Myocardium is the heart muscle, which consists of cardiomyocytes - cells that provide an impulse to pass through the ventricles and contract the heart muscle. If these cells are damaged, there is a violation of contractility and conduction in the heart muscle. It is this condition that occurs during the development of diffuse myocardial rearrangements.
Diffuse changes in the myocardium on the ECG: what does it mean?
Typically, the patient receives the conclusion "diffuse changes in the myocardium" after an electrocardiogram or ultrasound examination of the heart. This conclusion is not an independent diagnosis, but only indicates that there is some kind of pathology in the heart muscle, and gives the doctor a basis for further diagnostic search. At the heart of diffuse changes is a violation of repolarization and depolarization in the myocardium. The most characteristic diffuse changes in left ventricular myocardial repolarization, which is normally provided by an increased intake of potassium ions in the cardiomyocyte. Most often, this problem occurs precisely in the lower part of the wall of the left ventricle.
Thus, diffuse changes in the left ventricular myocardium are not specific, but can occur in various diseases. It is about them that will be discussed later.
Reasons for the development of diffuse changes
Diffuse changes in the left ventricular myocardium can often be prevented by changing the patient’s lifestyle and eliminating risk factors. The main conditions that increase the likelihood of diffuse changes include:
- unbalanced nutrition - insufficient intake of nutrients, vitamins, trace elements in the body adversely affects myocardial function;
- increased body weight - excessive weight and obesity contribute to the deposition of fat vacuoles in cardiomyocytes;
- hypoxia of cardiomyocytes (reduced oxygen supply) due to a decrease in blood flow to them with atherosclerosis of blood vessels;
- diabetes mellitus, which affects both the vascular wall, reducing blood flow to the heart muscle, and disrupts the work of cardiomyocytes directly;
- thyrotoxicosis (hyperfunction of the thyroid gland) - thyroid hormones have a direct toxic effect on the myocardium;
- chronic stress and physical overload, lack of sleep;
- chronic overheating or hypothermia;
- prolonged use of drugs that have a toxic effect on the heart muscle;
- myocardial inflammation due to acute infectious diseases, autoimmune processes;
- myocardial overload and its hypertrophy due to resistance to blood flow with high blood pressure.
Options for diffuse changes
Diffuse changes in the left ventricular myocardium proceed in different types:
- Myocardial dystrophy is a restructuring in the structure of the myocardium that is not accompanied by inflammation or proliferation of connective tissue, disorders occur at the microscopic level with a violation of chemical processes that ensure normal contractility and myocardial conductivity.
- Myocarditis - the development of inflammation of the muscle membrane due to autoimmune processes, infectious diseases (influenza viruses, rubella, diphtheria).
- Myocardiosclerosis is an overgrowth of connective tissue in the myocardium, which can develop both with autoimmune inflammation, and after a past myocardial infarction, with coronary heart disease.
Symptoms of myocardial dystrophy
The main complaints with myocardial dystrophy are increased fatigue, shortness of breath, which at first is only present during physical exertion, and then in peace. Pain in the sternum is also characteristic. And with a prolonged course of the disease, edema can develop, which is characterized by the appearance in the evening on the lower extremities and a decrease in the morning, after sleep.
With early diagnosis on the ECG, distinct diffuse changes in the left ventricular myocardium are visible. In the later stages, the heart performs its pumping function worse and worse, heart failure occurs.
Myocarditis symptoms
In addition to symptoms suggesting a violation of the muscle wall of the heart (shortness of breath, chest pain, swelling), symptoms of the development of the inflammatory process in the body are also characteristic.
In viral infections, the development of fever, weakness, chills, aching joints, runny nose, cough is characteristic. With autoimmune myocarditis, the patient also shows signs of the main autoimmune process: arthritis, dermatitis, disorders of the nervous system with rheumatism; rash on the skin, damage to the kidneys and lungs with systemic lupus erythematosus; muscle pain, limb weakness and arthritis with dermatomyositis.
Symptoms of myocardiosclerosis
The development of diffuse changes in the left ventricular myocardium according to the type of myocardiosclerosis can be suspected in a person with a history of heart disease. Small foci of myocardial sclerosis can be asymptomatic and can be determined by chance on planned electrocardiograms after suffering autoimmune diseases, myocardial infarction, and angina pectoris.
Thus, the symptoms of moderate diffuse changes in the left ventricular myocardium are very non-specific, and only a comprehensive examination of the patient with a detailed history, additional instrumental examination methods will help to find the cause of this pathology.
Basic diagnostic methods
After a thorough and scrupulous conversation with the patient, the doctor directs him to additional examination methods. The main methods to establish a diagnosis are as follows:
- Electrocardiography (ECG) consists in recording the conduct of an impulse in the heart muscle by applying electrodes.
- Holter monitoring - a round-the-clock electrocardiogram, on which the patient can also use a special button to record the time of occurrence of unpleasant sensations (shortness of breath, pain behind the sternum, etc.).
- ECG with bicycle ergometry - a method of recording an ECG with a load on the bicycle ergometer.
- Echocardiography is an ultrasound examination of the heart.
How to determine diffuse changes on the ECG?
Since changes in the myocardium of the left ventricle of a diffuse nature for a long time pass without any complaints from the patient, this pathology can only be determined using instrumental examination methods. What are they? The most widely used method for diagnosing diffuse changes in the left ventricular myocardium is an ECG.
What signs on the ECG allow you to diagnose diffuse changes? The main ones include:
- a decrease in the height, or amplitude, of the T wave, which is responsible for the repolarization of the ventricle;
- the presence of negative T waves;
- decrease in voltage, that is, the height of the teeth.
ECG symptoms of left ventricular hypertrophy
Usually diffuse changes in the myocardium and hypertrophy of the left ventricle (thickening of its wall) are observed not in isolation, but together with each other. Therefore, ECG signs of diffuse changes often accompany changes characteristic of hypertrophy:
- displacement of the electrical axis of the heart to the left, which is manifested by an increase in the height of the R wave in the I standard lead;
- increase in R in the left chest leads - V1 and V2;
- moving the transition zone to V2 (the transition zone is the ECG lead, in which the height R is S, normally it is in V3);
- negative T in I, V5, V6.
All these signs allow us to conclude "left ventricular hypertrophy" and are the basis for a further search for the diseases that caused these changes in the myocardium. Often the causes of hypertrophy are similar to the causes of diffuse rearrangement of the heart muscle, and hypertrophy itself is the cause of these changes, or vice versa.
Therapeutic measures
Treatment of diffuse changes in the left ventricular myocardium should be comprehensive and aimed both at eliminating the immediate cause of the restructuring of the heart muscle, and at modifying the lifestyle. In addition, symptomatic therapy is used to reduce the patient's complaints and increase his standard of living.
Non-drug treatment
Therapy of any diseases of the heart and blood vessels should begin with lifestyle modification and elimination of bad habits. The basic principles are as follows:
- Good nutrition and diet. Diet therapy in the presence of diffuse changes requires the exclusion of fatty, fried, smoked foods from the diet, minimizing animal fats and increased consumption of vegetable fats. Refusal of pickled products, overly seasoned dishes. Particular attention should be paid to diet for people with high blood cholesterol, chronic ischemic heart disease.
- Dosed physical activity. Motor activity is very important for the normal functioning of the heart muscle. However, it should be remembered that weightlifting and physical overload cause hypertrophy of the heart muscle, which increases its need for oxygen. Therefore, physical activity should be moderate. Enough walking in the fresh air, a little jogging, charging in the morning.
- Quitting alcohol and smoking.
- Correction of blood pressure when it is increased by limiting the intake of salt and water.
- Weight correction for obesity under the strict supervision of a dietitian.
- Normalization of work and rest, a full 8-hour sleep.
Drug treatment
Treatment of diffuse changes in the myocardium of the left ventricle (lower wall) is aimed both at removing the cause of these changes, which is called etiotropic therapy, and at reducing patient complaints (symptomatic therapy).
Etiotropic therapy directly depends on the cause of myocardial rearrangement.
With the autoimmune origin of the changes, non-steroidal anti-inflammatory drugs (Nimesil, Diclofenac), corticosteroids (Pednisolone, Hydrocortisone), cytostatics (Azathioprine, Methotrexate) are prescribed. These drugs inhibit the immune system, preventing the development of antibodies against their own cells.
If myocarditis caused by infection is detected, antibiotic therapy (with the bacterial nature of the infection) or antiviral therapy (with a viral origin) is used.
In endocrinological diseases, treatment is aimed at regulating the level of hormones in the blood: insulin for type 1 diabetes mellitus, "Merkazolil" for hyperthyroidism.
Correction of blood pressure is sometimes impossible only by limiting salt and water, then they turn to such groups of drugs as ACE inhibitors (Captopril, Enalapril), calcium channel blockers (Verapamil, Nifedipine), diuretics (Furosemide) ) The most effective antihypertensive drugs, which also reduce left ventricular hypertrophy and normalize myocardial function, are beta-blockers (Metoprolol, Bisoprolol).
With elevated cholesterol and diagnosed vascular atherosclerosis, the use of statins, drugs that reduce the synthesis of cholesterol in the liver (Lovastatin, Atorvastatin) is effective.
As a rule, elimination of the cause of diffuse changes in the myocardium of the left ventricle, lower wall, leads to the normalization of impulse conduction and contractility of the heart muscle, and subsequently to an increase in the patient's standard of living.
In most cases, diffuse changes in the myocardium are not terrible and the doctor can even consider them the norm. However, you should not leave these phenomena completely unattended, because non-specific changes in the heart muscle may hide a more serious pathology of the body. Non-specific changes themselves, which have not been disturbing a person for a long time, can lead to serious consequences in the future: heart attack, heart failure.
Therefore, if you have a diagnosis of diffuse changes in the myocardium written in your ECG, don’t delay, consult a doctor and undergo a full medical examination!