysm, blinking in the eyes and headaches appear. Regardless of the magnitude of the aneurysm and patient complaints, all patients should receive medical advice. Features of treatment depend on the size of the aneurysm and associated human diseases. However, surgery is almost the only method of treating the disease. If the patient refuses surgical intervention, drug therapy can be prescribed.
So what is an aneurysm of the heart? This is a limited area on which the protrusion of the myocardial muscle occurred. Aneurysm can also occur with atherosclerosis, syphilis, myocardial infarction and other diseases. A complete cure requires surgery. It is also necessary to cure the underlying disease.
Very often, aneurysm is not detected for a long time, and the disease is asymptomatic. Aneurysm can cause interruptions in the blood supply to tissues.
Let us consider in more detail what a heart aneurysm is, what are its causes and symptoms, as well as methods for diagnosing and treating this disease.
Heart aneurysm
Aneurysm of the heart is a limited protrusion of the thinned walls of the myocardium, which is accompanied by a sharp decrease or complete disappearance of contractile abilities of the pathologically altered region of the myocardium. In cardiology, aneurysm is detected in 10-35% of patients who have suffered myocardial infarction; 68% of chronic or acute cardiac aneurysms are diagnosed in men, whose age is from 40 to 70 years.
The size of the aneurysm of the heart ranges from 1 to 18-20 cm in diameter. Violations of myocardial contractility in the area of cardiac aneurysm include akinesia (when there is no contractile activity) and dyskinesia.
Reasons for the development of pathology
In 95-97% of cases, the cause of thinning of the walls of the heart muscle is transmural extensive myocardial infarction, most often the left ventricle. Most aneurysms are formed in the region of the anterolateral walls and the apex of the left heart ventricle; about 1% appears in the area of the right ventricle and atrium, interventricular septum, as well as the posterior walls of the left ventricle.
Myocardial infarction provokes the destruction of the structure of the muscle walls of the heart. Under the influence of the pressure force, the necrotic organ wall is stretched and also thinned.
A significant role in the development of aneurysm belongs to a number of factors contributing to an increase in the load on the main organ and an increase in intraventricular pressure: early rising, arterial hypertension, repeated heart attack, tachycardia, progressive failure. Do not forget about the effects of smoking on the heart. The development of the chronic form of cardiac aneurysm is pathogenetically and etiologically directly associated with postinfarction cardiosclerosis. In this case, under the influence of blood pressure, protrusion of the organ wall in the area of the connective tissue scar begins.
Much less often than post-infarction forms, congenital, infectious and traumatic aneurysms are diagnosed. Traumatic occur due to closed as well as open organ injuries. This group can also include postoperative cases of aneurysm, which often occur after interventions to correct congenital heart disease.
In addition, cardiac aneurysms, which are caused by infectious processes (for example, bacterial endocarditis, syphilis, rheumatism, tuberculosis), are quite rare.
Also note that nicotine has a negative effect on the cardiovascular system. It is best to quit smoking when the first symptoms of the disease appear. The effect of alcohol on the cardiovascular system is also far from positive.
Disease classification
According to the time of development, a subacute, acute and chronic form of aneurysm is distinguished. The methods of treatment will depend on the form of the disease. Acute aneurysm is formed within 1 to 2 weeks after myocardial infarction, subacute aneurysm - for 3-8 weeks, chronic form - more than 8 weeks after a heart attack.
In an acute form, the walls of the aneurysm are represented by a necrotic region of the myocardium, which swells externally or in the cavity of the ventricle under the influence of intraventricular pressure (with the spread of the aneurysm in the area of the interventricular septum).
The walls of the subacute aneurysm are formed by a thickened endocardium with a large accumulation of histiocytes and fibroblasts, newly formed reticular, collagen, and also elastic fibers; at the sites of myocardial destroyed fibers, connecting elements of varying degrees of maturity appear.
As for the chronic form of the aneurysm, it is a kind of fibrous sac, which microscopically consists of three layers: intramural, endocardial and epicardial.
In the endocardium, the wall of chronic aneurysm grows with hyalinized and fibrous tissue. The walls of the chronic aneurysm are thinned, sometimes their thickness is not more than 2 mm. In the cavity of the chronic form of the aneurysm, a parietal thrombus of various sizes is often formed, which is capable of lining only the inner surfaces of the aneurysmal sac or occupying almost the entire volume. Parietal loose thrombi often undergo fragmentation, and are considered a potential source of a possible risk of thromboembolic complications.
In the field of medicine, aneurysms of the following three varieties are found today:
- fibro-muscular;
- muscle
- fibrous.
As a rule, aneurysm of the heart is single, but 2-3 can also be detected at the same time. Aneurysms are of the following types: true, that is, formed by the region of a viable myocardium with poor contractility, bulging into the systole, as well as false, which are formed as a result of ruptures of the myocardium and are limited to pericardial adhesions.
Given the depth, as well as the vastness of the lesion, a true aneurysm can be saccular, flat (diffuse), mushroom, and there are also “aneurysms in the aneurysm”. In diffuse aneurysms, the contours of the external protrusion are flat, gentle, and from the side of the organ cavity they are defined by a depression in the form of a bowl.
Sack-shaped aneurysms of the heart have a convex rounded wall, as well as a wide base.
Mushroom aneurysms are characterized by the presence of a strong protrusion with a rather narrow neck.
As for the concept of “aneurysm in aneurysm,” in medicine a defect is defined that consists of several protrusions that are enclosed in one another: these aneurysms have a thinned wall and are more prone to rupture. During the examination, it is most often diffuse aneurysms of the organ that are detected, less often bag-like aneurysms, and even less often “aneurysms in the aneurysm” and mushroom-shaped ones.
Symptoms and signs of aneurysm
Why does my heart beat hard? Could this be a symptom of an aneurysm? The clinical picture of acute aneurysm is characterized by constant weakness, shortness of breath with attacks of cardiac asthma, as well as pulmonary edema, excessive sweating, prolonged fever, tachycardia and cardiac arrhythmias (for example, bradycardia or tachycardia, blockade, extrasystole, ventricular and atrial fibrillation). Therefore, if you are wondering why the heart beats so hard, this may indicate an aneurysm. With a subacute form, signs of circulatory failure develop rapidly.
Symptoms of chronic aneurysm correspond to strongly expressed signs of ordinary heart failure: syncope, shortness of breath, angina pectoris, interruptions in the work of the heart; in the most advanced stage, the veins of the neck swell, swelling, hepatomegaly, hydrothorax, ascites appear. In the chronic form of heart aneurysm, fibrous pericarditis may appear, which causes the development of an adhesion process in the sternum.
Thromboembolic syndrome in the case of chronic aneurysm is presented in the form of acute occlusion of the vessels of the limbs (in most cases of the femoral-popliteal and iliac segments), arteries of the brain, brachiocephalic trunk, lungs, kidneys, intestines. Potentially dangerous complications of chronic aneurysm can be limb gangrene, kidney infarction, stroke, pulmonary embolism, myocardial infarction, mesenteric vessel occlusion.
Rupture of chronic aneurysm is very rare in practice. Acute rupture usually occurs 2-9 days after myocardial infarction. As for the symptoms, the rupture of the aneurysm is manifested by a sharp and sudden onset: pallor, which is replaced by cyanotic skin, cold sweat, overflow of neck veins with blood (a sign of tamponade of the heart), loss of consciousness, cold extremities. In parallel with this, the patient’s breathing becomes hoarse, noisy, superficial, and also rare. As a rule, death occurs in this case instantly.
Diagnostics
A pathognomonic symptom of a cardiac aneurysm is considered to be a pathological precordial pulsation, which is found on the front wall of the chest, and also intensifies with another heartbeat.
During an ECG with an aneurysm of an organ, symptoms of transmural myocardial infarction are recorded, however, which do not change in stages, but at the same time retain a "frozen" character for a rather long time.
As for echocardiography, it helps specialists visualize the entire cavity of the aneurysm, clarify its size, evaluate the entire configuration and diagnose thrombosis of the ventricular cavity. Using stress echocardiography and a PET organ, myocardial viability in the area of chronic aneurysm is determined.
Radiography of all organs of the chest can detect cardiomegaly, the phenomenon of stagnation in the pulmonary circulation.
In addition, MRI and MSCT, scintigraphy of the heart, radiopaque ventriculography are considered highly highly specific methods of topical diagnosis of this disease, determining the size of the aneurysm and detecting thrombosis in its cavity.
Also, according to the indications of patients with heart aneurysm, a sounding of the heart cavity, coronarography, as well as EFI is done. Qualitative diagnosis is necessary, since the aneurysm can be confused with diseases such as a coelomic pericardial cyst, mitral heart disease, mediastinal tumors.
Treatment
And how is the strengthening of the heart muscle during aneurysm? How to treat this disease? And what to take with a fast heartbeat?
In the preoperative period, patients with aneurysm are prescribed special cardiac glycosides, antihypertensives, anticoagulants (subcutaneously "Heparin"), oxygen therapy, oxygen barotherapy.
Surgical intervention
Often, surgery is prescribed for aneurysm of the heart. Surgical intervention for acute and subacute aneurysm of the heart is prescribed due to the rapid progression of heart failure in the patient and the threat of rupture of the entire aneurysm sac. In the case of a chronic form of heart disease, surgery is performed to prevent the risk of thromboembolic complications.
In the treatment of cardiac aneurysm in the role of palliative intervention, specialists resort to strengthening the heart muscle and walls using polymer materials.
The following types of surgical intervention are referred to as radical surgery: resection of an atrial or ventricular aneurysm, as well as Cooley septoplasty (in case of interventricular septal aneurysm).
With post-traumatic aneurysm of the heart, the patient is prescribed suturing of the heart walls, as well as strengthening the heart muscle. If necessary, additional revascularizing surgery, at the same time, a resection is performed in combination with CABG. This is how the treatment of heart aneurysm is carried out.
Then, after resection, as well as plastic surgery of the aneurysm, the development of the so-called low-ejection syndrome, arrhythmia, repeated myocardial infarction, insolvency of bleeding and sutures, renal failure, respiratory failure, thromboembolism of the brain vessels is possible.
Prevention and prognosis of the disease
Without surgery, the course of the heart aneurysm is unfavorable: in most cases, patients with post-infarction aneurysms die 2-3 years after the development of heart disease.
Almost flat asymptomatic aneurysms occur; the worst prognosis is a saccular and mushroom aneurysm, often complicated by intracardiac thrombosis, as well as heart aneurysm in children. In addition, the addition of heart failure is considered a very poor prognosis for patients.
Prevention of aneurysm and its complications will consist of timely diagnosis of a heart attack disease, rehabilitation of patients, adequate therapy, a gradual increase in motor regimen, as well as monitoring of thrombosis and rhythm disturbance.
Smoking aneurysm
Aneurysm is a potentially life-threatening problem in which a blood vessel weakens in one place, and then protrudes and bursts. It should be noted that this can happen in any area of the body, including even the brain. As new studies have shown, smoking significantly increases the risk of a large aneurysm localized in the brain.
Little conclusion
So, we have sorted out what constitutes an aneurysm of the heart, what symptoms accompany this disease, and also what is dangerous for an aneurysm of the heart. Do not ignore the doctor's recommendations when treating an ailment, otherwise serious consequences can occur. Do not forget about the effect of smoking on the heart and adhere to the preventive rules that were described in this article.