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Cardiovascular disease is at the top of the list of causes of death in the world. Most deaths are associated with coronary artery disease. In order to recognize and prevent heart problems in time, various diagnostic methods are used, in particular, an electrocardiogram (ECG) and an ultrasound scan (echo-CG).

And in patients who received the result of ECHO-KG or ECG, which says "diffuse changes in the myocardium", the question arises: what is it?

The myocardium is the muscular middle layer of the heart that contains contractile cells (cardiomyocytes). The coordinated contraction of cardiomyocytes causes the heart to contract and expel blood. As a type of muscle tissue, the myocardium is unique among all other muscle tissues in the human body.

The thickness of the myocardium determines the strength of the heart's ability to pump blood.

The heart muscle is adapted to be highly resistant to fatigue, so if the patient complains of rapid fatigue, this may indicate problems with the myocardium. Cardiomyocytes have a large number of mitochondria, which allows for continuous aerobic respiration. The heart muscle also has a large blood supply in relation to its size, which ensures a continuous flow of nutrients and oxygen to the heart, while ensuring that metabolic waste is removed in a timely manner.

The term "diffuse changes" means that the processes that have occurred in the myocardium do not have the features typical for a particular disease. On the basis of only one conclusion about diffuse changes in the myocardium, the cardiologist will not be able to make an accurate diagnosis, he will need the results of a physical examination, questioning the patient about disturbing symptoms, as well as data from a blood test and other studies.

Possible causes of diffuse changes in the heart muscle:

A variant of the norm, that is, the absence of cardiological pathology. For example, in children, diffuse changes without complaints of shortness of breath, pain in the heart and fatigue refer to a variant of the norm.
Hormonal or other types of metabolic disorders in the myocardium.
Endothelial dysfunction (the lining of blood vessels that separates blood flow and deeper layers of the vascular wall).
Autoimmune neuropathy.
Abnormal glucose levels.
The result of exposure to certain drugs, including cardiac glycosides, streptomycin and chlorpromazine.
Inflammation of the myocardium, also called myocarditis.
Disturbances in water-salt metabolism in the myocardium and in the body as a whole.
Cardiosclerosis. With this pathology, myocardial muscle fibers are gradually replaced by connective tissue cells. This is due to the inflammatory process or metabolic disorders.
Lack of nutrients (such as proteins or carbohydrates), as well as vitamins and minerals. This can occur, for example, due to renal failure or chronic enterocolitis.
Age-related changes in the myocardium. Often nonsignificant and asymptomatic.
Drug and / or alcohol use.

Symptoms of diffuse changes in the myocardium are not specific. If the ECG showed mild diffuse changes, and the person does not complain of symptoms characteristic of heart disease, then they do not focus on these harmless changes.

The doctor does not use the term "diffuse myocardial changes" as a definitive diagnosis and the name of a particular disease. For a cardiologist, this is just a diagnostic marker, which is a reason to prescribe additional studies.

Treatment of diffuse myocardial changes is aimed at eliminating the cause of this condition. It is important to restore the functioning of the heart muscle, and for this one should eat well, minimize negative experiences and take a complex of vitamins, which will be recommended by the attending cardiologist.

Changes in the myocardium on the ECG: what does it mean and what can threaten

An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the causes of chest pain. And it so happens that after the test, the doctor tells the patient that he has recorded changes in the myocardium on the ECG. What does this formulation mean? This is a signal that the heart muscle is undergoing changes. And already the doctor's task is to find out their nature. They can be caused by age (for example, myocardial changes are very common in children and the elderly), or an inflammatory disease. And, perhaps, the point is in intense sports. Athletes experience thickening of the myocardial walls. This condition has even received a special term - "sports heart".

Three types of changes can occur in the entire heart muscle or in any of its parts:

metabolic;
diffuse;
dystrophic.

The most common are diffuse moderate myocardial changes. What it is? This is a uniform lesion of all parts of the heart muscle. Possible causes are inflammation in the myocardium or problems with the exchange of water and salt. Or there may be a consequence of taking medications such as cardiac glycosides.

Moderate metabolic disorders in the myocardium are usually associated with high loads and stimuli, including hypothermia, overweight, stress. If stimuli act irregularly, the myocardium returns to normal.

Sometimes moderate dystrophic changes in the myocardium are detected on the ECG. What does the difference mean in the expenditure of energy by the body and its supply to the heart.

Diabetes mellitus (DM) is one of the major metabolic disorders and currently affects over 250 million people worldwide. The number of people with diabetes is projected to rise to 350 million by 2030. This pathology is often the cause of moderate changes in the myocardium. We have already found out what it is, it remains to find out what the neglect of the ECG results can lead to.

If you do not pay attention to changes in the myocardium, accompanied by unpleasant symptoms, this can threaten the development of coronary heart disease, chronic cerebral ischemia and cardiomyopathy. What is chronic cerebral ischemia? In short, this is a gradual deterioration in cerebral blood flow. A frequent "companion" of this disease is stroke.

Symptoms that should be the reason for going to the doctor:

Dyspnea.
Painful sensations in the region of the heart.
Regular and unexplained fatigue.

How to deal with moderate myocardial changes:

Try to lose weight.
Engage in the treatment of chronic (chronic) diseases.
Do not overcool or overheat.
Do not expose yourself to great nervous and physical tests.
Donate blood for hormones and blood sugar levels.

What to do if changes are detected in the work of the myocardium? It is imperative to sign up for a consultation with a cardiologist and work out a set of health measures together with a doctor.

Types of myocardial lesions: dystrophic and metabolic changes in the myocardium on the ECG

The lesions of the heart muscle are metabolic, dystrophic and diffuse.

Metabolic changes in the myocardium on the ECG occur as a result of metabolic disorders in the heart muscle.

This can be caused by the following reasons: exposure to cold, excess weight, strong stress on the body and psyche, a long-term disease in the body.

If the factor that caused the metabolic change in the myocardium on the ECG disappeared, then the body, as a rule, returns to normal without the help of drugs.

But if the factor continues to act constantly, then the change in the myocardium can become irreversible.

More serious causes of metabolic changes in the myocardium on the ECG are:

arrhythmia;
exposure to radiation;
hypertonic disease;
alcoholism;
angina pectoris;
myocardial dystrophy.

Dystrophic changes in the myocardium on the ECG can be the result of common cardiac pathology, such as heart disease, coronary artery disease, and myocardial inflammation. Launched metabolic changes in the myocardium can eventually lead to dystrophic ones. The most common sign of dystrophic changes is pain in the left chest. Unlike metabolic changes, dystrophic ones are irreversible.

Significant diffuse (aka nonspecific) changes in myocardial tissue occur when:

myocarditis - myocardial damage of an infectious or inflammatory nature;
violation of blood circulation in the myocardium (myocardiosclerosis), and subsequent heart failure;
violation of water-salt metabolism;
dystrophic myocardial damage.

The consequence of metabolic changes in the myocardium on the ECG may be myocardial ischemia. In this state, the heart sharply adapts to the limited supply of oxygen and substrates, and undergoes a sharp switch from aerobic to anaerobic metabolism. This change in energy metabolism can cause calcium overload, as well as a decrease in the synthesis of one of the most important chemical structures of the body - ATP energy - in the myocardium, which contributes to functional damage to the heart muscle.

The consequence of dystrophic changes in the myocardium on the ECG can be an irreversible process called "change in the left ventricular myocardium." Usually this is left ventricular hypertrophy (aka cardiomyopathy), leading to the fact that the septum between the left and right ventricle loses its elasticity. Is it dangerous? Undoubtedly, because cardiomyopathy is one of the main causes of heart failure and sudden death from arrhythmia.

Prevention of myocardial changes

Despite significant improvements in medical care, cardiovascular disease remains the leading cause of death and disability worldwide, mainly from heart attack and stroke. Preventable risk factors such as high blood pressure, cholesterol levels and diabetes, as well as lifestyle factors such as smoking and obesity play a significant role in most deaths.

There are many steps you can take to prevent changes in the myocardium. One way is to eat heart-healthy foods like whole grains, vegetables, fruits, and reduce your intake of sugar, saturated fat, trans fat, and cholesterol.

This is especially important for people with diabetes, hypertension and high cholesterol levels.

In addition, it is important to quit smoking if metabolic or dystrophic changes in the myocardium are recorded on the ECG. Quitting smoking will significantly reduce your risk of heart attack and improve both heart function and lung health. You should also avoid secondhand smoke (being near a smoker).

On an ECG, most heart pathologies can be diagnosed. The reasons for their appearance are due to concomitant diseases and the characteristics of the patient's lifestyle.

What does this mean if myocardial changes were found on the ECG? In most cases, the patient requires conservative treatment and lifestyle correction.

Electrocardiogram (ECG) - one of the most informative, simple and accessible cardiological research. It analyzes the characteristics of the electrical charge that contributes to the contraction of the heart muscle.

Dynamic recording of charge characteristics is carried out on several muscle sites. The electrocardiograph reads information from electrodes placed on the ankles, wrists and chest skin in the area of the heart projection and converts them into graphs.

Norm and deviations - possible causes

Normally, the electrical activity of the parts of the myocardium, which is recorded by the ECG, should be uniform. This means that the intracellular biochemical metabolism in heart cells occurs without pathologies and allows the heart muscle to produce mechanical energy for contractions.

If the balance in the internal environment of the body is disturbed by various reasons - the following characteristics are recorded on the ECG:

diffuse changes in the myocardium;
focal changes in the myocardium.

The reasons for such changes in the myocardium on the ECG can be both harmless states, not threatening the life and health of the subject, and serious dystrophic pathologies requiring urgent medical attention.

One of these serious pathologies is myocarditis, or. Regardless of its etiology, areas of inflammation can be located both in the form of foci and diffusely throughout the heart tissue.

Causes of myocarditis:

as a consequence of scarlet fever, tonsillitis, chronic tonsillitis;
complications of typhus, scarlet fever;
consequences of viral diseases: influenza, rubella, measles;
autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.

One of the reasons for changes in muscle tissue can be cardiac dystrophy - a metabolic disorder in the cells of the heart without affecting the coronary arteries. Lack of nutrition of cells leads to a change in their normal life, impairment of contractility.

Causes of cardiac dystrophy:

The ingestion of toxic metabolic products into the blood due to severe impaired renal and liver function;
Endocrine diseases: hyperthyroidism, diabetes mellitus, adrenal gland tumor, and, as a result, an excess of hormones or metabolic disorders;
Constant psycho-emotional stress, stress, chronic overwork, starvation, unbalanced diet with nutritional deficiencies;
In children, a combination of increased loads with a sedentary lifestyle, vegetative-vascular dystonia;
Lack of hemoglobin (anemia) and its consequences - oxygen starvation of myocardial cells;
Severe infectious diseases in acute and chronic form: influenza, tuberculosis, malaria;
Dehydration of the body;
Avitaminosis;
Alcohol intoxication, occupational hazards.

Definition by cardiogram

With diffuse lesions heart deviations from the normal picture are noted in all leads. They look like numerous areas with impaired conduction of electrical impulses.

This is expressed on the cardiogram, as a decrease in the T waves, which are responsible for. With focal lesions, such deviations are recorded in one or two leads. These deviations are plotted as negative T waves in the leads.

If focal changes are represented, for example, by scars remaining in the connective tissue, they look on the cardiogram as electrically inert areas.

Diagnostics

Decoding electrocardiogram data takes 5-15 minutes... Her data can reveal:

The size and depth of the ischemic lesion;
Localization of myocardial infarction, how long ago it happened in the patient;
Electrolyte metabolism disorders;
Enlargement of the heart cavities;
Thickening of the walls of the heart muscle;
Intracardiac conduction disorders;
Heart rhythm disorders;
Toxic damage to the myocardium.

Features of diagnosis for various myocardial pathologies:

myocarditis- the cardiogram data clearly shows a decrease in teeth in all leads, a violation of the heart rhythm, the result of a general blood test shows the presence of an inflammatory process in the body;
myocardial dystrophy- ECG indicators are identical to the data obtained with myocarditis, this diagnosis can be differentiated only with the help of laboratory data (blood biochemistry);
myocardial ischemia- the data on the ECG show changes in the amplitude, polarity and shape of the T wave, in those leads that are associated with the ischemic zone;
acute myocardial infarction- horizontal displacement of the ST segment upward from the isoline, trough-shaped displacement of this segment;
cardiac muscle necrosis- irreversible death of myocardial cells is reflected in the ECG graph as a pathological Q wave;
transmural necrosis- this irreversible damage to the wall of the heart muscle throughout its thickness is expressed in the cardiogram data, as the disappearance of the R wave and the acquisition of the QS type by the ventricular complex.

In the case of a hypertensive crisis, decompensated heart failure, electrolyte disturbances or suspicion of acute myocardial infarction, a coronary T scar appears on the ECG graph.

When making a diagnosis, additionally you should pay attention to the symptoms of concomitant diseases... It can be pain in the heart with myocardial ischemia, swelling of the legs and arms with, signs of heart failure as a result of a heart attack on the legs, tremors of the hands, sudden weight loss and exophthalmos with hyperthyroidism, weakness and dizziness with anemia.

The combination of such symptoms with diffuse changes detected on the ECG requires an in-depth survey.

What diseases do they accompany

Pathological changes in the myocardium, identified on the ECG, may be accompanied by impaired blood supply to the heart muscle, repolarization processes, inflammatory processes and other metabolic changes.

A patient with diffuse changes may exhibit the following symptoms:

dyspnea,
chest pain
increased fatigue,
cyanosis (blanching) of the skin,
heart palpitations (tachycardia).

Such manifestations most often become the reason for conducting an electrocardiogram. In medical practice, there are many examples when myocardial pathologies did not cause tangible changes in the well-being of patients and were detected during preventive examinations.

Diseases accompanied by changes in the heart muscle:

Myocardial dystrophy- violation of biochemical metabolic processes in the heart;
Allergic, toxic, infectious myocarditis- inflammation of the myocardium of various etiology;
Myocardiosclerosis- replacement of heart muscle cells with connective tissue, as a consequence of inflammation or metabolic diseases;
Violations water-salt exchange;
Hypertrophy parts of the heart muscle.

To differentiate them, additional examinations are required.

Additional diagnostic tests

Cardiogram data, despite their informativeness, cannot be the basis for making an accurate diagnosis. In order to fully assess the degree of myocardial changes, additional diagnostic measures are prescribed by a cardiologist:

- the level of hemoglobin and such indicators of the inflammatory process as the level of leukocytes in the blood and (erythrocyte sedimentation) are assessed;
Blood biochemistry analysis- the indicators of the content of protein, cholesterol, glucose are estimated for the analysis of the work of the kidneys, liver;
General clinical urine analysis- indicators of kidney function are assessed;
Ultrasound in case of suspicion of pathology of internal organs - according to indications;
ECG indicators;
Carrying out Stress ECG;
Ultrasound of the heart(echocardiography) - the state of the heart is assessed to determine the cause of myocardial pathology: expansion (dilation), hypertrophy of the heart muscle, signs of a decrease in myocardial contractility, impaired motor activity.

After analyzing the anamnesis and the data of laboratory and instrumental examination, the cardiologist determines the method of treating the changes.

Treatment for focal and diffuse disorders

In the treatment of myocardial pathologies, are used various groups of drugs:

If conservative treatment does not lead to significant improvements in the patient's condition with myocardial diseases, he is given an operation to implant a myocardial pacemaker.

In addition to remedies, the patient is advised to change his lifestyle and establish a balanced diet. For a patient with such pathological manifestations, physical activity, alcohol consumption and smoking are unacceptable. He is shown physiotherapy exercises and feasible work.

The main provisions of the dietary nutrition:

Salt and excess fluid intake is limited to a minimum;
Spicy and fatty foods are not recommended;
The menu should include vegetables, fruits, lean fish and meat, dairy products.

Myocardial changes detected on the ECG, require additional laboratory and instrumental examination... If necessary, a cardiologist will prescribe treatment in a hospital or on an outpatient basis. Timely measures taken will help to avoid serious complications.

The myocardium is a heart muscle, some of its structural changes are often provoked by external and internal factors. Transformations do not always speak of pathology or any negative violation, but in any case, they need to be focused on. After all, the heart is an important organ of the human body, it is akin to a car engine: it converts biochemical reactions into mechanical energy. The movements of the heart muscle must follow the rhythm, all sorts of violations of this process and changes in the myocardium are shown by an electrocardiogram (ECG).

Signs of a problem

Cardiac activity depends on many criteria that affect intracellular metabolism in the tissues of the heart muscle. The constancy of the internal environment can be periodically disturbed, which is fraught with malfunctions in the work of heart cells. Diffuse changes in the myocardium are not considered a disease, it is a syndrome that means the accumulation of changed cells with impaired conduction of electrical impulses in this area, clearly displayed on the ECG. It is important to determine the cause of such failures, it can be of a hormonal nature, an infectious origin, or be a consequence of heart diseases of varying severity.

Changes are not always only diffuse, covering sectors in each section of the organ. They can be focal as a result of the formation of scars in the myocardium of any size. The scar is a connective tissue that does not conduct impulses; the electrical inertness of this area is visible on the cardiogram.

The variety of myocardial diseases is very large, but the general signs of problems with the cardiovascular system and symptoms of myocardial changes are as follows:

burning and pressing pains behind the sternum;
shortness of breath at the slightest physical exertion or even at rest;
violations of the heart rhythm and frequency of contractions;
increased fatigue, general weakness, chronic fatigue.

A primary change in the heart muscle provokes the development of certain processes:

myocardial hypoxia;
circulatory disorders;
failures in transporting oxygen to cells and tissues;
irreversible necrotic consequences.

A critical case of the development of myocarditis is an acute infarction, its course is also different.

Causes of myocardial changes

The detected deviations have different origins. The reasons can be minor and significant. The latter provoke a fatal outcome. A thorough examination will reveal the problem to an experienced cardiologist.

Changes in the myocardium can form several groups of factors:

Inflammatory. Are the cause of myocarditis. Its nature can be infectious or aseptic, that is, pathogens do not participate in this process. Usually, such areas have a diffuse nature of the location, but sometimes there are foci of inflammation.

The manifestations of myocarditis, expressed with varying degrees of intensity, are accompanied by the following pathologies:

typhus, diphtheria;
acute rheumatic fever or rheumatism of streptococcal origin, which is a consequence of angina, tonsillitis, scarlet fever;
weakening of the immune system (systemic lupus erythematosus, rheumatoid arthritis affecting the heart, etc.);
defeat by viruses of rubella, measles, flu, etc.

diseases of the endocrine system: hyperfunction of the thyroid gland, diabetes mellitus, adrenal gland tumor, as a result, an excessive amount of hormones or a lack of glucose in the heart cells provoke disruptions in metabolic processes inside these cells;
hepatic and renal failure lead to the accumulation of toxins in the blood, formed as a result of metabolic processes;
anemia - a decrease in the level of hemoglobin - brings with it a lack of air for the cells of the heart muscle;
dehydration, fever;
difficult physical conditions: frequent stress, hard work, constant overwork, malnutrition and starvation;
mental stress in combination with increased emotional stress lead to changes in the myocardium in children, especially if the child is not active enough; here, among the consequences of vegetative-vascular dystonia and failures in the control of the nervous system of the heart;
infections: tuberculosis, flu, malaria;
intoxication - acute or chronic, including alcoholism, work in hazardous work, constant contact with chemicals;
food unsaturated with vitamins.

Diagnosing and fixing the problem

Minor changes in the myocardium will not require drastic measures. The patient will be advised to correct blood pressure, take a course of vitamins and adhere to a healthy lifestyle.

More serious changes in the myocardium already imply the presence of a disease; for diagnosis, the following measures are usually performed:

Clinical blood test. Examines hemoglobin parameters and criteria for inflammation.
Blood biochemistry. Determines the state of the liver, kidneys, the amount of glucose, proteins, cholesterol.
General urine analysis. Evaluates renal performance.
Ultrasound. Visual examination of internal organs.
ECG. Diffuse changes are indicated by a decrease in the T waves, which are responsible for ventricular repolarization. Focal changes are evidenced by negative T waves in 1–2 sectors.
Echocardiogram. The most informative method that identifies the causes of changes in the heart muscle due to clear visualization of its departments.

Therapy must be combined with diet and lifestyle correction. By default, changes in the myocardium of a dystrophic or metabolic nature require adequate rest, adherence to sleep and diet.

The heart responds well to those present in the diet:

nuts;
spinach;
carrots and potatoes;
apricots, peaches, bananas;
lean poultry and meat;
red fish and caviar;
cereals, cereals;
dairy products.

Chocolate and confectionery should be consumed to a minimum. Fatty meat and poultry are extremely rare. Soda, coffee and alcohol are excluded. You also need to remove spicy, fatty, salty, spicy and fried foods.

The following drugs contribute to the improvement of metabolic processes in the cells of the heart muscle:

Asparkam, Panangin, Magne B6, Magnerot - potassium and magnesium stabilize the frequency of contractions.
"Mexidol", "Actovegin" - antioxidants that eliminate lipid oxidation products in myocardial cells.
Vitamins A, B, C, E - without them, intracellular metabolism is impossible.

If the cause of myocardial changes is a disease, then appropriate therapy will correct the situation. The lack of hemoglobin is replenished with iron-containing drugs, antibiotics and "Prednisolone" are prescribed for myocardial inflammation, urinary drugs and cardiac glycosides are indicated for cardiosclerosis.

The human heart muscle is a unique complex of cells that are able to transform the energy received as a result of biochemical processes into mechanical energy that causes the heart to contract. This type of activity depends on many factors that promote intracellular metabolism in the myocardium. Therefore, any shifts in the constancy of the internal environment of the body can be reflected in the disruption of the vital activity of the heart cells, whether it be heart disease, hormonal disorders in the body, or a condition after an infectious disease.

Diffuse changes in the myocardium are not a disease, but a syndrome, upon detection of which the doctor should determine what caused it - a serious illness or minor metabolic disorders. The appearance of such signs is due to the fact that part of the cells during biochemical shifts begin to work and contract not quite correctly, as a result of which the electrical activity of the parts of the heart muscle, recorded on the ECG, will not be uniform. In other words, diffuse changes in the myocardium are accumulations of altered cells through which the conduction of electrical impulses is impaired.

Disorders of cell activity can be not only diffuse, that is, covering areas in all parts of the heart, but also focal, for example, during the formation of small or large scars in the myocardium. Scars are represented by connective tissue that cannot conduct impulses and is electrically inert, which is what the doctor sees on the cardiogram.

Why do myocardial changes occur?

The reason for such deviations on the cardiogram can be both harmless and quite serious, posing a threat to human life. In order to more accurately find out what exactly causes diffuse or focal changes in the myocardium, it is necessary to carefully examine the patient. Pathological changes in the myocardium can be caused by various processes, and therefore several subgroups are distinguished among them.

The causes of inflammatory changes are- infectious or aseptic (without the participation of microorganisms) inflammation of the heart muscle. As a rule, areas of inflammation are diffusely located, but they can also occur in the form of foci.

Myocarditis. The photo on the right is a cross-section of the heart. Arrows indicate diffuse inflammatory processes in the heart tissue in myocarditis.

Myocarditis of varying severity occurs in diseases such as:

Acute, caused by hemolytic streptococci due to previous tonsillitis, scarlet fever or chronic tonsillitis,
Diphtheria, typhus,
Influenza, measles, rubella, Coxsackie viruses, etc.
Autoimmune diseases, for example, rheumatoid arthritis with heart damage, etc.

Dystrophic changes in the myocardium are characterized by metabolic and function disorders in the heart cells, caused by non-inflammatory and non-coronary (not caused by coronary artery disease) diseases. Literally, this means that myocardial cells lack nutrients for their vital activity, which leads to their inhomogeneous contraction. This state is called in another way. This condition can occur in the following cases:

Severe violations of the liver and kidneys with the development of failure of these organs, as a result of which toxic metabolic products accumulate in the blood,
Diseases of the endocrine organs - adrenal tumor, thyroid hyperfunction, as a result of which an excess of hormones or insufficient absorption of glucose by heart cells leads to a violation of intracellular metabolism,
Constant stress, exhausting physical activity, malnutrition and starvation, chronic overwork,
In children, in addition to the previous reason, increased emotional and mental stress in the absence of sufficient mobility can lead to changes in the myocardium, as a result of which dysregulation of the heart by the nervous system develops,
- a decrease in hemoglobin in the blood and, as a result, oxygen starvation of myocardial cells,
Acute and chronic infectious diseases (influenza, malaria, tuberculosis),
Fever and dehydration
Lack of vitamins in food,
Acute and chronic intoxication - alcoholism, occupational poisoning with chemicals, etc.

Metabolic changes in the myocardium are caused by impaired repolarization processes in muscle cells. Depolarization and repolarization are subtle mechanisms of exchange of potassium and sodium ions inside each cell, the generated energy in which is converted into energy necessary for the contraction and relaxation of the cell. When the electrolyte composition in the blood and in the heart muscle is disturbed, a change in the metabolism of muscle cells occurs. Sometimes such violations in the conclusion of the ECG are formulated as nonspecific changes in the myocardium.

In addition to conditions that can provoke myocardial dystrophy, this can be caused by coronary arteries and,. That is, those conditions in which the heart receives insufficient nutrients and trace elements. We can say that impaired repolarization processes and moderate changes in the myocardium mean that this is not so much coronary heart disease as the first bell for the patient that the blood supply to the heart muscle is impaired, and in the near future he is likely to develop myocardial ischemia.

Insignificant and moderate changes in the myocardium of the left ventricle in childhood are considered absolutely normal due to imperfect metabolism and in the elderly due to the aging processes of all internal organs.

Cicatricial changes in the myocardium indicate that an inflammatory process previously occurred in the heart muscle or myocardial infarction with necrosis (death) of heart cells was transferred. Cicatricial changes after myocarditis, also called, as a rule, diffuse, and after - focal. The differences between these terms are that cardiosclerosis is a diagnosis reflecting the disease, and cicatricial changes in the myocardium are the pathomorphological basis of the disease, reflected on the cardiogram. Postinfarction cardiosclerosis is more often represented by a focal scar, and can be large or small focal, and located along one or more walls of the left ventricle - the lower (posterior) wall, its anterior or lateral sections.

Can there be symptoms with diffuse changes in the myocardium?

As a rule, in the absence of cardiological pathology, changes in the ECG do not manifest themselves clinically and are only an accidental finding during examination. However, the patient should undergo further follow-up examination as directed by the doctor to make sure that he does not have the initial signs of any disease and, if necessary, begin timely treatment.

By themselves, diffuse changes in the myocardium do not have any clinical signs, especially when it comes to minor or moderate changes... Nevertheless, pronounced changes the heart muscle in most cases indicates some kind of cardiac or other disease, therefore, symptoms may appear on the part of the underlying disease. These include pain in the heart caused by myocardial ischemia; and edema with cardiosclerosis; signs of chronic heart failure after a previous myocardial infarction; trembling of the limbs, weight loss and displacement of the eyeballs anteriorly (exophthalmos) with hyperfunction of the thyroid gland; pallor, dizziness and weakness with anemia, etc.

In this regard, a patient with diffuse changes in the myocardium should remember that if he has unpleasant symptoms, he should consult a doctor as soon as possible to find out the cause of this condition.

What kind of examination may be needed?

In each specific case, only a doctor, during a face-to-face examination of a patient, can decide whether there is a need for further examination. So, for example, with minor diffuse changes in the myocardium in adult patients without signs of a serious illness, the doctor may limit himself to recommendations for correcting blood pressure levels, maintaining a healthy lifestyle and taking vitamins.

If there is a suspicion of a disease that caused changes in the myocardium, additional diagnostic methods may be prescribed:

Treatment

Therapy of absolutely any disease begins with a lifestyle correction and the foundations of a balanced diet. When it comes to dystrophic or metabolic changes in the myocardium of minor and moderate severity, Sleep, proper rest and diet are essential.

For a sufficient supply of energy substrates to the heart muscle, it is necessary to receive balanced and healthy food 4-6 times a day.

Low-fat varieties of meat and poultry are welcomed in the diet, which is most important for anemia, sea and red fish, red caviar, fruits and vegetables, especially peaches, apricots, bananas, carrots, potatoes, spinach, nuts. Also useful is the daily consumption of dairy products, grains and cereals. Confectionery and chocolate, fatty meats and poultry are limited. Salty, fatty, fried, spicy and spicy foods, alcohol, coffee, carbonated drinks are excluded.

To improve metabolism (metabolism) in cardiac tissues, drugs such as:

Panangin, asparkam, magnerot, magne B6 - contain potassium and magnesium, which are necessary for the correct contractions of the myocardium,
Actovegin, Mexidol - antioxidants, eliminate the negative effect of lipid peroxidation products (LPO) in myocardial cells,
Vitamins A, C, E, group B are irreplaceable participants in intracellular metabolism.

If severe diffuse changes in the myocardium are caused by a disease, treatment is required. For example, replenishment of hemoglobin deficiency with iron-containing drugs, correction of thyroid function, antihypertensive drugs for arterial hypertension, antibiotic therapy and prednisolone for myocarditis, diuretics and cardiac glycosides for heart failure caused by cardiosclerosis, etc.

When the muscle fibers of the heart are replaced with scar tissue, cardiosclerosis is formed. Its development can be the outcome of coronary atherosclerosis (ischemia), inflammation or myocardial dystrophy. At the initial stages, hypertrophy of the heart muscle is detected, and then the cavities of the ventricles expand, which is accompanied by valve insufficiency. For the initial diagnosis, an ECG is used, which helps to establish the localization of the scar.

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Causes of cicatricial changes in the myocardium

The most common factors in the formation of coarse fibrous tissue in the heart muscle are inflammatory and atherosclerotic processes. In this case, it occurs mainly in young people, in childhood and adolescence, and blockage of the coronary arteries due to the deposition of cholesterol is almost always detected in patients after 40 years.

Scars with myocarditis

Formed in the area of inflammation. They arise after infectious diseases, allergic processes.

On the cardiogram, changes of a common nature, more often in the right ventricle, indicate that the blood pressure is normal or.

Insufficiency of blood circulation also has signs of a right ventricular (edema, enlarged liver, cardiac asthma). In the study of blood - normal lipid profile, eosinophilia or increase.

Atherosclerotic form

It develops slowly against the background of chronic myocardial ischemia. The defeat of the heart muscle is diffuse. Muscle fibers die due to lack of oxygen and metabolic disorders. In the initial stages, the clinical signs of scar formation do not differ from the standard course.

Subsequently, such violations are added:

an increase in the muscle mass of the left ventricle;
labored breathing;
accelerated heartbeat;
and the accumulation of fluid in the chest, pericardium, abdominal cavity;
sick sinus syndrome with bradycardia;
formation;
weakening of heart sounds, more than the first;
noise during systole over the aorta and apex;
various types of blockages, atrial fibrillation, extrasystoles;
in blood.

Postinfarction cardiosclerosis

Unlike the two previous forms, the scar in the myocardium after necrosis (infarction) is located in the zone of destruction and does not extend to the rest of the heart muscle.

With repeated attacks of acute ischemia, the connective tissue can have various localization and length, some of the scars can be crossed. In this case, the cavities of the heart expand after a period of hypertrophy. High blood pressure in the area of scar tissue can cause the wall to bulge and form an aneurysm. Symptoms for postinfarction lesions do not differ from atherosclerotic ones.

Watch the video about coronary heart disease:

What will the ECG show with changes

For the first stage of diagnostics of cicatricial structures in the myocardium, it is used, it can help in topical (locating) diagnostics.

Left ventricle

Scar tissue leads to the formation of:

abnormal Q in the first three standard leads, as well as V1 - 6;
ST is located on the isoline;
T is usually positive, low and smooth.

At the same time, connective tissue fibers cannot generate signals, as well as the focus of destruction. But the focus becomes smaller due to the contraction of the remaining muscle fibers.

Therefore, with repeated ECG studies at the stage of scarring, a positive trend is noted.

Bottom wall

Pathological Q is noted in the second standard lead, and a lower (negative) ventricular complex is also found there in comparison with the third standard lead.

Partition area

For a cicatricial infarction in the septal zone, the Q waves in leads V1, V2 are of diagnostic value, and the R waves in V1,2,3 are low or cannot be determined.

Additional examinations

In addition to electrocardiographic examination, patients are prescribed:

Ultrasound of the heart to assess the extent and expansion of cavities;
CT scan or if there is a discrepancy between clinical signs and ECG data;
myocardial scintigraphy to detect diffuse or focal defects in the accumulation of radioisotopes;
blood tests - lipidogram, coagulogram, immunological complex, specific enzymes (troponin, myoglobin, creatine phosphokinase).

How to treat abnormalities

It is not possible to influence the already formed scars in the myocardium.

For this, drugs are prescribed from various groups:

for angina pectoris - beta-blockers (Bisoprol), nitrates (), (Enap), diuretics (Trifas), anticoagulants (, Clopidogrel);
with myocarditis - antibiotics (Augmentin) anti-inflammatory (Nimid), antiviral and immunomodulators (Cycloferon), vitamin complexes (Milgamma);
to improve myocardial nutrition - antioxidants (Kudesan, Cytochrome C), metabolic stimulants (Mexidol, Panangin, Riboxin);
hypolipidemic - Tulip, Roxera;
- Ritmonorm, Kordaron;
- Korglikon, Digoxin.

If there is no result from drug therapy, and there is also a threat, in case of severe rhythm disturbance, surgical treatment is performed: installation of a stent or, suturing of the aneurysm.

Scarring in the heart muscle is the final stage after myocarditis or myocardial infarction, it is also considered the outcome of atherosclerotic coronary artery disease. An ECG is used to detect focal or diffuse scarring of the myocardium.

To clarify the diagnosis, an in-depth clinical and instrumental examination is recommended. Symptoms and prognosis of cardiosclerosis depend on the severity of the underlying pathology. There are no specific manifestations, complications can be various violations of the rhythm of heart contractions, circulatory failure. For treatment, drug therapy is used, in case of threatening conditions, an operation is prescribed.