Cardiomegaly is a change in the shape, parameters and total mass of the heart toward an increase in these parameters, which is the manifestation of the main chronic cardiac, and sometimes extra-cardiac pathological changes. In most situations, this term means not a separate nosological unit, but a syndrome. Cardiomegaly can be both congenital and acquired type, therefore this pathology can occur among patients of different age categories.
Causes of cardiomegaly
Idiopathic variant of cardiomegaly is a rarity, but now due to the use of high-precision diagnostic methods even cardiomegaly of the fetus can be detected. The emergence of cardiomegaly of the congenital form is provoked by hereditary genetic factors, and therefore, the forecast regarding the preservation of the normal quality of life of this category of patients is extremely doubtful.
The main provoking factors in the formation of cardiomegaly acquired form are various pathological changes in the heart of an organic and non-organic nature. A remarkable fact is that cardiomegaly is mostly caused by diseases accompanied by cardiohemodynamics, including valvular heart disease, hypertension and various forms of cardiomyopathies (alcoholic, toxic, dilated, constrictive). To a lesser extent, the parameters of the heart change with organic diseases, since the development of even massive cardiosclerosis does not affect the state of the cavities and muscle mass of the heart. Despite the fact that recently there has been a decrease in the incidence of myocarditis incidence of infectious nature, all the pathological changes that occur in this pathology provoke the development of cardiomegaly in the shortest possible time.
Also, one should not forget about the physiological variant of cardiomegaly, which occurs in persons of hypersthenic type of physique and professional athletes. The increase and extension of cardiac muscle fibers in this situation is a compensatory mechanism and should not be considered as a pathology.
At present, cardiologic practice shows a significant increase in the incidence of cardiomyopathy of alcoholic genesis, which inevitably provokes the development of cardiomegaly due to a significant expansion of the heart cavities. This clinical variant of cardiomegaly is characterized by an extremely unfavorable prognosis and a high level of lethality due to complications.
In pediatrics, cardiomegaly complicates the course of viral myocarditis, which occurs as a manifestation of childhood viral diseases. This category of pathological changes in the myocardium occurs as a result of the triggering of autoimmune mechanisms.
Symptoms of cardiomegaly
Due to the fact that the process of cardiomegaly development takes an extended period of time and arises against the background of the existing cardiac pathology, patients do not present specific complaints that allow establishing a correct conclusion without using additional survey methods. More patients complain, which reflects the underlying pathology. That is, in a situation where a person suffers from hypertension for a long time, the primary symptoms that he will note will be the symptoms of high blood pressure, especially those that are manifest in the course of the crisis (headaches, nausea, dizziness ).
Unfortunately, cardiomegaly belongs to the category of "clinically concealed syndromes", which are masked under the manifestations of other diseases. Most patients with cardiomegaly note a pain syndrome in the heart that has nothing to do with a typical attack of angina pectoris, but can significantly impair the patient's quality of life. This pain syndrome, as a rule, is quickly stopped by taking Valocordin 15 drops once. The appearance of signs of cardiomegaly in patients is most often accompanied by the development of a clinical picture of heart failure, manifestations of which is an increasing slowly progressive dyspnea, minor violations of the rhythm of cardiac activity, dizziness and decreased efficiency.
In the initial examination of a patient with cardiomegaly, special care should be taken to collect anamnestic data that can assist in verifying the cause of its development. In addition, detailing the patient's complaints makes it possible to clarify the nature and nature of cardiomegaly. For example, for this pathology pathognomonic deterioration of the patient during the night, during which progression of dyspnea is noted, and with severe cardiomegaly, the occurrence of paroxysmal cardiac asthma is pathognomonic.
Practically in 100% of cases of cardiomegaly, which arises as a result of the progression of background cardiological pathology, patients note a progressive decrease in the tolerance of habitual physical activity. Many patients do not believe that this symptom is related to the progression of cardiomegaly, and cardiologists are of the opposite opinion.
Diagnosis of cardiomegaly
A significant increase in heart parameters can be diagnosed by the cardiologist already during the initial examination of the patient on the basis of percussion data and auscultatory changes. Thus, the expansion of relative cardiac dullness is observed with pronounced dilatation of the cavities of the right heart. In addition, there is an expansion and some displacement of the apical impulse. Auscultatory changes reflect the concomitant damage of the valvular apparatus to a greater extent and consist in the appearance of noise in various auscultative points. Diagnosis of venous hypertension and stagnation over a large range of blood circulation in an experienced physician does not cause difficulties and consists in determining the signs of edema of soft tissues of lower extremities, ascites, skin and vascular manifestations.
As diagnostic measures that allow to establish reliably the presence of changes in the shape and size of the heart, it is possible to use instrumental diagnostic methods that are accessible and not complicated in terms of technical performance (beam imaging methods, electrocardiographic monitoring). However, angiography, transesophageal echocardioscopy, and even puncture biopsy, which are 100% authentic, are now used to more accurately examine the patient, which makes it possible to establish the root cause of cardiomegaly.
The standard diagnostic method for screening methods for any category of patients is radiologic, but it should be noted that this technique allows one to recognize the pronounced degree of cardiomegaly caused by a significant expansion of the heart cavities due to thinning of its muscular wall. In some situations, the detection of cardiomegaly with a standard X-ray examination is not difficult and consists of visualizing the altered shadow of the mediastinum, an enlarged cardiothoracic index and the formation of typical heart configurations. Supplement to the standard X-ray examination of the chest cavity is radiography in the lateral projection with simultaneous contrasting of the esophagus, which allows to indirectly determine the localization of the affected parts of the heart. Differential diagnosis of cardiomegaly during an X-ray examination should be carried out with such diseases as pericardial cysts, neoplasms of the mediastinum and pericarditis , since all these pathologies, one way or another, are visualized as an enlarged shadow of the mediastinum.
Electrocardiographic examination of the patient allows to establish indirect signs of cardiomegaly only in a situation where the size of the heart is increased due to hypertrophy of the left or right divisions, although these changes are characteristic for a number of cardiac pathologies.
In a situation where cardiomegaly is suspected in children, and if necessary, detail changes in not only the size but also the structure of the muscle tissue, assess hemodynamic parameters, the only reliable diagnostic method is echocardiography performed in standard transthoracic access. When performing ultrasound examination of the heart structures, the valve apparatus, the presence of diffuse or focal myocardial damage, and the cavity are examined for the presence of volume formations.
Invasive methods of heart examination, which include intracavitary catheterization, are used as a therapeutic and diagnostic measure and are the most informative way to determine the cause of cardiomegaly. With the help of these techniques, the change in the intracavitary pressure gradient, the state of the valvular heart apparatus, the presence of changes in the coronary arteries, and the pathological shunt are evaluated.
Treatment of cardiomegaly
If a person is diagnosed with cardiomegaly, the patient should be warned that this pathology implies the development of irreversible changes in the myocardium and heart cavities, and surgical is the only effective method for eliminating these pathological changes. In other respects, conservative treatment, as well as non-pharmacological methods, are used to eliminate the possible aggravation of cardiomegaly and prevent complications.
Not medicinal methods of preventive treatment is the correction of eating behavior (restriction of foods saturated with cholesterol and triglycerides, as well as a sharp restriction of salt intake into the body with food). With cardiomegaly, accompanied by cardiovascular failure , special attention should be given to water regimen and daily diuresis control. If possible, the patient should limit physical activity if there is a severe degree of heart failure .
The main direction of drug treatment of a patient with cardiomegaly is etiotropic therapy, whose drugs can compensate for hemodynamic disorders, as well as eliminate factors that aggravate the course of cardiomegaly. In a situation where an increase in the size of the cavity or thickness of the heart wall is observed in a patient with a hypertensive anamnesis, the drugs of choice are combined antihypertensive drugs, which must contain a diuretic (Enap H-1 tablet in the morning). If cardiomegaly developed against ischemic heart damage, then the following categories of drugs should be included in multicomponent therapy: beta-blockers (Egilok in a daily dose of 50 mg), prolonged nitrates (Cardiac retard 40 mg per day), cardiac glycosides (digoxin in the supporting dosage of 125 μg).
In connection with the fact that cardiomegaly is most often accompanied by a hemodynamic disturbance in a large range of blood circulation, close attention should be paid to patients with signs of stagnation accompanied by a pronounced edematous syndrome. In this situation, the only justified method of drug correction is adequate stimulation of diuresis with the use of diuretic drugs of different pharmacological action (Furosemide in a daily dosage of 40 mg, Veroshpiron in a daily dose of not less than 0.025 mg).
Among the surgical techniques for the treatment of cardiomegaly palliative surgical manuals for the elimination of valvular defects are applied.