Moderate impairment of left ventricular diastolic function. An overview of left ventricular diastolic dysfunction: symptoms and treatment. Probable causes of occurrence

In modern terminology, systolic heart failure. However, in the late 1970s - 80s, it became clear that a significant part of patients with a clinical picture of heart failure have a normal contractile function of the heart, normal values of the left ventricular ejection fraction. This clinical picture in modern terminology is described as diastolic heart failure.

The study of diastole and, in fact, diseases associated with its changes, began as early as 1877, when Francois-Franck, on the basis of experiments, concluded that the maximum filling of the left ventricle with blood occurs in early diastole. In 1906 Hendorson described the three phases of diastole, and in 1921 Wiggers and Katz found that the contribution of the left atrium to the filling of the left ventricle with blood can increase in people with altered LV properties. In 1927, Meek experimentally established that the phase of active relaxation of the myocardium in diastole affects the contractility of the myocardium. In 1949, Wiggers coined the term "inherent elasticity" to describe the behavior of the LV myocardium during diastole, ie. made an attempt to describe the main state of the myocardium in diastole - relaxation.

In 1975 W.H. Gaasch, in a series of experimental and clinical studies, determined the differences in diastole in healthy people and patients with cardiovascular diseases, using changes in pressure in the LV cavity and changes in its volume. In particular, it was found that the volume of blood during passive filling of the LV is reduced in patients with cardiovascular diseases. In 1983-1984 N.N. Echeverria, A.N. Dougherty, R. Souter introduced the term "diastolic heart failure" into clinical practice.

Diastolic heart failure (SDH) is a clinical syndrome with symptoms and signs of heart failure, normal LVEF and impaired diastolic function.

Clinically, diastolic heart failure manifests itself as a slight limitation of physical activity (I FC according to the NYHA Heart Association classification), and the presence of symptoms at rest (IV FC).

Normal LV diastolic function is its ability to "accept" the volume of blood required to maintain adequate cardiac output, without increasing the mean pulmonary venous pressure (> 12 mm Hg). LV diastolic dysfunction occurs if the proper volume of blood can enter the LV only by increasing its filling pressure or if it is not able to increase filling during exercise and thereby provide an adequate increase in cardiac output. Any increase in LV filling pressure is always indicative of diastolic dysfunction. Almost all patients with systolic dysfunction of the left ventricle of the heart have violations of its diastolic function.

Diastole is limited to the time interval from closure of the aortic valve to closure of the mitral valve. Two key mechanisms occur in diastole - LV relaxation and LV filling. Relaxation of the LV begins already in the second half of systole (during the period of slow blood expulsion), reaches a maximum during the isovolumetric relaxation phase, and ends already during LV filling, which consists of phases of rapid filling, delayed filling (diastasis) and atrial systole.

LV diastolic function depends on the ability of the myocardium to relax, which depends on the functioning of the sarcoplasmic reticulum of cardiomyocytes.

LV diastolic function also depends on the mechanical properties of the myocardium - elasticity (change in the length of muscle fibers depending on the force applied to them), compliance (change in ventricular volume with a given change in pressure) and stiffness (characteristic opposite to compliance). The passive characteristics of the heart reflect the ability of the LV to stretch as blood enters it.

At a young age, LV filling is caused by a high pressure gradient at the beginning of diastole, which is formed by a high relaxation rate and elastic properties of the myocardium. In this situation, the LV is mainly filled with blood in the first half of diastole.

Aging, hypertension, ischemic heart disease lead to a significant slowdown in relaxation processes. In such a situation, the filling of the LV with blood occurs mainly not in the first half of diastole, but in the systole of the left atrium.

The diastolic function of the myocardium is significantly influenced by the state (size, volume) of the left atrium, the rate of transmitral blood flow and the number of heartbeats.

A change in the volume of blood entering the left atrium changes its contractility in full accordance with Starling's law. The increased force of left atrial contraction generates a shock stream, which changes the filling rate of the LV and displaces subsequent phases in time, increasing myocardial stiffness. These changes are obvious with AV block, high heart rate and left atrial blood volume overload.

Symptoms and signs of left stomach diastolic dysfunction

Patients with diastolic heart failure present the same complaints as patients with heart failure - a feeling of lack of air, fatigue, palpitations.

In patients with diastolic heart failure, hypertension is more common and postinfarction cardiosclerosis is less common. Such patients are usually older than patients with systolic heart failure, and are often overweight. For patients with diastolic heart failure, atrial fibrillation is characteristic (among elderly patients - up to 75%).

In patients with diastolic heart failure, signs of venous stasis and associated symptoms (edema, wheezing in the lungs, swelling of the neck veins, dyspnea) are less common than in patients with the classic, systolic form of the disease.

On auscultation of patients with diastolic heart failure, 4 heart sounds can often be heard. Although the detection of III heart sound is more typical for patients with systolic heart failure. With severe diastolic dysfunction, especially with a restrictive type of LV filling, this symptom is found very often.

The largest clinical and epidemiological study of the clinical picture of circulatory failure is a study carried out in the Russian Federation (EPOCHA-O-CHF) in 2001-2002.

The data obtained showed a tendency towards an increase in the prevalence of diastolic heart failure in recent years. Normal LV systolic function is recorded in 35-40% of patients with heart failure. The prevalence of diastolic heart failure varies by age. In patients under the age of 50, the diastolic form is diagnosed in 15% of patients, over the age of 70 - already in 50% of patients.

The incidence of heart failure with normal LV systolic function depends on the severity of the examined patients and the criteria for assessing systolic function. So, among patients hospitalized with cardiac decompensation, normal LVEF is recorded in 20-30% of patients, and in end-stage heart failure - in 5-10% of patients. At the same time, in outpatient practice, the prevalence of heart failure with normal LV systolic function, diagnosed using “soft” criteria (for example, based on an excess of ejection fraction by 40%), reaches 80%. Thus, as the severity of heart failure increases, the contribution of isolated diastolic dysfunction as the main cause of heart failure decreases.

Diastolic heart failure prognosis

The frequency of readmission to patients with SDS and in patients with systolic insufficiency does not differ - approximately 50% per year.
Mortality in patients with SDS is 5-8% per year (with systolic circulatory failure - 15% per year). In recent years, there has been no decrease in the mortality rate in SDS.
Mortality in diastolic heart failure depends on the cause of heart failure, with its non-ischemic genesis - 3% per year.

Diagnosis of diastolic heart failure

The diagnosis of diastolic dysfunction is verified if the patient has 3 criteria.

Symptoms or signs of heart failure.
Normal or slightly reduced LV contractile function (LVEF> 45% and its end-diastolic size index<3,2 см/м 2).
Signs of impaired relaxation or filling of the LV, its increased rigidity, obtained with instrumental research methods.

The basis for the diagnosis of diastolic heart failure is echocardiography.

Diastolic elevation of the base of the left ventricle. In diastolic dysfunction, the maximum rate of early diastolic elevation of the LV base (E m) is below 8 cm / s. In addition, the ratio of the maximum velocities of the wave of transmitral blood flow E and E> 15 indicates an increased end-diastolic pressure in the LV (> 12 mm Hg), E / E m<8 - о нормальном, а при Е/Е m 8-15 необходимы дополнительные данные.

The generally accepted biochemical marker of diastolic heart failure is the brain natriuretic peptide (NT-pro-BNP) precursor. Diastolic heart failure is characterized by an increase in the level of this peptide.

Diastolic heart failure treatment

Treatment of myocardial ischemia. IHD is one of the main factors leading to diastolic disturbances. Some diastole disorders are detected in more than 90% of patients with coronary artery disease. Improvement of diastolic function in conditions of ischemic heart disease is possible with the use of drugs (β-acrenoblockers, calcium antagonists) and measures for myocardial revascularization.

Treatment of arterial hypertension. In patients with hypertension, LV diastolic dysfunction is one of the early and common manifestations of myocardial dysfunction, especially at the stage of myocardial hypertrophy. Normalization of blood pressure is one of the simple and at the same time effective ways to improve LV diastolic filling.

Decrease in LV filling pressure (decrease in its preload). The most important treatment principle for this condition is to reduce LV preload (use of diuretics). An excessive decrease in preload dramatically decreases LV filling volume and decreases cardiac output. In these cases, the tactic of slowly decreasing LV preload is justified. Taking diuretics is accompanied by excessive activation of the renin-angiotensin system, therefore, it is advisable to combine them with blockers of the renin-angiotensin system (ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists).

Maintaining and / or restoring sinus rhythm, preserving the contractile function of the left atrium. The contractile function of the left atrium plays a critical role in ensuring normal exercise tolerance in conditions of diastolic heart failure, the progression of which dramatically increases the risk of atrial fibrillation. With atrial fibrillation, the doctor chooses the tactics of "rhythm control" or "frequency control". Careful fulfillment of the requirements of the chosen tactics prevents the progression of diastolic heart failure.

Patients with diastolic heart failure should have target heart rate levels: with coronary artery disease - 55-60 per minute. In CHF, a 16% decrease in baseline heart rate (80-84 bpm) is accompanied by a decrease in the risk of death. To reduce heart rate, β-blockers, phenylalkylamines and If channel blockers are used.

October 24, 2017 No comments

Diastolic dysfunction and diastolic heart failure

The concepts of "diastolic dysfunction" and "diastolic heart failure" in modern cardiology are not synonymous, that is, they mean various forms of impairment of the pumping function of the heart: diastolic heart failure always includes diastolic dysfunction, but its presence does not yet indicate heart failure. The analysis of heart failure presented below focuses on a cardiogenic (mostly “metabolically determined”) myocardial anomaly resulting in inadequate ventricular pumping function, ie, ventricular dysfunction.

Ventricular dysfunction can be the result of weak ventricular contraction (systolic dysfunction), abnormal relaxation (diastolic dysfunction), or abnormal thickening of the ventricular walls, resulting in obstruction of blood flow.

One of the main problems of modern cardiology is chronic heart failure (CHF).

In traditional cardiology, the main cause of the onset and development of CHF was considered a decrease in myocardial contractility. However, in recent years, it is customary to talk about the different "contribution" of systolic and diastolic dysfunction in the pathogenesis of chronic heart failure, as well as about the systolic-diastolic relationship in heart failure. In this case, the violation of diastolic filling of the heart plays no less, and maybe even a greater role than systolic disorders.

To date, a large number of facts have accumulated that cast doubt on the "monopoly" role of systolic dysfunction as the main and only hemodynamic cause responsible for the onset of CHF, its clinical manifestations and prognosis of patients with this form of pathology. Modern research indicates a weak relationship between systolic dysfunction with clinical manifestations and prognosis in patients with chronic heart failure. Insufficient contractility and low left ventricular ejection fraction do not always unambiguously determine the severity of decompensation, exercise tolerance, and even the prognosis of CHF patients. At the same time, strong evidence was obtained that the indicators of diastolic dysfunction, to a greater extent than myocardial contractility, correlate with clinical and instrumental markers of decompensation and even with the quality of life of patients with CHF. At the same time, a direct causal relationship was established between diastolic disorders and the prognosis of patients with chronic heart failure.

All this made us overestimate the importance of left ventricular systolic dysfunction as the only and obligatory factor of CHF, and take a fresh look at the role of diastolic disorders in the pathogenesis of this form of pathology.

Of course, at present, systolic function, which is assessed mainly by the left ventricular ejection fraction, is still assigned the role of an independent predictor of the prognosis of CHF patients. Low left ventricular ejection fraction remains a reliable marker of myocardial injury, and contractility assessment is mandatory to determine the risk of cardiac surgery and can be used to determine the effectiveness of treatment.

So far, the assessment of diastolic function has not yet become a mandatory procedure, which is largely due to the lack of proven and accurate methods for its analysis. Nevertheless, even now there is no doubt that it is diastolic disorders that are responsible for the severity of cardiac decompensation and the severity of clinical manifestations of chronic heart failure. As it turned out, diastolic markers more accurately than systolic ones reflect the functional state of the myocardium and its reserve (the ability to perform additional load), and more reliably than other hemodynamic parameters can be used to assess the quality of life and the effectiveness of therapeutic measures.

In addition, there are all the prerequisites for the use of diastolic indices as predictors of prognosis in heart failure. The observed trend towards a shift in emphasis from systolic to diastolic dysfunction is not surprising when viewed from an evolutionary point of view. Indeed, if we compare the relationship between the processes of contractility and relaxation of the myocardium with other similar so-called. antagonistic processes in the body (for example, pressor and depressor systems for regulating blood pressure levels, the process of excitation and inhibition in the central nervous system, coagulation and anti-coagulation systems of the blood, etc.), then it is possible to find inequality in the potential of such "antagonists": in fact, the pressor system is more powerful depressor, the excitation process is stronger than the inhibition process, the coagulation potential exceeds the anticoagulant one.

In continuation of this comparison, myocardial contractility is "more powerful" than its relaxation, and it cannot be otherwise: the heart first of all "must" contract, and then relax ("diastole without systole is meaningless, and systole without diastole is unthinkable"). These and other similar "inequalities" are evolutionarily developed, and the superiority of one phenomenon over another has a protective and adaptive value. Naturally, with the increased demands of the organism to the named and other "antagonists" dictated by the conditions of the organism's vital activity, first of all "the weak link drops out of the game", which is observed in the heart. Left ventricular diastolic dysfunction often occurs before left ventricular systolic dysfunction.

Let us consider in more detail the pathogenetic essence of the concepts of "systolic dysfunction" and "diastolic dysfunction", taking into account the fact that these concepts are not very common in domestic medical educational and teaching materials (in any case, incomparably less often than in similar foreign literature).

Most often, heart failure is associated with a decrease in the contractile function of the heart. At the same time, in about a third of patients, symptoms of heart failure develop with virtually normal left ventricular function as a result of abnormal filling, which is commonly called diastolic dysfunction (in this case, left ventricular).

The main criterion for diastolic dysfunction of the left ventricle is its inability to fill with blood volume sufficient to maintain adequate cardiac output at normal mean pulmonary vein pressure (below 12 mm Hg). According to this definition, diastolic dysfunction is a consequence of heart damage in which increased pressure in the pulmonary veins and left atrium is required to adequately fill the cavity of the left ventricle.

What can prevent full filling of the left ventricle?

Two main reasons for a decrease in its filling with blood in diastolic dysfunction have been established: 1) violation of active relaxation ("relaxation") of the left ventricular myocardium and 2) a decrease in the compliance ("extensibility") of its walls.

Diastolic dysfunction is probably an extremely common form of pathology. According to the Framingham Study (note in parentheses: everything that is known in the medical world about risk factors for any form of cardiac and vascular pathology was obtained in this study), such an indirect marker of diastolic dysfunction as left ventricular hypertrophy is observed in 16-19% of the population and in at least 60% of patients with essential hypertension.

More often, diastolic dysfunction is found in older people who are less resistant to this disease and coronary heart disease, which causes diastolic disorders. In addition, with age, the mass of the myocardium increases and its elastic properties deteriorate. Thus, in the long term, in connection with the general aging of the population, the role of diastolic dysfunction as a precursor of chronic heart failure will obviously increase.

"Relaxation" of the myocardium

Reduction of cardiomyocytes is an active process that is impossible without the consumption of energy of macroergic compounds. Equally, this provision applies to the process of relaxation of cardiomyocytes. By analogy with the concept of "contractility", this ability should be called "relaxation" of the myocardium. However, there is no such concept in the medical vocabulary, which does not contribute to its scientifically based analysis and use. Nevertheless, within the framework of the discussed problem, the term seems to be adequate to denote the ability of cardiomyocytes to relax.

Myocardial contractility and relaxation are two sides of the same coin, i.e. cardiac cycle. As already noted, the diastolic filling of the heart chambers in normal conditions and when it is damaged is determined by two main factors - myocardial relaxation and compliance (stiffness, extensibility) of the chamber wall.

Relaxation of the myocardium depends not only on the energy supply of cardiomyocytes, but also on a number of other factors:

a) load on the myocardium during its contraction;

b) load on the myocardium during its relaxation;

c) completeness of separation of actinomyosin bridges during diastole, determined by the reuptake of Ca2 + by the sarcoplasmic reticulum;

d) uniformity of load distribution on the myocardium and separation of actinomyosin bridges in space and time.

The ability of the ventricular myocardium to relax can be judged primarily by the maximum rate of drop in intraventricular pressure in the phase of isometric relaxation (-dp / dt max) or by the average rate of drop in pressure (-dp / dt average), i.e. isovolumic laxity index (IR).

IR = DC aorta / FIR,

where DC aorta. - diastolic pressure in the aorta; FIR - the duration of the phase of isometric relaxation of the ventricle.

Diastolic dysfunction may be associated with preserved or slightly reduced systolic function. In such cases, it is customary to talk about "primary" diastolic dysfunction, which is very often associated in domestic medicine exclusively with hypertrophic cardiomyopathy, constrictive pericarditis or restrictive (from English, restrict - to limit) forms of myocardial pathology - myocardial dystrophy, cardiosclerosis, infiltrative cardiomyopathy. Although in the overwhelming majority of cases, diastolic dysfunction with preserved systolic function is characteristic of the most common diseases of the cardiovascular system - hypertension and ischemic heart disease.

Causes and mechanisms of development of diastolic dysfunction

First of all, it must be borne in mind that "diastolic dysfunction" is not observed in patients with mitral stenosis, who, like patients with diastolic dysfunction, have increased pressure in the left atrium and impaired filling of the left ventricle, but not due to myocardial damage, but due to mechanical obstruction to blood flow at the level of the atrioventricular opening.

Arterial hypertension

Arterial hypertension - increased afterload. With constant systemic arterial hypertension, the afterload on the left ventricle increases. Prolonged afterload can cause so-called. parallel replication of sarcomeres with subsequent thickening of cardiomyocytes and the ventricular wall, i.e. concentric hypertrophy, without a concomitant increase in the volume of its cavity. The development of such hypertrophy can be explained on the basis of one of the provisions of Laplace's law: for a given volume of the ventricle, an increase in intraventricular pressure increases the tension of individual cardiomyocytes of the heart wall.

The total wall stress depends not only on the intracavitary pressure, but also on the inner radius of the ventricle and the thickness of the ventricular wall. In conditions of prolonged increased intracavitary pressure, the maintenance of constant wall tension is ensured by an increase in their thickness without a concomitant increase in intraventricular volume. The thickening of the wall reduces the extensibility and compliance of the left ventricle. Individual cardiomyocytes begin to separate by an extensive, branched network of collagen fibers. In addition, in different experimental models it has been proven that the content of high-energy phosphates in the heart overloaded with pressure decreases.

In a hypertrophied heart, diastolic dysfunction precedes systolic dysfunction. During systole, Ca2 + is rapidly released from the sarcoplasmic reticulum along an electrochemical gradient, and during diastole, on the contrary, extrusion (from Latin extrusio - pushing out) of Ca2 + occurs through the sarcolemma and its return to the sarcoplasmic reticulum. This movement (essentially a deposit) of Ca ++ is an energy-consuming and therefore limited process. This fact indicates that the possibilities for relaxation of cardiomyocytes are less than for the process of their contraction.

Primary ventricular hypertrophy

Ventricular hypertrophy can be a genetically determined form of a pathology called hypertrophic cardiomyopathy. Some forms of hypertrophic cardiomyopathy are associated with a defect in the interventricular septum, leading to impaired intracardiac hemodynamics and abnormal filling of the left ventricle.

Absolute coronary insufficiency (myocardial ischemia)

Another important cause of diastolic dysfunction is absolute coronary insufficiency (myocardial ischemia). Due to the fact that the relaxation of cardiomyocytes is an energy-demanding process, a decrease in the content of macroergs in them leads to a decrease in the deposition of Ca ++ and its accumulation in the sarcoplasm, disrupting the relationship between actin and myosin of myofilaments. Thus, ischemia determines a decrease not only in the distensibility of the ventricle, but also, accordingly, in the volume of its filling.

Infiltrative cardiomyopathy

The most common of this form of pathology are sarcoidosis, amyloidosis, hemochromatosis, which are characterized by infiltration of the extracellular space of the myocardium with substances of noncardiogenic origin, which leads to an increase in its rigidity and the development of diastolic dysfunction.

Analysis of Diastolic Dysfunction Using the Pressure-Volume Loop

As a rule, the pathogenetic basis of such disorders is the abnormal distensibility of the left ventricle and its blood supply. In most clinical cases, diastolic dysfunction is associated with reduced compliance, i.e. elasticity of the ventricular wall, and a decrease in compliance, i.e., the relationship between intraventricular pressure and the volume of the ventricular cavity. The mechanisms of such dysfunction can be objectified with the help of its graphic representation, that is, by constructing and analyzing the pressure-volume loop.

On the I fragment - a decrease in the compliance of the left ventricle determines a steeper initial rise in the curve of its diastolic filling [compare the slopes of the segments a-b and A-B); the degree of slope is inversely proportional to compliance; in fragment II - a decrease in extensibility is also characterized by an upward shift in the curve of diastolic pressure in the ventricle [compare positions a - b and A - B]. A decrease in compliance or extensibility does not lead to a decrease in stroke volume [c-d = C - D], but both these factors determine the increase in end-diastolic pressure [point B]. In most clinical cases, diastolic dysfunction is associated with decreased compliance and decreased compliance of the ventricle.

Normally, diastolic filling of the left ventricle causes a very slight increase in intracavitary pressure, although the volume of the ventricle increases. In other words, the diastolic pressure curve is usually quite "flat". However, with a decrease in ventricular compliance graphically, in the coordinates of the pressure-volume loop, the slope of the diastolic pressure curve becomes steeper.

The pressure-volume loop for the normal ventricle is represented by the a-b-c-d cycle. If the ventricle becomes less compliant, then its diastolic filling will begin at point A and end at point B. In this case, an increased end-diastolic pressure at point B will cause an increase in pressure in the left atrium. By analyzing the pressure-volume loop, one can also understand the difference between ventricular compliance and ventricular compliance. With a decrease in the distensibility of the ventricle, a higher pressure is required to fill it to a given volume, which leads to an upward shift of the diastolic pressure curve, but its slope remains unchanged, i.e., the correspondence between AV and AP does not change. An increase in end-diastolic pressure is the pathophysiological basis of the clinical manifestations of heart failure, which developed as a result of diastolic and systolic dysfunctions.

So, the most common in clinical practice is the combined variant of dysfunctions. At the same time, reduced contractility is always accompanied by impaired diastolic filling of the heart, i.e., systolic dysfunction always (!) Occurs against the background of impaired diastolic function. It is no coincidence that a decrease in systolic function is the most frequent marker of diastolic disorders. Diastolic dysfunction may develop primarily in the absence of systolic dysfunction.

Left ventricular aneurysm of the heart is a pathology that develops after myocardial infarction. Usually the place of localization of the disease is the area in the front or upper part of the heart. This happens due to the thinning of muscle tissue, it no longer has the ability to contract, which means that the process of their protrusion begins under high blood pressure.

Reasons for development

Starting to talk about an aneurysm developing in the left ventricle, experts identify several reasons.

The main among them is the rapid deterioration of the tissue of the muscular type of the "heart" organ, others include the following:

disruption of the functioning of all wall layers of tissues, the apex of the left ventricle at the time of a heart attack;
the fact of an increase in pressure in the area located inside the ventricle;
neglect of the recommendations of specialists on the organization of physical activity in a heart attack state, that is, its excess;
failures in the process of regeneration of muscle tissue in a post-infarction state, as a result of which a scar appears;
mechanical injuries;
a severe form of one or another ailment that has developed in the body due to infection in it;
mechanical trauma to the heart with a knife or other sharp, stabbing, cutting objects;
getting a closed injury (usually after falling from a great height, car accident);
rheumatism;
bacterial endocarditis;
syphilis infection.

The main forms of the course of the disease are determined by the period of its occurrence.

Left ventricular diastolic dysfunction is, at first glance, a complex ornate medical term. But to understand it is simple, understanding the anatomy and work of the heart. In Latin dis - violation, functio - activity, function. So dysfunction is a dysfunction. Diastolic dysfunction is a violation of the function of the left ventricle in the diastole phase, and since relaxation occurs in diastole, the violation of diastolic dysfunction of the left ventricle is associated precisely with a violation of relaxation of the myocardium of this cardiac chamber. With this pathology, proper relaxation of the ventricular myocardium does not occur, its filling with blood slows down or does not occur in full.

The diastolic function of the left ventricle is as follows: while relaxing, this section fills with blood in order to further transfer it to its destination, according to the continuous cardiac cycle. From the atria, blood moves to the ventricles, and from there to organs and tissues. The right half of the heart is responsible for the pulmonary circulation, and the left for the large.

The left ventricle pumps blood into the aorta, supplying oxygen to the entire body. Waste blood returns to the heart from the right atrium. Then, through the right ventricle, it travels to the lungs to replenish with oxygen. The enriched blood flow again goes to the heart, heading already into the left atrium, which pushes it into the left ventricle.

Thus, an enormous load is placed on the left ventricle. If dysfunction of this chamber develops, then all organs and systems will suffer from a lack of oxygen and nutrients. Diastolic left ventricular pathology is associated with the inability of this department to fully accept blood: the cardiac cavity is either not completely filled, or this process is very slow.

When type 1 left ventricular diastolic dysfunction is diagnosed, what is it, what are the symptoms of the disease, how to diagnose the disease - questions that interest patients with such a heart problem. Diastolic dysfunction is a pathology in which the blood circulation process is disrupted at the time of relaxation of the heart muscle.

Scientists have recorded that heart dysfunction is most common in women of retirement age, men are less likely to be diagnosed with this diagnosis.

The circulation in the heart muscle takes place in three steps:

1. Muscle relaxation.
2. There is a pressure difference inside the atria, due to which the blood slowly moves to the left heart ventricle.
3. As soon as the contraction of the heart muscle occurs, the remaining blood dramatically flows into the left ventricle.

For a number of reasons, this well-oiled process fails, as a result of which the diastolic function of the left ventricle is impaired.

There can be many reasons due to which this disease occurs. This is often a combination of several factors.

The disease occurs against the background:

1. Heart attacks.
2. Retirement age.
3. Obesity.
4. Dysfunction of the myocardium.
5. Violations of blood flow from the aorta to the cardiac ventricle.
6. Hypertension.

Most heart disease causes left ventricular diastolic dysfunction. This critical muscle is negatively affected by addictions such as alcohol abuse and smoking, and the love of caffeine also puts additional stress on the heart. The environment has a direct impact on the state of this vital organ.

The disease is divided into 3 types. Type 1 left ventricular diastolic dysfunction is, as a rule, changes in the functioning of organs against the background of old age, as a result of which the volume of blood in the heart muscle decreases, but the volume of blood ejected by the ventricle, on the contrary, is increased. As a result, the first step in the work of blood supply is disrupted - relaxation of the ventricle.

Type 2 left ventricular diastolic dysfunction is a violation of atrial pressure, inside the left it is higher. The filling of the heart ventricles with blood occurs due to the difference in pressure.

Type 3 of the disease is associated with a change in the walls of the organ, they lose their elasticity. At the same time, the atrial pressure is much higher than the norm.

Symptoms of left ventricular dysfunction may not appear for a long time, but if the pathology is not treated, the patient will have the following symptoms:

1. Shortness of breath that occurs after physical activity and at rest.
2. Increased heart rate.
3. Cough for no reason.
4. Feeling of tightness in the chest, possible lack of air.
5. Heart pains.
6. Swelling of the legs.

After a patient complains to a doctor about symptoms characteristic of left ventricular dysfunction, a number of studies are assigned. In most cases, a narrow specialist, a cardiologist, works with the patient.

First of all, the doctor prescribes general tests, on the basis of which the work of the body as a whole will be assessed. They pass biochemistry, general analysis of urine and blood, determine the level of potassium, sodium, hemoglobin. The doctor will assess the work of the most important human organs - the kidneys and liver.

In case of suspicion, thyroid examinations will be ordered to determine the level of hormones. Often, hormonal disorders have a negative effect on the entire body, while the heart muscle must cope with double work. If the cause of dysfunction lies precisely in disorders of the thyroid gland, then an endocrinologist will take care of the treatment. Only after adjusting the level of hormones will the heart muscle return to normal.

An ECG study is the main method for diagnosing problems of this nature. The procedure lasts no more than 10 minutes; electrodes are installed on the patient's chest to read information. During ECG monitoring, the patient must follow several rules:

1. Breathing should be calm, even.
2. You can not pinch, you need to relax the whole body.
3. It is advisable to undergo the procedure on an empty stomach, after eating, 2-3 hours should pass.

If necessary, the doctor may prescribe an ECG using the Holter method. The result of such monitoring is more accurate, because the device reads information during the day. A special belt with a pocket for the device is attached to the patient, and electrodes are installed and fixed on the chest and back. The main task is to lead a normal life. The ECG is able to detect not only LVDD (left ventricular diastolic dysfunction), but also other heart diseases.

Simultaneously with the ECG, an ultrasound of the heart is prescribed, it is able to visually assess the state of the organ and track the blood flow. During the procedure, the patient is placed on the left side and the sensor is guided along the chest. No preparation for an ultrasound is required. The study is able to reveal many heart defects, explain chest pain.

The doctor makes the diagnosis on the basis of general analyzes, the results of ECG monitoring and ultrasound of the heart, but in some cases an extended study is required. The patient may be prescribed an ECG after exercise, chest X-ray, MRI of the heart muscle, coronary angiography.

If the work of the left ventricle is impaired according to type 1, the doctor begins to treat the patient. At first, the ailment does not make itself felt, so they begin to take action later.

Timely prescribed treatment and the implementation of simple preventive rules in many cases can save the patient from chronic problems with blood circulation in the heart muscle. The doctor prescribes a complex of drugs, each of which performs its own function.

In case of violation of LV diastolic function according to type 1, the doctor prescribes ACE inhibitors - these are drugs aimed at lowering pressure, they are often prescribed to patients with hypertension. This drug group has been used for several decades, which confirms its safety and effectiveness.

With pronounced symptoms, in the case of grade 4 or grade 3 heart dysfunction, the doctor prescribes serious medications of different groups. Diuretics are used, they normalize the body's water balance, as a result of which the blood volume is adjusted. It can be Uregit, Mannitol, Ethacrynic acid.

Prescribed drugs that reduce the number of heart contractions, but at the same time increase the force of each blow - glycosides. This is a strong group of drugs, an overdose threatens with serious side effects, the patient may begin to suffer from auditory and visual hallucinations, bleeding, temporary clouding of the mind, headaches.

Development mechanism

Left ventricular diastolic dysfunction is a disturbance in the normal filling of the ventricle with blood during a period of relaxation of the heart (diastole). This type of pathology, as a rule, develops in old age, more often in women.

Normally, filling with blood consists of several stages:

relaxation of the myocardium;
passive blood flow from the atrium to the ventricle due to pressure differences;
filling due to atrial contraction.

Due to the action of various reasons, a violation of one of the three stages occurs. This leads to the fact that the incoming blood volume is not able to provide adequate cardiac output - left ventricular failure develops.

Left ventricular diastolic dysfunction develops when at least one of the successive stages of enrichment of the heart chamber with blood during diastole is impaired.

Myocardial tissues enter the relaxation phase.
There is a passive blood flow from the atrium into the ventricular cavity due to the pressure drop in the chambers.
The atrium makes a contractile movement, freeing itself from the rest of the blood, pushing it into the left ventricle.

As a result of abnormal relaxation of the left ventricle, blood circulation deteriorates, the myocardium experiences negative structural changes. Hypertrophy of the muscle walls develops, as the heart tries to make up for the lack of cardiac output with more intense activity.

Causes

Normally, in a healthy person, the heart is filled with blood in three stages. First, the heart muscle relaxes, blood flows from the atrium to the ventricle, the atrium contracts, the ventricle fills. If failures occur at any one stage, diastolic dysfunction develops.

As a result of insufficient filling of the ventricle with blood, an incorrect ejection occurs, the supply of internal organs and myocardial function is disrupted.

With diastolic dysfunction, the walls of the ventricle lose elasticity, the heart muscle loses its ability to completely relax.

The main reason for the development of the pathological process is myocardial hypertrophy, the development of which is facilitated by the following factors:

aortic stenosis;
hypertension;
hypertrophic cardiomyopathy.

Hemodynamic parameters can be impaired due to diseases such as:

pericarditis - a condition when the ventricles and atria are compressed as a result of thickening of the pericardium;
amyloidosis - muscle tissue atrophy caused by accumulation of deposits;
diseases of the coronary vessels, which lead to a decrease in the elasticity of the myocardium and the development of coronary artery disease.

Type 1 left ventricular diastolic dysfunction develops most often in patients who are overweight or have been diagnosed with diabetes.

Factors leading to the development of diastolic dysfunction worsen the relaxation process, reduce the elasticity of the walls of the left ventricle, mainly due to the development of hypertrophy (thickening) of the myocardium.

The following diseases lead to myocardial hypertrophy:

hypertrophic cardiomyopathy;
hypertonic disease;
aortic stenosis (narrowing of the aortic opening).

In addition, the cause of hemodynamic disorders can be diseases such as:

constrictive pericarditis - is a thickening of the pericardium, resulting in compression of the chambers of the heart;
primary amyloidosis - amyloid deposition causes muscle fiber atrophy and decreased myocardial elasticity;
pathology of the coronary vessels, leading to the development of chronic ischemic heart disease and the development of rigidity (stiffness) of the myocardium due to cicatricial changes.

In connection with the development of compensatory pulmonary hypertension, the preload on the right parts of the heart increases, and diastolic dysfunction of both ventricles is formed.

Especially often the disease develops in people with diabetes or obesity. In this case, the pressure on the chambers of the heart increases, the organ cannot fully function and ventricular dysfunction develops.

Ischemic heart disease (heart ischemia), which occurs due to insufficient oxygen supply to the myocardium and causes the death of cardiomyocytes. As you know, the role of blood in the body is very great, it is a carrier of the necessary elements: hormones, oxygen, trace elements.
Sclerosis of the heart, which appeared as a result of a heart attack (postinfarction cardiosclerosis). Sclerosis is not a memory disorder, as people think. This is tissue hardening. If scars appear on the organ, it interferes not only with normal metabolism, but also disrupts the stretching function. Even the myocardium is not protected from such a disease. Depending on the localization of the disease that led to cardiosclerosis, different disorders are distinguished. And one of them is left ventricular diastolic dysfunction.
Hypertrophic cardiomyopathy - thickening of the left heart also leads to abnormal diastolic function.
Primary arterial hypertension.
Aortic valve stenosis or insufficiency.
Inflammation of the pericardium (outer shell from the heart) with the imposition of fibrin filaments - fibrinous pericarditis. Fibrin tightens the heart muscle and prevents it from working to its full extent.

Violation of the diastolic function of the ventricular myocardium can occur due to an increase in its mass - hypertrophy, or a decrease in the elasticity, compliance of the myocardium. It should be noted that almost all heart diseases to one degree or another affect the function of the left ventricle. Most often, diastolic dysfunction of the left ventricle occurs in diseases such as hypertension, cardiomyopathy, ischemic disease, aortic stenosis, arrhythmias of various types and origins, and pericardial disease.

It should be noted that a loss of elasticity and an increase in the rigidity of the muscular wall of the ventricles is observed during the natural aging process. Women over sixty are more susceptible to this disorder. High blood pressure leads to an increase in the load on the left ventricle, due to which it increases in size, the myocardium hypertrophies. And the altered myocardium loses the ability to normal relaxation, such violations first lead to dysfunction, and then to failure.

More often, a combination of several factors acts as the reasons:

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 abnormalities, such as a heart attack.

pathology 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.

The main reasons for the deterioration of relaxation of the left ventricle are hypertrophy of its walls and their loss of elasticity. Various factors lead to this condition:

arterial hypertension;
aortic stenosis;
cardiomyopathy;
heart rhythm disturbances;
myocardial ischemia;
age-related changes;
gender factor (women are more vulnerable);
an abnormal condition of the coronary arteries;
inflammation of the pericardium of the constrictive type;
overweight;
diabetes;
heart defects;
heart attack.

The clinical picture of the disease

Very often, diastolic dysfunction occurs without any symptoms. Basically, 45% of patients go to the hospital when the pathological process is rapidly progressing.

The absence of clinical signs is the insidiousness and danger of this disease.

A person may not even suspect that he is developing this disease until it turns into an advanced form. Signs appear already when there is stagnation of blood in the pulmonary arteries.

Diastolic dysfunction is accompanied by the following symptoms:

slight shortness of breath, which manifests itself first with increased stress, then at rest;
dry cough;
heart rhythm failure, chest pain;
increased fatigue, which increases with physical work.

In order to diagnose the disease in time, you should regularly visit a cardiologist, get tested, and monitor your health.

Varieties of diastolic dysfunction

Diastolic dysfunction develops gradually. Signs appear alternately.

Depending on the degree of development and neglect of the disease, it is divided into several types:

Type 1 diastolic left ventricular dysfunction - relaxation is impaired, the process of ventricular relaxation is slowed down.
Type 2 diastolic dysfunction - an increase in atrial pressure occurs, the left ventricle fills up due to the pressure difference.
Type 3 diastolic dysfunction - the elasticity of the tissues of the left ventricle decreases, they become stiff.

Early diagnosis will help avoid complications and prevent disease progression. If the pathological process is started, irreversible changes begin to occur in the heart. Then it is very difficult to save a person, because concomitant diseases develop.

Dysfunction of left ventricular diastole is formed gradually. Depending on the degree of intracardiac hemodynamic disturbances, the following types of dysfunction are distinguished:

Type I (violation of relaxation) - the initial stage of the development of pathological changes. Type 1 diastolic dysfunction is associated with a slowdown in ventricular relaxation during diastole. In this case, the main volume of blood enters during the contraction of the atria.
Type II (pseudo-normal) - at the same time, pressure reflexively increases in the cavity of the left atrium, filling of the ventricles occurs due to the pressure difference.
Type III (restrictive) - the terminal stage of the formation of diastolic dysfunction, is associated with an increase in pressure in the atrial cavity and a decrease in the elasticity of the left ventricle, its excessive rigidity.

Type 1 left ventricular diastolic dysfunction is treatable, while subsequent stages of the disease cause irreversible changes in the work and physiological state of the organ. That is why it is necessary to see a doctor at the first manifestation of symptoms of the disease.

Left atrial enlargement

There are three types of left ventricular dysfunction.

Type I - type 1 left ventricular diastolic dysfunction is classified as mild in severity. This is the initial stage of pathological changes in the myocardium, its other name is hypertrophic. In the early stages, it is asymptomatic, and this is its insidiousness, since the patient does not assume about disturbances in the work of the heart and does not seek medical help. With type 1 dysfunction, heart failure does not occur, and this type is diagnosed only with the help of echocardiography.

Type II - dysfunction of the second type is characterized as moderate. In type II, due to insufficient relaxation of the left ventricle and a reduced volume of blood ejected from it, the left atrium takes on a compensatory role and begins to work "for two", which causes an increase in pressure in the left atrium, and subsequently its increase. The second type of dysfunction can be characterized by clinical symptoms of heart failure and signs of pulmonary congestion.

Type III - or restrictive type dysfunction. This is a severe disorder, which is characterized by a sharp decrease in the compliance of the walls of the ventricle, high pressure in the left atrium, a vivid clinical picture of congestive heart failure. Often in type III, sharp deterioration of the condition with access to pulmonary edema, cardiac asthma. And these are serious life-threatening conditions that, without proper urgent treatment, often lead to death.

The diastolic function of the heart muscle is the ability to relax it after the stage of blood expulsion. The effectiveness of the diastole of the heart depends on its condition and the work of the entire cardiovascular system. Therefore, the development of pathology in the heart affects all its work, including the ability to relax.

The main reasons for the development of impaired diastolic function include ischemic heart disease, valvular defects and cardiomypathy. In ischemic disease, diastolic dysfunction occurs as a result of a decrease in the ability of muscle cells to relax. Valvular defects initially overload the heart muscle, which ultimately disrupts its trophic functions and also contributes to an increase in rigidity - poor relaxation. Cardiomyopathies are the result of certain pathological processes.

Violation of diastolic function begins to manifest itself as a decrease in various parts of the heart. The most significant of these is the left ventricle. This is primarily due to the fact that it throws blood into a large circle, which ensures its movement through the vessels of the internal organs. As is known from the Frank-Starling law, which the heart obeys, the amount of blood pushed into the systemic circulation depends on the amount received during diastole.

There are two types of impairment in the ability of the muscle cells of the left ventricle to relax. This is a violation of the diastolic function of the left ventricle in type 1 and type 2. Although, some cardiologists suggest dividing the second type into two independent ones.

The impairment of the relaxation function of the left ventricle of the first type is based on the change in blood flow velocity during diastole. At the first stage, it slows down and then increases. This negatively affects the work of the left atrium. Blood circulation in the vessels of the lungs is impaired (pulmonary circulation).

And since impaired left ventricular diastolic function of type 1 is often found in patients with ischemic heart disease, it becomes clear why stagnation in the pulmonary circulation is most common in this category of people. This is manifested by a tendency to shortness of breath, the development of chronic lung diseases.

On the other hand, it is possible to determine exactly whether it is diastolic dysfunction of the left ventricle of type 1 or of the second type only with special studies - echocardiographic Doppler. Therefore, regardless of the type of diastolic dysfunction, the clinical manifestations will be the same.

Manifestations of impaired myocardial relaxation function mean irreversible changes. That is, it is no longer possible to restore diastolic function. Even at the present stage of medicine. Nevertheless, diastolic dysfunction of the left ventricle, the treatment of which is lifelong, must be corrected by medical and non-drug methods.

On the other hand, there are no clear therapeutic recommendations for her. Perhaps this is due to the fact that diastolic dysfunction of the left ventricle, the treatment of which is aimed at the mechanisms of its formation, is not an independent disease, but the result of a certain pathology. Most often, it is ischemic heart disease and malformations. Therefore, diastolic dysfunction is taken into account when choosing a therapy for the underlying disease.

The drugs desirable for proven myocardial dysfunction during heart diastole include: angiotensin enzyme inhibitors (enalapril series), beta-blockers (atenololl, egilok, concor, etc.) and the so-called "weak diuretics" (spironolactone and hypothiazide).

An open oval window is most often an anatomical feature. Thousands of people live, work, give birth to children, despite this diagnosis.

There is debate about the exact causes of thrombus formation. Pathologies of hematopoiesis are promoted by constant nervous stress, a sedentary lifestyle.

Complete blockade of the right bundle branch is not a disease, but one of the auxiliary symptoms in the diagnosis. Such changes can be about.

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Do not self-medicate! Be sure to see a doctor!

Today, this pathology is usually divided into the following types:

type 1 diastolic myocardial dysfunction. This stage is characterized by disturbances (slowing down) 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;
type 2 diastolic myocardial dysfunction is characterized by an increase in pressure in the left atrium, due to which filling of the lower chamber is possible only due to the action of a pressure gradient (this type is called "pseudo-normal");
type 3 diastolic myocardial dysfunction. This stage is associated with an increase in atrial pressure, a decrease in the elasticity of the ventricular walls, and an increase in stiffness.

Depending on the severity of the pathology, an additional subdivision is made into:

light (type I disease);
moderate (type II disease);
severe reversible and irreversible (type III disease).

The heart is our fiery motor, a muscle pump that works for a lifetime. Unfortunately, there are also interruptions in his work. Wrong lifestyle, weighed down heredity, trauma can lead to the development of heart failure. Left ventricular diastolic dysfunction often develops in the presence of high blood pressure. Why is this happening?

What are the signs of type 1 left ventricular diastolic dysfunction? First of all, these are symptoms caused by fluid retention in the body. The person complains of edema, especially in the evening. They are concentrated most often in the lower extremities. The patient may notice heart pains arising from myocardial ischemia, complain of shortness of breath, especially after exercise.

Normally, the heart works in two modes alternately: in systole it contracts, in diastole it relaxes. Dysfunction means disruption of the normal functioning of any tissue or organ. As a result, the following definition is obtained: diastolic dysfunction of the left ventricle is a violation of the functioning of the left ventricle in the relaxation phase.

Why is the left ventricle so important? The fact is that, by contracting, it pushes oxygenated blood into the aorta. From the aorta, the blood is carried to all tissues and organs through an innumerable set of vessels, saturating them with oxygen. The left ventricle is the starting point of the systemic circulation. If left ventricular function is impaired, the vast majority of human body tissues will suffer from a lack of oxygen.

Factors provoking the development of pathology

Dysfunction of the ventricle is more often an age-related disorder and occurs mainly in the elderly. Women are especially susceptible to this pathology. Diastolic dysfunction of the left ventricle causes hemodynamic disturbances and atrophic changes in the structure of the myocardium. The diastole period is characterized by muscle relaxation and filling of the ventricle with arterial blood. The process of filling the heart chamber consists of several stages:

relaxation of the heart muscle;
under the influence of the pressure difference from the atrium, the blood passively flows into the ventricle;
with atrial contraction, the remaining blood is sharply pushed into the ventricle.

If one of the stages is violated, there is an insufficient release of blood, which contributes to the development of left ventricular failure.

Reasons for development

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

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

Separately, the 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).

How to come for treatment

Type 1 left ventricular diastolic dysfunction: main symptoms

Diastole dysfunction may be asymptomatic for a long time before it becomes clinically apparent. These patients are characterized by the following symptoms:

shortness of breath that occurs during physical exertion, then at rest;
cough that gets worse when lying down;
decrease in exercise tolerance, fatigue;
palpitations;
paroxysmal nocturnal dyspnea;
rhythm disturbances (atrial fibrillation) are often present.

If such symptoms are found, it is necessary to seek medical help and undergo an examination in order to identify the cause of the appearance of discomfort and eliminate the disease at the initial stage.

In addition to violations of the relaxation phase - the first stage of diastole, the causes of which have already been described above (ischemia, fibrosis), there may be violations of the following two stages - passive filling of the left ventricle with blood (the process is normally provided by the pressure difference between the left atrium and the left ventricle) and active filling ventricles with blood (provided by the contraction of muscle cells of the left atrium; with atrial fibrillation, for example, the left atrium cannot contract to the required extent, and dysfunction occurs).

What types of left ventricular diastolic dysfunction do doctors identify? There are three of them in total. The first type is hypertrophic. When the heart cannot handle the stress, it tries to compensate for its weakness by increasing the volume and number of muscle cells. The wall of the left ventricle is significantly thickened.

In this case, the relaxation of the left ventricle becomes slower than usual. This type is considered a pathology of mild severity and should not be scared. The second type is more serious. To slow down the relaxation of the left ventricle, an increase in pressure in the left atrium is added. Thus, both the first and second stages of diastole are violated.

Diagnosis of diastolic dysfunction of the left ventricle is carried out by echocardiography, or, as it is called easier and more accessible - ultrasound of the heart. A competently collected anamnesis also plays a role, from which you can find out the onset of the onset of symptoms, their severity and adjust the treatment taking into account the existing diseases.

Ischemia is a constant companion of people who have hypertension. This happens because in this condition, the lumen of the coronary arteries is narrowed more than it should be. Individuals with impaired cholesterol metabolism also suffer, but it is important to remember that clinical signs begin to appear only when the plaque has already closed 70 or more percent of the lumen of the coronary artery.

Treatment of left ventricular diastolic dysfunction according to type 1 is aimed at normalizing the heart rate (normally beats per minute), correcting blood pressure (normally 120/80 mm Hg), and eliminating the consequences of ischemia. In addition to drug treatment, it is important to reconsider the lifestyle, the diet that promotes recovery and the correct psychological attitude of the patient. All this allows you to forget about the disease and live fully.

Symptoms

Shortness of breath with physical activity

In the early, early stages of diastolic dysfunction, the patient may not have complaints. It is not uncommon for diastolic dysfunction to be detected as an accidental finding during echocardiography. At later stages, the patient is concerned about the following complaints:

Dyspnea. At first, this symptom worries only with physical activity, with the progression of the disease, shortness of breath may appear with little exertion, and then completely disturb at rest.
Palpitations. An increase in heart rate is not uncommon with this violation of the heart. In many patients, the heart rate reaches submaximal values even at rest and increases significantly during work, walking, and excitement.

When such symptoms and complaints appear, the patient must undergo a comprehensive examination of the cardiovascular system.

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 ailment gives. The necessary treatment, how long it needs to be carried out, whether it can be completely cured.

Diastolic dysfunction of the left ventricle (abbreviated LVDV) 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 detected much less frequently.

With such a dysfunction, the heart muscle is unable to completely relax. From this, the filling of the ventricle with blood decreases. Such a dysfunction of the left ventricle affects the entire period of the heart rate cycle: if during diastole the ventricle was insufficiently filled with blood, then during systole (myocardial contraction), too little of it will be pushed into the aorta.

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 therapist.

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 and tear. The prognosis depends on the type of dysfunction, the presence of concomitant diseases, the correctness and timeliness of treatment.

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

Dyspnea. Appears at first only with intense physical activity, later at rest.
Weakness, rapid fatigability, decreased exercise tolerance.
Violation of the heart rhythm, more often its increased frequency or atrial fibrillation.
Lack of air, compression in the chest area.
Cardiac cough, worse lying down.
Swelling of the ankles.

At the initial stages of diastolic dysfunction, the patient is unaware of the onset of heart failure, and weakness and shortness of breath are attributed to banal fatigue. The duration of this asymptomatic period is different for each person. A visit to a doctor occurs only when tangible clinical signs appear, for example, shortness of breath at rest, swelling of the legs, affecting the quality of human life.

Diastolic myocardial dysfunction is quite often asymptomatic, not giving out its presence for years. If the pathology manifests itself, then you should pay attention to the appearance:

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 gets worse when lying down);
severe sleep apnea (occurring a couple of hours after falling asleep).

Signs of left ventricular diastolic dysfunction make themselves felt when serious changes have already begun in the body. List of characteristic symptoms:

Palpitations become rapid both in an active state and in a calm state.
The person cannot take a deep breath, as if the chest is compressed.
Attacks of dry cough indicate the appearance of congestion in the lungs.

Any small effort is difficult.
Shortness of breath occurs both during movement and at rest.
An increase in sleep apnea attacks is also an indicator of problems in the left ventricle.
Another sign is leg swelling.

Describe your problem and get a response from a doctor from Israel with treatment options and necessary diagnostics

After detecting the primary signs of pathology, you should immediately consult a doctor. Cardiologists are engaged in the treatment.

The specialist will consult and prescribe a number of additional diagnostic techniques:

Laboratory Methods. It is imperative to pass a general blood test, a blood test for biochemical parameters, hormones, hemoglobin levels and some trace elements.
ECG is an informative method with which you can determine the state of the heart muscle, diagnose hypertrophy, arterial hypertension or ischemic disease.
Echocardiography - using this technique, you can determine the ejection fraction, the size of the ventricles, diagnose defects, cardiomyopathy.
Radiography allows you to see changes in the structure of the myocardium, to determine hypertrophy.
MRI is prescribed as an auxiliary method when it is difficult to confirm or deny the diagnosis.

Early diagnosis helps prevent irreversible changes. In order to identify the development of pathology, the following diagnostic methods are used:

two-dimensional echocardiography with dopplerography - refers to the available and informative methods for verifying the diagnosis;
radionuclide ventriculography is a highly informative method for diagnosing violations of myocardial contractility, it is indicated for unsatisfactory results of echocardiography;
electrocardiography - is an auxiliary diagnostic method that allows you to identify signs of myocardial ischemia, the presence of hypertrophied myocardium;
chest x-ray - used to detect signs of pulmonary hypertension.

Diastolic dysfunction is detected mainly when conducting such an instrumental examination method as echocardiography. With the introduction of this method into the practice of clinical physicians, the diagnosis of diastolic dysfunction began to be exposed many times more often. EchoCG, as well as Doppler EchoCG, allows you to identify the main disorders that occur during myocardial relaxation, the thickness of its walls, to evaluate the ejection fraction, stiffness and other important criteria that allow you to establish the presence and type of dysfunction.

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

Treatment of the disease

If the disease is diagnosed even at the stage of asymptomatic course, you still need to prescribe treatment.

This will help prevent complications and improve the patient's condition.

When the symptoms of diastolic dysfunction are expressive, the patient is prescribed drugs from different pharmacokinetic groups:

Diuretic drugs stimulate the elimination of excess fluid from the body, removal of edema, and elimination of stagnant processes in the internal organs.
Beta-blockers. As a result of taking these drugs, the load on the heart decreases, its contractions normalize.
ACE inhibitors, sartans increase the elasticity of the myocardium, help lower blood pressure.
Calcium antagonists have a positive effect on the myocardium, promoting its relaxation.

First you need:

to refuse from bad habits;
to provide the correct mode of rest and work;
do not forget about healthy sleep.

Moderate physical activity will also have a positive effect on the patient's health.

As for the diet, it is recommended to exclude fried, spicy, fatty foods from the daily diet, to limit the amount of liquid and table salt entering the body. It is useful for the patient to eat fermented milk products, fruits and vegetables, cereals. Rational nutrition, broken down into 5-6 meals, will reduce the load on the circulatory system and improve the functioning of the heart. Without diet and lifestyle adjustments, the situation will only get worse.

The correct approach and timely treatment will help to successfully cope with unpleasant symptoms, improve a person's condition and increase his life expectancy.

The methods of correcting hemodynamic disorders include the following therapeutic measures:

blood pressure control;
a decrease in the frequency of heart contractions;
maintaining water-salt metabolism to reduce preload;
remodeling of left ventricular hypertrophy.

The main groups of drugs used for treatment are:

Adrenergic blockers - slow down the heart rate, reduce blood pressure, improve the nutritional processes of myocardial cells.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists (sartans) are two classes of drugs that have similar effects: a positive effect on myocardial remodeling, improving its elasticity, lowering blood pressure, reducing preload. They have a proven positive effect on prognosis, life expectancy and improvement of its quality in patients with chronic heart failure.
Diuretics - by removing excess fluid, reduce the manifestations of shortness of breath, in combination with drugs of other antihypertensive classes, they contribute to more effective control of blood pressure. They are prescribed in small doses, as they can lead to a significant decrease in the stroke volume.
Calcium antagonists - have a direct positive effect on diastolic dysfunction: due to a decrease in calcium in myocardiocytes, they contribute to myocardial relaxation. They also lower blood pressure levels. They are the drugs of choice for intolerance to adrenergic blockers.
Nitrates belong to an additional group of drugs, their appointment is possible in the presence of signs of myocardial ischemia, proven instrumental.

To eliminate violations of the hemodynamic process and prevent the development of irreversible changes, it is necessary to prescribe drugs that allow maintaining optimal performance of the heart (blood pressure, heart rate). Normalization of water-salt metabolism will reduce the burden on the heart. Elimination of left ventricular hypertrophy is also required.

After the examination, the attending physician will select a suitable set of drugs that can maintain all indicators in the normal range. Heart failure also plays an important role, the treatment of which requires adherence to a large number of medical recommendations.

Reasons for development

The heart is a hollow muscular organ, consisting of four parts (right and left ventricle and atria, respectively). It has the shape of a dome and, working since intrauterine life, never takes rest breaks like other organs.

That is why some disturbances sometimes arise in the heart.

The most significant in the heart is the left ventricle. The systemic circulation, supplying oxygen to all organs and tissues, except for the lungs, begins in the left ventricle.

Therapy depends on the stage and severity of the disease, it is categorically contraindicated to prescribe this or that drug to oneself, because the heart is a vital organ, therefore it is better not to harm your health by wrong actions.

If there are no symptoms of deficiency, your doctor may advise you to take angiotensin-converting enzyme (ACE) inhibitors. It is a regulator of blood pressure and protects the target organs in this disease.

Target organs are those that suffer primarily from dysfunction of the cardiovascular system, that is, they are the first "targets" on the path of blood failure. These include the kidneys, brain and spinal cord, heart, blood vessels and the retina of the eye.

Taking ACE inhibitors daily at the dose prescribed by your doctor can reduce the risk of developing complications in the target organs and prevent the development of chronic heart failure. These drugs include Enalapril, Quadroril, Lisinopril. It is difficult to say which is better, everything is discussed at an appointment with a therapist or cardiologist and is prescribed based on the symptoms and past experience of taking medications.

If you have an intolerance to ACE inhibitors or, for some objective reason, the doctor decided that they would not help you, ARA II (angiotensin receptor antagonists) are prescribed. They have exactly the same properties. These include Losartan, Valsartan and others.

With pronounced signs of the disease, even more drugs are prescribed to relieve symptoms:

diuretics (diuretics) - reduce the volume of circulating blood by removing excess fluid;
beta-blockers - make the heart rate less frequent, reducing the load on the organ;
cardiac glycosides - increase the strength of heart contractions;
Aspirin - prescribed to reduce the risk of blood clots and, therefore, ischemia;
statins - carry out lipid control in the blood due to the normalization of cholesterol fractions harmful to blood vessels.

Is it worth treating diastolic dysfunction if there are no symptoms of the disease and the clinic? Many patients are wondering. Cardiologists agree: yes. Despite the fact that there are no clinical manifestations in the early stages, dysfunction is capable of progression and the formation of heart failure, especially if the patient's history has other diseases of the heart and blood vessels (AH, IHD).

ACE inhibitors - this group of drugs is effective both in the early and late stages of the disease. Group representatives: enalapril, perindopril, diroton;
AK - a group that helps to relax the muscular wall of the heart, causes a decrease in hypertrophy, dilates the vessels of the heart. Calcium antagonists include amlodipine;
b-blockers, allow you to slow down the heart rate, which leads to a lengthening of diastole, which has a beneficial effect on relaxation of the heart. This group of drugs includes bisoprolol, nebivolol, nebilet.

To cope with the violation of the left ventricular diastolic function is possible only if it is caused by a cardiac surgical pathology, which can be completely eliminated by surgery. 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 precise implementation of medical recommendations to the patient.

The goals of treatment measures:

elimination of heart rhythm disturbances (pulse normalization);
stabilization of blood pressure;
correction of water-salt metabolism;
elimination of left ventricular hypertrophy.

The essence of the treatment of diastolic dysfunction of the left ventricular wall is reduced to the restoration of blood circulation. This requires:

eliminate tachycardia;
keep blood pressure normal;
normalize metabolism in the myocardium;
minimize hypertrophic changes.

blockers of adrenal receptors;

calcium channel inhibitors;

drugs from the group of sartans and nitrates;

cardiac glycosides;

diuretic agents;

ACE inhibitors.

Among the most commonly used drugs are: Carvedilol, Digoxin, Enalapril, Diltiazem.

Diastolic dysfunction can be diagnosed mainly with the help of EchoCG, Echocardiography, supplemented by Doppler studies, ECG, laboratory tests.

Left ventricular diastolic dysfunction is a pathology that requires careful attention. Late access to a doctor can result in an unpleasant prognosis for a person: disability or death. People with a history of cardiac diseases should be especially careful about their health.

Often, with ventricular dysfunction, elevated blood cholesterol levels are recorded, which increases the chance of myocardial infarction and strokes. The doctor carries out therapy with statins, they affect the liver, as a result, it reduces the production of cholesterol. The most popular statins are Atorvastatin, Lovastatin, Niacin.

Modern therapy of pathological disorders

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

Among the drugs used for the treatment of dysfunction, the following groups are distinguished:

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

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Prevention of heart disease

To avoid the development of most heart pathologies, it is necessary to adhere to a healthy lifestyle. This concept includes regular healthy food, sufficient physical activity, absence of bad habits and regular examination of the body.

Diastolic dysfunction of the left ventricle, the treatment of which requires high professionalism of the doctor and strict adherence to all his prescriptions, is rare in young active people. That is why, with age, it is important to maintain activity and periodically take vitamin complexes that help to saturate the body with necessary microelements.

Diastolic dysfunction of the left ventricular myocardium, which is detected in time, will not bring much harm to human health and will not cause serious atrophic changes in the heart tissue.

Forecast

Given the severity of the disease, it cannot be started. Remember that postponing a visit to the doctor will only harm your health. There are so many drugs in the world that there is one for you that will reduce unpleasant symptoms. By following a healthy lifestyle, eating right, and following the recommendations of your healthcare provider, you can significantly reduce the risk of complications and worsening of the condition.

Violation of left ventricular diastolic function cannot be completely stopped, but with adequate drug correction of circulatory disorders, treatment of the underlying disease, proper nutrition, work and rest mode, 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 poor course, it can lead to a heart attack, stagnation of blood in the heart and lungs, and edema of the latter. Complications are possible, especially with severe dysfunction: thrombosis, pulmonary embolism, ventricular fibrillation.

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

With regular proper treatment, dietary adjustments with salt restriction, control over the condition and level of blood pressure and cholesterol, the patient can count on a favorable outcome, prolongation of life, and active.

The human heart is a rather complex organ, where all its elements fulfill their specific task with full responsibility. Each stage in this work is very important for the vital activity of the whole organism. The heart is a kind of pump that pumps blood from arteries and vessels and throws it out into the aorta. One of the main functions in this mechanism is produced by ventricular diastole. It is responsible for the moment of contraction of the heart muscle, which alternates with a stage of relaxation.

Left ventricular diastolic dysfunction is a process in which the heart muscles cannot fully relax, which causes the organ to not get enough blood it needs. During normal heart function, there are the following stages:

relaxation of the heart muscle;
moving blood along a specific route;
saturation with blood of all the necessary components of the heart.

With diastolic function of the left ventricle, the process of filling with blood at the time of its relaxation is disrupted. The body wants to correct this situation and in order to make up for the blood deficit, the left atrium works to its maximum in order to fill the gap in the current situation. As a result of such hard work, it increases, and this situation leads to its overload. Persistent high blood pressure and myocardial ischemia are the most common causes of this disease.

Type 1 left ventricular diastolic dysfunction is observed to a greater extent in the elderly, in particular in women. The main causes of left ventricular diastolic dysfunction are:

Myocardial ischemia.
Arterial hypertension.
Advanced age.
Overweight.
Aortic stenosis.

Insufficient elasticity of the muscle tissue of the heart, which leads to impaired function to contract and relax, is a major factor in the disease. Left ventricular diastolic dysfunction can occur in both adults and newborns. Special treatment is not needed here, this condition does not pose a great danger, the exception is the prematurity of the baby or in the case when the child has suffered oxygen starvation.

A clear distinction needs to be made between diastolic dysfunction and diastolic heart failure. If the second term includes the first, then diastolic dysfunction does not always mean heart failure.

Symptoms and types of disease

Type 1 hypertrophied or diastolic left ventricular dysfunction is the most common variant of the disease. The disease in the initial stages can develop almost asymptomatically. The person does not feel absolutely any discomfort. The heart adapts to changes and works harder. Hypertrophy consists in reducing the pumping of blood from the artery of the lungs into the ventricle as it fills. The main signs of the disease are:

shortness of breath with active actions at the initial stage, with the progression of the disease - shortness of breath in any condition;
cardiopalmus;
cough that worsens in a horizontal position;
arrhythmia;
feeling short of air at night.

It should also be noted the prevalence of this disease. In patients with arterial hypertension, diastolic dysfunction of the left ventricle occurs in 50-90% of cases, so it is very important to monitor your high blood pressure. In addition, the symptoms of this disease are manifested in almost any heart disease.

Diagnosis, prevention and treatment of the disease

The problem of early diagnosis of the disease manifests itself in the fact that it is almost impossible to immediately identify the disease, and most often patients seek help at the later stages, when a serious ailment is neglected. Typically, type 1 left ventricular diastolic dysfunction arises from age-related changes and is asymptomatic. Most often, the disease is detected in people over forty-five years old.

Unfortunately, today the treatment of left ventricular diastolic dysfunction does not have a clear scheme, therefore experts recommend the following main stages of the approach to solving this problem:

Complete smoking cessation.
Continuous monitoring of increased pressure.
Normalization of the heart.
Maximum reduction in the amount of salt and water in the diet;
Decrease in excess body weight.
Active lifestyle, artistic gymnastics, walks in the fresh air.
Correct balanced nutrition with the obligatory addition of vitamins and minerals.

Effective treatment of the disease directly depends on the timely and correct diagnosis. First of all, it is necessary to pay attention to those factors that contribute to the development of diastolic dysfunction of the left ventricle. The main drugs that are used in the treatment of the disease are:

Medicines, the main action of which is based on the treatment of hypertension, improving the nutritional mechanism of heart muscle cells.
Drugs that have a positive effect on improving the elasticity of the heart muscle, reducing pressure.
Medicines that relieve shortness of breath and normalize blood pressure by removing fluid from the body.
Medicines that help reduce calcium levels also fight the manifestation of hypertension.
Medicines that are prescribed only with a well-defined diagnosis of coronary heart disease. They are also prescribed if the first group of medicines is not suitable.

Diagnosis and treatment at the initial stages of the disease help prevent irreversible processes in the human body. Left ventricular diastolic function can be determined using the following methods:

X-ray of the chest cavity organs, with the help of which the main signs of an increase in pressure in the pulmonary artery system are established;
electrocardiography makes it possible to detect the presence of changes in the heart muscle, signs of insufficient oxygen supply to it;
two-dimensional echocardiography with the study of blood flow in the vessels, with the help of which it is possible to obtain reliable information about the presence of a disease in the body;
radionuclide ventriculography, using this method, violations of the contractility of the heart muscle are diagnosed. This method is indicated for failed echocardiographic readings.

At first glance, it seems that minor malfunctions in the work of the myocardium, especially when the symptoms are not pronounced at the same time, do not pose any danger to human health. But in fact, if you do not start the correct treatment of left ventricular diastolic dysfunction in a timely manner, then this can lead to serious consequences, which are manifested in the form of arrhythmias, large drops in blood pressure and other, to put it mildly, unpleasant moments. Therefore, you need to carefully consider your health problems, take into account all the factors and risks that can lead to a serious illness, and at the slightest suspicion, contact a specialist for help, especially those who have congenital heart failure or have heart pathologies.

The myocardium is the muscle tissue that surrounds the heart. It provides alternate contraction and relaxation of its parts, which stimulates blood flow. If there is diastolic myocardial dysfunction, this means that the heart muscle is not able to relax, which is why not enough blood flows into the left ventricle. In this case, the left atrium, where blood is transported from the ventricle, tries to draw in as much blood as possible, works in increased tension. Over time, this leads to overload. The atrium increases in volume, ceases to function normally. If this condition persists for a long time, heart failure will soon begin to develop, posing a danger to human health and life.

Several varieties are known in medical practice.

Hypertrophic. This type of dysfunction is defined by abnormally slow relaxation of the LV heart muscle. Very little blood enters the ventricle, which contributes to the increased work of the atrium, due to which the required volume of blood is taken. In this case, we are talking about type 1 diastolic myocardial dysfunction.
Pseudo-normal. Here, the relaxation of the ventricle is carried out even more slowly than in the previous case. In this case, the ventricle does not fully relax. There is an increased pressure in the atria. Doctors assess this pathology as moderate.
Restrictive. It is characterized by even higher indicators of atrial pressure, refers to severe forms of dysfunction. The prognosis in this case is worse than in the rest, complicated by the presence of heart failure. At this stage, patients may be prescribed a heart transplant.

Given the seriousness of the condition, it is important to understand the reasons for its development. This will allow you to take preventive measures to reduce the likelihood of such an ailment.

Dysfunction reasons

Basically, the mechanism of development of diastolic dysfunction of the LV myocardium looks like this: any disease provokes the development of LV myocardial hypertrophy, as a result of which there is a thickening of the heart muscle. This is what causes her diastolic dysfunction.

Thus, the reasons leading to LVH should be considered:

arterial hypertension;
cardiomyopathy;
aortic stenosis.

Additional reasons for the development of a pathological condition include:

constrictive pericarditis. Here we are talking about a thickening of the pericardium, which contributes to the subsequent compression of the heart chambers;
primary amyloidosis. As a result of amyloid deposition, the elasticity of the heart muscle decreases, which provokes the development of its dysfunction;
coronary artery disease. They contribute to the development of HF. As a result, due to numerous cicatricial changes on the surface, the myocardium becomes more rigid and cannot perform its usual functions.

Important! Considering the fact that the load also increases on the right side of the heart, diastolic dysfunction of both ventricles is formed as a result of such disorders.

Clinical picture

In order to be able to start treatment of the disease on time, it is necessary to carefully study the features of its manifestation. The situation is complicated by the fact that in the early stages the pathology does not manifest itself in any way, it is asymptomatic. When the disease progresses to a more serious stage, a person begins to notice the following manifestations:

decreased performance;
increased fatigue;
shortness of breath, which initially occurs with significant stress on the body, and then in a calm state;
cough that occurs when the body is lying down;
heart palpitations;
heart rhythm disturbances.

If you have these symptoms, you should seek medical attention. The cardiologist will conduct a physical examination of the patient, take a life history, and study the medical history. After that, a diagnostic program will be drawn up, which allows you to establish an accurate diagnosis.

Diagnostic methods

In order to receive full information about the patient's health, he will be sent to the following studies:

two-dimensional echocardiography;
radionuclide ventriculography;
electrocardiography;
chest x-ray.

The listed methods will make it possible to assess structural changes in all parts of the heart, study the frequency and intensity of organ contraction, and obtain information on the volume of pumped blood. Also, doctors will determine whether a person has signs of pulmonary hypertension, which is quite important in this case.

Treatment and methods

Initially, medical treatment will be carried out. His program is compiled by the doctor individually for each patient, depending on the type of cardiac diseases and their severity. Usually, drugs from the following groups are used in treatment:

adrenergic blockers - normalize heart rhythms and blood pressure, improve the nutrition of the heart muscle;
ACE inhibitors - have a similar effect with adrenergic blockers, make symptoms less vivid, eliminate signs of heart failure;
diuretics - used in small dosages. They remove excess fluid, stabilize the pressure. The main thing is to choose the right dosage so as not to provoke dehydration and a decrease in blood volume;
calcium antagonists - provide effective relaxation of the myocardium;
nitrates - used if there are signs of myocardial ischemia.

Usually, drug treatment can achieve good results. Surgical intervention is recommended mainly for patients with severe disease. The decision on the tactics of treatment is made by the doctor after weighing all indications and contraindications, assessing the general state of human health.