Types of violations of diastolic function of the left ventricle. Diastolic dysfunction of the myocardium: description of the pathological condition Diastolic dysfunction of the left

Diastolic dysfunction of the myocardium of the left ventricle

Oxygen transport is a fundamental feature of the functioning of any organism. Provides her blood flow. And also a key link in this system is the heart, which is an organ-pump. Its function is to alternately contract and relax the muscular tissue called the myocardium. When a failure occurs in any of the functions, these processes are disrupted. Dysfunction of the ventricles of the heart develops. Gradually, the blood in the aorta ceases to fall, because of which the work of vital organs suffers.


Ventricular dysfunction of the heart is a problem with the contraction of the heart muscle during the systole phase.

Blood flows from the chambers into the vessels. Relaxation is achieved, on the contrary, during diastole. Here, tissue relaxation is formed, which helps blood from the atria to pass into the myocardium. Be that as it may, these processes lead to a violation of hemodynamics within the heart. That is, the blood in the heart chambers moves abnormally. Congestion forms in the lungs.

Both thickened and stretched ventricular muscle are associated with chronic heart failure. It is pronounced if the function of the ventricles is depressed to one degree or another. But sometimes dysfunction of the heart is not required for chronic heart failure to occur. At the same time, dysfunction cannot be detected without concomitant heart failure. It can be pronounced or minor. It all depends on the symptoms. This point must be taken into account if it is considered optional to take medication. It should also be taken into account that with myocardial dysfunction diagnosed in such cases, a malfunction is the main sign of adverse processes that take place in the myocardium.

Diastolic myocardial dysfunction of the first type is a hypertrophic variant of the development of the disease.


This ailment is characterized by inhibition of the work of the muscular tissue of the left ventricle. Accordingly, diastolic dysfunction leads to the fact that the ventricle cannot relax and fill with blood to the fullest. The ejection fraction remains normal or is 50% higher than the normal value. Diastolic dysfunction in its pure form can occur only in 20% of cases. There are such varieties as restrictive, pseudo-normal types, violation of relaxation.

Impaired relaxation and the pseudo-normal variety may not show any symptoms, while the restrictive type always leads to symptoms of chronic heart failure with vivid symptoms.

Causes

The main factor that contributes to dysfunction is chemical heart disease. Post-infarction pathology is also distinguished, which is accompanied by atherosclerotic phenomena in the heart and myocardial remodeling. Another symptom hypertrophic cardiomyopathy is an increase in the ventricles by thickening their walls. Possible factors include:

  • myocardial fibrosis;
  • fibrinous pericarditis;
  • aortic valve stenosis;
  • hypertension.

Characteristic features

The diastolic dysfunction of the myocardium of the left ventricle differs from the malfunction of the specified chamber with insufficient work in the systole phase. Slightly less than half of the cases, the course of the disease is asymptomatic. Clinical signs are explained by an increase in pressure in the left atrium due to the fact that insufficient blood enters the left ventricle. The thing is, he's under constant pressure. There is stagnation of blood in the arteries of the lung. It makes itself felt with such symptoms:

  • Shortness of breath, which initially manifests itself when climbing stairs or walking. It happens at the first stages insignificant, gradually becomes pronounced, even in the absence of any active movements.
  • Dry cough, especially at night and when lying down.
  • Failure in the rhythm of the heart. Discomfort and pain in the chest, with simultaneous violation of the heart rhythm. Most often, atrial fibrillation is diagnosed here.
  • Fatigue that comes on quickly. Physical activity is not as well tolerated as before.

Important! Systolic dysfunction of the left ventricle is accompanied by a decrease in the contractility and muscle of the heart and a decrease in the volume of blood circulating in the aorta. Approximately 45% of people with chronic heart failure have this type of dysfunction. In all other cases, myocardial contractility does not suffer.

The key criterion is a decrease in the ejection fraction of the left ventricle. According to the results of an ultrasound examination, this figure is at a level of less than 45%.

Causes

Main reasons:

  • Here there may be characteristic symptoms, and the complete absence of any manifestations. This is the so-called asymptomatic dysfunction.
  • dilated cardiomyopathy. Chambers expand under the influence of hormonal disorders, problems with tissue metabolism and inflammation.
  • Myocarditis. May be caused by bacteria or viruses.
  • Secondary heart disease, in other words, insufficiency mitral valve.
  • Launched variant of hypertension.
  • Myocardial infarction in the acute stage. The development of left ventricular dysfunction is noted in 78% of patients with this disease.

Systolic dysfunction has manifestations that make themselves felt due to a decrease in the amount of circulating blood. Respectively, internal organs and skeletal muscles do not receive enough blood. Key signs include cyanosis and pallor of the skin, the appearance of swelling on the legs. Other features include:

  • Fatigue, weakness in the muscles, which does not have any objective cause.
  • Irritability and problems with falling asleep, other pathologies of the psycho-emotional sphere caused by insufficient blood flow in the brain tissues. Possible memory problems.
  • Kidney dysfunction, associated changes in urine and blood tests, increased blood pressure, edema due to activation of renal mechanisms.

Right ventricular injury

This disease can cause all of the above pathologies. In addition to them, isolated right ventricular failure can be provoked by emphysema and bronchial asthma, valve defects, including the pulmonary artery, tricuspid valve. Experts also talk about congenital heart defects.


Symptoms

The symptoms that characterize right ventricular dysfunction are characteristic. Here there is a threshold of a large circle of blood circulation, congestion in the vessels of the brain, liver, kidneys, muscles and skin. Notable features:

  • Cyanosis of the nasolabial triangle, phalanges of the fingers, tips of the ears.
  • Swelling in the legs, which mainly make themselves felt in the evening and go away on their own after waking up.
  • Liver dysfunction. In some cases, the occurrence of cardiac cirrhosis of the liver is likely. This is followed by painlessness and an increase in this organ, a change clinical analyzes blood.

Important! With damage to the ventricles of the heart, chronic heart failure occurs. Violation of diastole acts as an obligatory link in a single process.

List of studies

If you find symptoms resembling dysfunction of the ventricles of the myocardium, you should go to the local therapist or cardiologist. The specialist will conduct an examination, ask questions of interest and prescribe additional methods of examination. They combine:

  • standard methods. These include urine and blood tests, blood biochemistry to detect the normal functioning of the liver, kidneys, and assessment of hemoglobin levels.
  • Determination of sodium and potassium levels.
  • Detection of hormones in the blood. Hormones that are produced by the adrenal glands and the thyroid gland are being studied. Such an examination is necessary if a specialist suspects an excess of these compounds in the body, which is unfavorable for heart function.
  • ECG. This research method is one of the mandatory ones. Thanks to him, it is possible to recognize myocardial hypertrophy, a characteristic manifestation of ischemia and arterial hypertension.
  • Treadmill test, bicycle ergometry. In other words, this is a cardiogram under physical activity, including while cycling. This test is necessary to assess myocardial load tolerance in the event of a breathing problem, tachycardia. The study reveals changes in blood flow.
  • Echocardiography. The next most important research option. When studying dysfunction of the ventricles of the heart, echocardiography is a kind of gold standard. Due to it, it is possible to determine the ejection fraction. In the case of normal indicators, it exceeds 50%. What else can be determined by it? These are the dimensions of the ventricles, visualization of potential defects, dilated and hypertrophic variants of cardiomyopathy. To diagnose dysfunction of the right ventricle, it is necessary to view its final volume in diastole. Normally, this parameter varies from 15 to 20 mm. It increases significantly if right ventricular dysfunction is detected.
  • x-ray chest. It plays the role of an ancillary study when myocardial hypertrophy is suspected. An x-ray makes it possible to see what the degree of expansion of the heart is in a transverse image. If, nevertheless, hypertrophy is confirmed, with diastolic dysfunction, an increase in the pulmonary pattern is observed, and with systolic, on the contrary, its depletion. This is due to the vascular component.
  • Coronary angiography. This method involves the introduction of a contrast agent into the coronary vessels. This compound makes it possible to visualize their lumen, which is clogged in coronary heart disease and infarction.
  • Magnetic resonance imaging. It belongs to the category of routine techniques. But it is considered the most informative for today and is ahead in this parameter even ultrasound examination hearts. That is why it is used in cases where the diagnosis is considered controversial.

Start of treatment

Impaired diastolic function in the LV region may adversely affect general condition heart and blood vessels. This is a disruption circulatory system when coronary vessels are especially damaged. Both the specialist and the patient must clearly understand that in the case of asymptomatic dysfunction, it is necessary to prescribe appropriate medications. This disease cannot be left unchecked.

Simple rules for taking at least one drug a day will avoid adverse complications and increase life expectancy, even if it joins. chronic insufficiency blood flow.

On the other hand, when the symptoms are especially pronounced, it is unlikely that one tablet will be able to achieve stabilization of well-being. However, the combination of drugs that was chosen correctly will make it possible to significantly slow down the progression of the disease and provide a more acceptable quality of life.

When the early stage occurs, there are almost no symptoms. Right now it is necessary to prescribe ACE inhibitors. If the patient does not tolerate them, angiotensin 2 receptor antagonists may be an alternative. These drugs protect organs well, do not allow hypertension and its symptoms to negatively affect him.

Which organs are the most vulnerable here? First of all it is:

  • a heart;
  • brain;
  • kidneys;
  • retina of the eye.

The prescribed drugs should be taken daily at the dose recommended by the cardiologist. Among other things, ACE inhibitors prevent the progression of myocardial remodeling. Chronic heart failure also slows down in development. Of the drugs, enalapril is considered classic, among ARA 2 valsartan, losartan and others can be distinguished. Also, do not forget about the need to correct the underlying disease, which provoked ventricular dysfunction.

When the symptoms are already becoming pronounced, for example, shortness of breath becomes regular, choking at night, swelling occurs, key groups of medicines are required. What applies to them:

  • Diuretic drugs. These are diuretics Hydrochlorothiazide, Furosemide, Veroshpiron. Their action is aimed at eliminating stagnation.
  • Beta blockers. Bisoprolol, Metoprolol and their analogues reduce heart rate, help relieve spasms of peripheral vessels, and reduce the load on the myocardium.
  • calcium channel inhibitors. These include Verapamil, Amlodipine. In their action, they are similar to beta blockers.
  • cardiac glycosides. Corglycone and digoxin increase heart rate and strength.

Also practiced in modern medicine and a combination of medications. For example, you can combine Indapamide and Noliprel, Perindopril, a combination of amlodipine, amozartan, losartan or hydrochlorothiazide, losartan, lorista is also acceptable.

Mandatory prescription of nitroglycerin is required.

As popular forms of the drug are pektrol, monocinque. It can be put under the tongue and used for angina in the form of tablets.

Aspirin, its analogues, such as Thrombo ASS, prevent the formation of blood clots in the vessels, but do not affect those that are already formed.


Statins. They are used when it is impossible to normalize blood cholesterol through diet. They are in demand for coronary heart disease and atherosclerosis.

Lifestyle change

Diet is a fundamental principle of changes that are made to life. It is necessary to limit sodium, reduce the amount of table salt in the menu. It can be consumed no more than 1 g per day. It is important to drink no more than one and a half liters per day. This reduces the load on the vessels and the heart. Nutrition should be as diverse as possible, rational. The frequency of meals is 4 to 6 times a day. It is necessary to abandon spicy, fried and fatty foods. The list of consumed fruits, vegetables, dairy products, grains and cereals will also have to be expanded.

The next point of treatment without medication is to give up bad habits. You need to get enough sleep, work hard and rest.

Required physical exercise. Loads should be in harmony with your capabilities. Suppose most people can walk in the evening on foot in the park, or go fishing.


This type of rest provides positive emotions and guarantees optimal functioning of the neurohumoral system. They are responsible for the activity of the heart. Of course, in the stage of decompensation, when the disease manifests itself, the load must be minimized or excluded completely for the period indicated by the doctor.

Potential Hazard

The main danger lies in the patient's neglect of his duties, when he does not agree to take responsibility for his health.

Accordingly, myocardial dysfunction begins to progress and turns into chronic heart failure. This moment is different for everyone. For some, it is slowed down, it takes decades. Someone gets symptoms during the first year after the diagnosis.

It turns out that it is impossible to predict exactly according to what plan the dysfunction in certain person. The most significant are the reduction of the ejection fraction to 30% or less. There are left ventricular failure, arrhythmia in the form of atrial fibrillation, thromboembolism of the lung artery.


Forecast data

If the treatment was not carried out properly, or the dysfunction acquired an impressive scale, contributed to the emergence of chronic vascular insufficiency, the prognosis is considered unfavorable. It is impossible to leave such a pathology without treatment.

If the patient complies with all recommendations, accepts all necessary medicines on time, he has every chance of recovery, since today they produce drugs to combat even such complex pathologies. A responsible approach to business can ensure a quality and long life.

Video "Hypertrophy of the left ventricle"

This video talks about left ventricular hypertrophy of the heart and what it can lead to.

And some secrets...

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Education: FGBU Clinical Hospital, Moscow. Occupation: general surgery…

Left ventricular diastolic dysfunction is a violation of the ejection of blood into big circle from the corresponding chamber due to insufficient filling at the time of relaxation of the muscular organ.

The disease carries a great danger to health due to the increasing ischemia of all tissues, including the heart.

The process of the first type is characterized by a violation of myocardial tone. The heart muscle is unable to relax during diastole. The muscles are tense, this does not allow the blood to move normally through the chambers.

Sooner or later, dysfunction acquires more dangerous features, becomes stable. The first type gives minimal risks in terms of death, without treatment it progresses within 1-2 years.

Symptoms are blurred, may be completely absent or disguised as the underlying pathological process.

  • Pseudo-normal appearance. If LVDD type 1 is characterized by the absence of organic defects in the heart muscle, this is determined by the weakness of the myocardium as a result of tissue breakdown.

Usually, the development of type 2 diastolic dysfunction is preceded by a previous heart attack or current angina pectoris (coronary insufficiency).

Symptoms are present, it is pronounced, but non-specific. It accompanies the patient constantly, the paroxysmal course is uncharacteristic, since there are no periods of exacerbation.

Starting from this stage, it is no longer possible to radically help the patient. Because the main diagnosis is usually difficult. This, myopathy and others.

  • The restrictive form is the third type of violation. It is characterized by a violation of elasticity, extensibility of the left ventricle.

Since the myocardium is not able to contract as it should, severe heart failure occurs.

The development of this type of dysfunction takes from 4 to 6 years, sometimes less.

Attention:

The terminal phase cannot be corrected. The maximum that can be expected is a slight extension of life.

All three types of left ventricular diastolic dysfunction described are secondary. The disease is never primary, therefore it is necessary to carefully stop the main diagnosis. This is the only way to prevent DDLD.

Physiological causes

Factors are not always pathological. In many cases, the condition develops as a result of natural moments. Which ones?

Age

In the high-risk group of the patient 60+. As the functional activity of the body fades, dangerous destructive changes occur.

The hormonal background drops as it begins menopause, the elasticity of cardiac structures decreases, atherosclerosis develops.

The burden of somatic diseases presses harder, the possibility of maintaining physical activity is minimal, stagnation begins. Hence the insufficiency of the work of the cardiac structures as a result of their natural wear and tear.

Such moments cannot be restored. The only thing that can be done is to take supporting drugs.

Fortunately, age-related diastolic dysfunction does not pose such a great danger, since it does not tend to progress rapidly.

Exercising for a long time

Inadequate load leads to a gradual growth of the heart. There is a restructuring of the whole body in a new way in order to provide the body with the necessary amount of nutrition.

The thickened myocardium is not able to contract normally, hence type 1 DDLV.

Over time, the condition only gets worse. If the cardiac structures do not receive the proper load, the phenomena of tissue dystrophy rapidly increase. Therefore, professional athletes and enthusiastic amateurs are by no means healthy people.

Pathological factors

There are many more of them and they provoke dysfunction in 70% of clinical situations.

Increased body weight

Strictly speaking, this is just a symptom of the underlying problem. Obese persons in 100% of cases suffer from metabolic disorders. Usually lipid metabolism is under attack.

Excessive deposition of fats on the walls of blood vessels is formed against the background of a genetic predisposition or hormonal imbalance.

Almost always, atherosclerosis occurs, which increases the likelihood of left ventricular diastolic dysfunction by a factor of three.

Weight loss won't help. This is an effect on the effect, not on the cause. Long-term maintenance treatment is needed. It is aimed at correcting the endocrine status of the patient.

This factor is relatively easy to correct. But it may take more than one year to discover it.

mitral valve stenosis

It occurs as a result of inflammatory processes, a heart attack, or congenital disorders of an organic plan. The bottom line is the lack of patency of the specified anatomical structure.

The mitral valve acts as a septum between the left atrium and the ventricle. Provides stable blood flow in one direction.

However, as a result or its infection, the liquid connective tissue is supplied in insufficient quantities. This means that emissions will also be reduced.

Without surgical treatment, the vicious circle cannot be broken. Mitral valve defects suggest prosthetics. Plastic effect does not give.

Postponed heart attack

Acute myocardial malnutrition and necrosis of functionally active heart tissues. It develops rapidly, cardiomyocyte cells die in a matter of minutes, less often hours.

Without urgent hospitalization, the chances of survival are minimal. Even if you're lucky, there will be a gross defect in the form of coronary artery disease.

An unpleasant consequence of a heart attack is cardiosclerosis. Replacement of active tissues with scar tissue.

They don't shrink, they can't stretch. Hence the restriction (loss of elasticity) of the ventricles, and the inability to accommodate a sufficient amount of blood.

Arterial hypertension

Regardless of the disease of the same name. Any stable symptomatic increase in pressure puts an excessive strain on the cardiac structures.

There is a direct relationship between the level of blood pressure and the risk of the described condition. An increase in the tonometer index by 10 mm Hg increases the likelihood of impaired left ventricular relaxation by 15% on average.

Since it is impossible to radically stop hypertension in advanced stages, the chances of a cure for LVDD are also very vague.

Inflammatory pathologies of the myocardium

They have an infectious origin or autoimmune genesis, but somewhat less frequently. They are characterized by an aggressive course. In the short term, they can lead to total destruction of the atria.

The volumes are so large that replacement with scar tissue is not possible. Requires prosthetics. Surgery is also considered a risk factor.

Therefore, if you suspect myocarditis, you should consult a doctor or call ambulance. Therapy is stationary.

Inflammation of the pericardium

The shell of the heart that holds the organ in one position. The defeat of structures leads to. That is, compression as a result of the accumulation of effusion.

Treatment is urgent, under the supervision of a specialized specialist. In the early stages, medication, in the later stages, if complications are detected, surgical treatment.

The list of causes is incomplete, but those described are particularly common. The state is never caused by extra-heart moments. This facilitates diagnosis, on the other hand, it gives an initially difficult prognosis for recovery and life.

Symptoms

Signs of LV dysfunction are cardiac and neurogenic. They talk about such manifestations of the pathological process:

  • Severe edema lower extremities. In the morning, also in the evening, after a long stay in vertical position. The symptom disappears, then returns again, and so on for a long period.
  • Intense cough. Unproductive, sputum is not excreted. In the prone position, the manifestation intensifies. The onset of respiratory failure, which is life-threatening, is likely.
  • Arrhythmia. On the early stages as a simple tachycardia. Then there is fibrillation or extrasystole. These signs require urgent correction. It is possible to stop the work of the body.
  • Dyspnea. At an early stage after intense physical activity. Then there is a disturbance at rest, which indicates a developed process.
  • Weakness, drowsiness, drop in efficiency to almost zero.
  • Headache.
  • Fainting states. As a rule, manifestations from the central nervous system occur relatively late. They testify in favor of a generalized process that has affected the cerebral structures. The risk of stroke rises sharply. Especially unfavorable in terms of prognosis are multiple syncope during one day.
  • Cyanosis of the nasolabial triangle.
  • Paleness of the skin.
  • Feeling of pressure in the chest, heaviness, discomfort.
  • From time to time there are bouts of causeless fear. Panic attacks as a clinically acceptable option.

These signs are nonspecific only for LV diastolic dysfunction, since they occur against the background of all possible problems with the cardiovascular system. but they last constantly, do not pass at all. A paroxysmal course is not typical.

Diagnostics

It is carried out under the supervision of a cardiologist, a specialized surgeon is involved as necessary, but usually at the stage of planning surgical treatment. The examination scheme depends on the suspected cause.

The priority list of activities is as follows:

  • Oral questioning of the patient for complaints. To objectify symptoms. At this stage, it is impossible to say anything concrete, apart from stating the fact of the cardiac origin of the pathology.
  • Collection of anamnesis. Lifestyle, past conditions, age, family history.
  • Measurement blood pressure, heart rate. There is a direct relationship between the stage of left ventricular diastolic dysfunction and indicators. Against the background of a running phenomenon, they are changed upwards. This is not an axiom. Options with unstable numbers are possible.
  • Daily monitoring. Blood pressure and heart rate are recorded for 254 hours, in dynamics.
  • Electrocardiography. Assessment of the functional state of cardiac structures. Used for early detection of arrhythmias.
  • . Visualization of heart tissues.
  • MRI or CT as needed.

Auscultation is also practiced - listening to heart sounds.

Treatment

Mostly etiotropic, that is, aimed at eliminating the root cause pathological condition. Both medical and surgical therapy is practiced.

As part of a conservative methodology, a group of questions is solved, which drugs are prescribed:

  • Antiarrhythmic. Quinidine or amiodarone, depending on tolerance. Correct the heart rate, prevent the development of dangerous fibrillation or extrasystole.
  • Beta blockers. For the same purposes, plus correction of high blood pressure. carvedilol,
  • Metoprolol as the main.
  • Hypotensive. Perindopril, Moxonidine, Diltiazem, Verapamil. Lots of options.
  • Nitroglycerin to relieve pain, if any.
  • cardiac glycosides. Improve myocardial contractility. Tincture of lily of the valley or Digoxin as the main ones.
  • Diuretics. Remove excess fluid from the body. It is better to use sparing drugs like Veroshpiron.

Surgical techniques are aimed at eliminating defects, defects. Prosthetics of the affected tissues and structures is practiced. A similar method is prescribed strictly according to indications, if there is no other way out.

Lifestyle changes, except for the exclusion of smoking and alcohol, do not make much sense. The process has already started.

Forecast

The likely outcome depends on a host of factors. By itself, diastolic dysfunction does not bode well for the patient, since it is not primary and depends on the course of the underlying disease.

What points should be taken into account when determining the forecast:

  • Age.
  • Floor. Men die from cardiac pathologies more often.
  • Family history.
  • Individual history. What diseases were and are, what the patient takes from them.
  • General health.
  • Lifestyle.
  • Body weight, degree of obesity, if any.
  • The nature of the treatment received.
  • Professional activity, whether physical activity is present.

In general, against the background of current pathologies, the probability of death is 60% over 3-5 years.

If there are no risk factors at all, the risk of death is estimated at 7-12%. Recovery has good prospects. The doctor can say something specific after a period of observation.

Possible Complications

Likely consequences:

  • Cardiac arrest as a result of malnutrition and a drop in myocardial contractility.
  • Heart attack. Necrosis of active, functional tissues. Usually extensive, associated with almost certain death.
  • Cardiogenic shock. As a result of a catastrophic drop in basic vital signs. Getting out of this state is almost impossible. The risks are the highest.
  • Stroke. Weakening of the trophism of nerve tissues. Accompanied by a neurological deficit of varying severity. Perhaps a violation of thinking, speech, vision, hearing, mnestic, cognitive abilities, behavior and other points.
  • vascular dementia. The symptoms are similar to Alzheimer's disease. Given the persistence of disorders of the cardiovascular system, it has poor prognosis and is difficult to reverse.
  • Respiratory failure, pulmonary edema.
  • Thromboembolism.

Death or disability, as a result of all the consequences described above.

Complications occur as a result of insufficient quality or missing treatment. Especially resistant forms, unfortunately, are not amenable to therapy at all, or the results are not clinically significant. There are few such cases, but they do exist.

Finally

LV diastolic dysfunction - a violation of blood output as a result of insufficient intake of fluid connective tissue into the left ventricle during relaxation of the muscular organ (in diastole).

Treatment prospects depend on the underlying diagnosis. Methods vary. Therapy is effective only in the early stages.

In this article, you will learn: everything important about left ventricular diastolic dysfunction. The reasons for which people have such a violation of the heart, what symptoms this disease gives. Necessary treatment, how long it should be carried out, whether it is possible to recover completely.

Article publication date: 04/05/2017

Article last updated: 05/29/2019

Left ventricular diastolic dysfunction (abbreviated as LVDD) is insufficient filling of the ventricle with blood during diastole, i.e. the period of relaxation of the heart muscle.

This pathology is more often diagnosed in women of retirement age suffering from arterial hypertension, chronic heart failure (abbreviated CHF) or other heart diseases. In men, left ventricular dysfunction is much less common.

With such a dysfunction, the heart muscle is unable to fully relax. From this, the filling of the ventricle with blood decreases. Such a violation of the function of the left ventricle affects the entire period of the cycle of heart contraction: if during diastole the ventricle was not sufficiently filled with blood, then during systole (myocardial contraction) little of it will be pushed into the aorta. This affects the functioning of the right ventricle, leads to the formation of blood stasis, in the future to the development of systolic disorders, atrial overload, CHF.

This pathology is treated by a cardiologist. It is possible to involve other narrow specialists in the treatment process: a rheumatologist, a neurologist, a rehabilitation specialist.

It will not be possible to completely get rid of such a violation, since it is often provoked by an underlying disease of the heart or blood vessels or their age-related wear. The prognosis depends on the type of dysfunction, the presence of concomitant diseases, the correctness and timeliness of treatment.

Types of left ventricular diastolic dysfunction

Types Brief definition
Hypertrophic type (left ventricular diastolic dysfunction type 1) The initial stage, often detected in patients in the early stages of hypertension. A slight violation of the relaxation of the muscles of the left ventricle is characteristic.
Pseudonormal type Detected in patients with more severe cardiac disorders. Muscle relaxation worsens, pressure in the left atrium increases, the left ventricle fills with blood due to the pressure difference.
Restrictive type The most severe (terminal) stage of diastolic dysfunction. The filling of the left ventricle is poor due to excessive rigidity and reduced elasticity of its walls.

Reasons for development

More often, the reasons are a combination of several factors:

  • elderly age;
  • arterial hypertension;
  • overweight;
  • chronic heart pathologies: arrhythmias or other rhythm disturbances, myocardial fibrosis (replacement of muscle tissue with fibrous tissue, which is unable to contract and conduct electrical impulses), aortic stenosis;
  • acute cardiac disorders, such as a heart attack.

Causes of pathology

Violation of blood flow (hemodynamics) can cause:

  • pathologies of the circulatory system and coronary vessels: thrombophlebitis, ischemia of the heart vessels;
  • constrictive pericarditis with thickening of the outer shell of the heart and compression of the heart chambers;
  • primary amyloidosis, in which the elasticity of the myocardium decreases due to the deposition of special substances that cause atrophy of muscle fibers;
  • postinfarction cardiosclerosis.

Symptoms

LVDD in approximately 45% of cases is asymptomatic for a long time, especially in hypertrophic and pseudonormal types of pathology. Over time, and in the most severe, restrictive type, the following manifestations are characteristic:

On the initial stages diastolic dysfunction, the patient is unaware of the onset of a violation of the heart, and writes off weakness and shortness of breath for banal fatigue. The duration of this asymptomatic period varies from person to person. A visit to the doctor occurs only when there are tangible symptoms. Clinical signs, such as shortness of breath at rest, swelling of the legs, affecting a person's quality of life.

Basic diagnostic methods

Among the additional measures, it is possible to study the function thyroid gland(determination of hormone levels), chest x-ray, coronary angiography, etc.

Treatment

It is possible to cope with a violation of the left ventricular diastolic function only if it is caused by a cardiac surgical pathology that can be completely eliminated surgically. In other cases, problems with heart diastole are corrected with medication.

Therapy is primarily aimed at correcting circulatory disorders. The quality of his future life depends on the timeliness, correctness of treatment and the strict implementation of medical recommendations by the patient.

The goals of medical measures:

The main groups of drugs Action
Beta blockers They normalize blood pressure, slow down heart contractions, prevent the progression of myocardial hypertrophy, and improve the nutrition of heart tissue.
calcium antagonists They have a positive effect on diastole: a decrease in calcium in the cells of the heart muscle facilitates the relaxation of the myocardium.
ACE inhibitors They reduce blood pressure, relax the walls of the heart vessels, improve myocardial elasticity, favorably affect the prognosis, quality and life expectancy of patients.
Sartans Similar actions with ACE inhibitors.
Diuretics They correct the water balance by removing excess fluid, eliminate swelling, and reduce shortness of breath. Together with antihypertensive drugs, they normalize A / D, alleviate all manifestations of heart failure.
Nitrates Used as adjuvant therapy for coronary artery disease, angina pectoris.
cardiac glycosides Serious drugs used under medical supervision. Reduce the number and increase the force of contractions of the heart.

Forecast

Violation of the diastolic function of the left ventricle cannot be completely stopped, but with adequate medical correction of circulatory disorders, treatment of the underlying disease, proper nutrition, work and rest schedule, patients with such a violation live a full life for many years.

Despite this, it is worth knowing what a violation of the cardiac cycle is - a dangerous pathology that cannot be ignored. With a bad course, it can lead to a heart attack, stagnation of blood in the heart and lungs, and swelling of the latter. Complications are possible, especially with a severe degree of dysfunction: these are thrombosis, pulmonary embolism, ventricular fibrillation.

In the absence of proper treatment, severe dysfunction with severe CHF, the prognosis for recovery is unfavorable. In most of these cases, everything ends with the death of the patient.

With regular proper treatment, adjusting nutrition with salt restriction, controlling the condition and level of blood pressure and cholesterol, the patient can count on a favorable outcome, prolonging life, and active.

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The MyEchocardiography.com virtual echocardiography system allows you to simulate the following studies:

Echocardiographic modes:

Two-dimensional echocardiography (B-mode), One-dimensional echocardiography (M-mode), Color Doppler (Color Doppler), Pulsed wave Doppler (PW), Continuous wave Doppler (CW).

Echocardiographic measurements: Linear dimensions, area, volume.

Echocardiographic calculations of the left ventricle: LV EF% - Left ventricular ejection fraction. (Simpson's Single Plane, Biplane), LV FS% - Fractional shortening of the left ventricle. CO - Minute volume, SV - Stroke volume, Cl - Cardiac index, LV Mass - Left ventricular mass.

Doppler parameters:

Vmax, Vmid, PGmax, PGmid, VTI, PHT.

Virtual echocardiography system "MyEchocardiography"

All major calculations recommended by the American Society of Echocardiography (ASE) can be performed to assess disease severity.

Mitral stenosis: MVA tracing, PISA, PHT, MVA by flow continuity equation, PG max.

Mitral regurgitation: Regurgitation area, Reg Area / LA area, PISA, Regurgitation volume and fraction (Continuity of flow equation), Vena Contracta.

aortic stenosis: Peak velocity, PG mid, AVA according to the continuity of flow equation.

Aortic regurgitation: PHT, D reg / D Lvot, Area reg / CSA Lvot, PISA, Vena Contracta, Regurgitation Volume and Fraction (Continuity Flow Equation).

Tricuspid stenosis: MG mid, TVA according to the flow continuity equation. PHT. VTI.

Tricuspid regurgitation: regurgitation area, PISA.

Valvular stenosis of the pulmonary artery: Flow rate, PG systolic.

Pulmonary valve defect: The length of the regurgitation flow.

Determination of pressure in the pulmonary artery: P systolic, P diastolic, P mean.

CLINICAL ECHOCARDIOGRAPHY

Online guide

The manual is intended for both novice and experienced operators. The guidelines are based on an analysis of the world-renowned echocardiographic literature, scientific research and guidelines. With the help of echocardiographic calculators, you can calculate different parameters - taking into account the severity of the pathological condition.

Chapter 1.

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6 Doppler echocardiography

Chapter 7. left ventricle

7.1.

7.2.

7.3 .

Chapter 9

Chapter 10

Chapter 11

Chapter 12

12.1.

12.2.

12.3.

It is one of the most dangerous, i.e. those that lead to particularly severe consequences (disability, death). For the development of any pathology in the myocardium - there is a reason, and one of them is systolic disorders - a decrease in the ability of the heart to eject blood into the aorta (this leads to the development of left ventricular failure and pulmonary hypertension). As a result, these performance problems reduce the overall release and delivery of oxygen in the blood and nutrients vital organs.

Diastolic myocardial dysfunction - what does it mean?

Dysfunction is a malfunction of the organ, translated from Latin “difficulty in action”, diastolic myocardial dysfunction, respectively, this is a violation of the process of the heart muscle and a decrease in the filling of the left ventricle with blood during diastole (its relaxation). With this pathological process, the ability of the left myocardial chamber to pump blood from the pulmonary artery into its cavity decreases, thus, its filling decreases during relaxation.

Diastolic dysfunction of the left ventricular myocardium is manifested by an increase in the ratio of ventricular end pressure and end volume during diastole. The development of this pathology is accompanied by a decrease in the compliance of the walls of the left chamber of the heart.

Fact! In 40% of patients with heart failure, there is no systolic dysfunction of the left chamber, and acute heart failure is a progressive diastolic dysfunction of the left ventricle.

As the left ventricle fills up, three main stages of the process are distinguished.

  1. Relaxation. This is a period of relaxation of the heart muscle, during which there is an active excretion of calcium ions from the filamentous muscle fibers (actin, myosin). During this, the contracted muscle cells of the myocardium relax, and their length increases.
  2. Passive filling. This stage occurs immediately after relaxation, the process directly depends on the compliance of the walls of the ventricle.
  3. Filling, which is carried out due to the contraction of the atria.

Interesting! Though cardiovascular diseases more commonly affects males, dysfunction, on the contrary, “prefers” women a little more. Age category - from 60 years.

Varieties of this pathology

To date, this pathology is usually divided into the following types:

  1. diastolic myocardial dysfunction type 1. This stage is characterized by disturbances (decelerations) in the process of relaxation of the left ventricle of the heart in diastole. The required amount of blood at this stage comes with atrial contractions;
  2. type 2 diastolic dysfunction of the myocardium is characterized by an increase in pressure in the left atrium, due to which the filling of the lower chamber is possible only due to the action of a pressure gradient (this type is called "pseudo-normal");
  3. diastolic myocardial dysfunction type 3. This stage is associated with an increase in atrial pressure, a decrease in the elasticity of the walls of the ventricle and an increase in rigidity.

Depending on the severity of the pathology, an additional division into:

  • mild (I type of disease);
  • moderate (type II disease);
  • severe reversible and irreversible (type III disease).

The main symptoms of the external manifestation of dysfunction

Diastolic dysfunction of the myocardium quite often proceeds asymptomatically, without betraying its presence for years. If the pathology manifests itself, then you should pay attention to the appearance of:

  • heart rhythm disturbances;
  • shortness of breath, which was not there before, then it began to appear during physical exertion, and over time - at rest;
  • weakness, drowsiness, increased fatigue;
  • cough (which in the "lying" position becomes stronger);
  • severe sleep apnea (manifested a couple of hours after falling asleep).

Factors provoking the development of pathology

First of all, it should be noted that the development of diastolic dysfunction of the myocardium is promoted by its hypertrophy, i.e. thickening of the walls of the ventricles and the interventricular septum.

Hypertension is the main cause of cardiac muscle hypertrophy. In addition, the danger of its development is associated with excessive physical activity on the body (for example, increased sports, hard physical labor).

Separately, factors contributing to the development of the main cause - hypertrophy are distinguished, and these are:

  • arterial hypertension;
  • heart disease;
  • diabetes;
  • obesity;
  • snoring (its effect is due to the involuntary cessation of breathing for a few seconds during sleep).

Ways to detect pathology

Diagnostics of the development in the myocardium of such a pathology as diastolic dysfunction includes the following types of examinations:

  • echocardiography in combination with dopplerography (the study makes it possible to obtain an accurate image of the myocardium and evaluate functionality in a given period of time);
  • electrocardiogram;
  • ventriculography (in this case, radioactive albumin is also used to determine the contractile function of the heart);
  • x-ray examination of the lungs;
  • laboratory blood tests.

Modern therapy of pathological disorders

Conservative methods are used to treat diastolic myocardial dysfunction. The treatment plan begins with the elimination of the causes of the development of pathology. Considering that the main development factor is hypertrophy, which develops as a result of hypertension, antihypertensive drugs are certainly prescribed and blood pressure is constantly monitored.

Among the drugs used to treat dysfunction, the following groups are distinguished:

  • blockers;
  • drugs designed to improve wall elasticity and reduce pressure that promote myocardial remodeling (angiotensin-converting enzyme inhibitors);
  • thiazide diuretics;
  • calcium antagonists.