Diastolic myocardial dysfunction in both ventricles

Violation of the function of the diastole of the left ventricle is formed gradually. Depending on the degree of intracardiac hemodynamics disturbances, the following types of dysfunction are distinguished:

  1. Type I (impaired relaxation) is the initial stage of the development of pathological changes. Type 1 diastolic dysfunction is associated with a slowdown in the process of ventricular relaxation in diastole. The main volume of blood is supplied during atrial contraction.
  2. Type II (pseudo-normal) – in this case, pressure in the left atrial cavity reflexively rises, filling of the ventricles occurs due to the pressure difference.
  3. 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 rig >

Should diastolic dysfunction be treated if there are no symptoms of the disease and the clinic? Many patients are wondering. Cardiologists agree: yes. Despite the fact that in the early stages there are no clinical manifestations, the dysfunction is capable of progression and the formation of heart failure, especially if the patient has a history of other heart and vascular diseases (AH, CHD).

  1. ACE inhibitors – this group of drugs is effective both in the early and late stages of the disease. Representatives of the group: enalapril, perindopril, diroton;
  2. AK – a group that helps to relax the muscle wall of the heart, causes a decrease in hypertrophy, dilates the blood vessels of the heart. Calcium antagonists include amlodipine;
  3. b-blockers can slow down heart rate, which is why diastole lengthens, which favors heart relaxation. This group of drugs includes bisoprolol, nebivolol, nebilet.

After the diagnosis, the patient must be aware that in order to improve the state of health he needs treatment. Do not neglect the advice of a doctor, and take the pill once or twice a day. Such measures will prolong the patient’s life for a long time and allow him to enjoy and enjoy life every day.

However, in the later stages of the pathology with tablets alone, the patient’s life and well-being cannot be improved, since stronger drugs are required. Diuretics are mainly prescribed, as well as aspirin, nitroglycerin, beta, and a doctor can also prescribe a combination of drugs.

The following treatment measures should be attributed to methods for correcting hemodynamic disorders:

  • control of blood pressure;
  • decreased heart rate;
  • maintaining water-salt metabolism to reduce preload;
  • remodeling of left ventricular hypertrophy.

The main groups of drugs used for treatment are:

  1. Adrenergic blockers – reduce the heart rate, reduce blood pressure, and improve the processes of nutrition of myocardial cells.
  2. Angiotensin-converting enzyme inhibitors (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, and reducing preload. They have a proven positive effect on the prognosis, life expectancy and improvement of its quality in patients with chronic heart failure.
  3. Diuretics – due to the removal of excess fluid, reduce the manifestations of shortness of breath, in combination with drugs of other antihypertensive classes contribute to more effective control of blood pressure. Assigned in small doses, as they can lead to a significant reduction in stroke volume.
  4. Calcium antagonists – have a direct positive effect on diastolic dysfunction: due to a decrease in calcium in myocardiocytes, they contribute to myocardial relaxation. In addition, they lower blood pressure. They are the drugs of choice for intolerance to adrenergic blockers.
  5. Nitrates belong to an additional group of drugs, their appointment is possible in the presence of signs of myocardial ischemia, proven instrumental.

The main problem for the effective treatment of the disease remains the restoration of full contractility of the body. Diastolic LV myocardial dysfunction includes drug and surgical therapy. Therefore, treatment has several main areas:

  1. stabilization of normal heart rate to prevent the development of arrhythmias;
  2. treatment of coronary disease;
  3. stabilization of blood pressure.
Blockersaimed at normalizing heart rate, lowering blood pressure, improve the procedure for feeding myocardial cells
Inhibitors or sartansthey work on myocardial remodeling, improve its elasticity, reduce the load. Significantly improve the results of analyzes of patients with permanent heart failure
Diureticsremove excess fluid, reducing asthmatic manifestations, and also allow you to control blood pressure. The drug is prescribed in small quantities, since it leads to a decrease in stroke volume
Calcium antagonistscontribute to myocardial relaxation, lower blood pressure
Nitratesonly additional drugs that can be prescribed for myocardial ischemia

The treatment process takes place in a hospital, where the state of the patient is monitored by medical personnel.

A patient with a ventricular dysfunction should always follow a diet. To do this, limit salt intake, monitor the fluid you drink – this will reduce the load on the circulatory system. It is worth eating rationally, adhering to the regimen, you need to divide the food 4-6 times. You need to abandon fatty, fried and spicy.

The treatment is aimed at correcting hemodynamic disorders

It is also important to adjust your lifestyle: get rid of bad habits, do not overwork, get enough sleep. Pay attention to physical activity. Loads should be rational, consistent with the capabilities of the body. You need to spend more time outdoors. If the disease is complicated, it is necessary to exclude the load or consult a doctor.

Subject to the recommendations of the doctor and taking medications, the prognosis of the disease is favorable.

Sazykina Oksana Yuryevna, cardiologist

In order for each cell of the human body to receive blood with vital oxygen, the heart must work correctly. The pumping function of the heart is carried out with the help of alternate relaxation and contraction of the heart muscle – myocardium.

If any of these processes are disturbed, dysfunction of the ventricles of the heart develops, and the ability of the heart to push blood into the aorta gradually decreases, which affects the blood supply to vital organs.

Developed dysfunction, or myocardial dysfunction.

Ventricular dysfunction is a violation of the ability of the heart muscle to contract with the systolic type to expel blood into the vessels, and relax with diastolic to take blood from the atria. In any case, these processes cause a violation of normal intracardiac hemodynamics (movement of blood through the heart chambers) and stagnation of blood in the lungs and other organs.

Both types of dysfunction are associated with chronic heart failure – the more ventricular function is impaired, the higher the severity of heart failure.

If heart failure can be without heart dysfunction, then dysfunction, on the contrary, does not occur without heart failure, that is, in every patient with ventricular dysfunction, there is chronic heart failure of the initial or severe stage, depending on the symptoms. This is important for the patient to consider if he considers medication to be optional.

You also need to understand that if a patient is diagnosed with myocardial dysfunction, this is the first signal that some processes are going on in the heart that need to be identified and treated.

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Diastolic dysfunction is a relatively new diagnosis. Until recently, even cardiologists rarely exhibited it. However, diastolic dysfunction is currently one of the most commonly detected heart problems with echocardiography.

Recently, cardiologists and therapists are increasingly setting their patients a “new” diagnosis – diastolic dysfunction. In severe cases of the disease, diastolic heart failure (HF) can occur.

Currently, diastolic dysfunction is detected quite often, especially in older women, most of whom are surprised to learn that they have heart problems.

Often, patients diagnosed with diastolic dysfunction may develop diastolic heart failure.

Neither diastolic dysfunction, nor diastolic heart failure are actually “new” diseases – they have always affected the human cardiovascular system. But only in the last decades, these two diseases began to be detected frequently. This is due to the widespread use of ultrasound methods (echocardiography) in the diagnosis of heart problems.

It is believed that almost half of patients admitted to the emergency department with acute heart failure actually have diastolic heart failure.

But to establish the correct diagnosis can be difficult, because after stabilizing the condition of such a patient, the heart may look completely normal during echocardiography, if the specialist purposefully does not look for signs of diastolic dysfunction. Therefore, inattentive and unguarded doctors often miss this disease.

The heart cycle is divided into two phases – systole and diastole. During the first ventricle (the main chambers of the heart), they contract, throwing blood from the heart into the arteries, and then relax. During relaxation, they are re-filled with blood to prepare for the next contraction. This phase of relaxation is called diastole.

The heart cycle consists of systole (contraction of the heart) and diastole (relaxation of the myocardium), during which the heart fills with blood

However, sometimes, due to various diseases, the ventricles become relatively “stiff.” In this case, they cannot completely relax during diastole. As a result, the ventricles are not completely filled with blood, but it stagnates in other parts of the body (in the lungs).

The pathological tightening of the walls of the ventricles and the resulting insufficient blood filling during diastole is called diastolic dysfunction. When diastolic dysfunction is so pronounced that it causes congestion in the lungs (that is, the accumulation of blood in them), it is considered that this is already diastolic heart failure.

Development mechanism

Diastolic dysfunction of the left ventricle is a violation of the normal process of filling the ventricle with blood during the period of relaxation of the heart (diastole). This type of pathology, as a rule, develops in old age, more often in women.

Normally, blood filling consists of several stages:

  • myocardial relaxation;
  • passive blood flow from the atrium to the ventricle due to pressure differences;
  • filling as a result of atrial contraction.

Due to various factors, one of the three stages is violated. This leads to the fact that the incoming blood volume is not able to provide an adequate cardiac output – left ventricular failure develops.

Development mechanism

First of all, it should be noted that the development of diastolic dysfunction of the myocardium is promoted by its hypertrophy, i.e. thickening of the walls of the ventricles and 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, factors contributing to the development of the main cause – hypertrophy are highlighted and this:

  • arterial hypertension;
  • heart disease;
  • diabetes;
  • obesity;
  • snoring (its effect is due to involuntary respiratory arrest for several seconds during sleep).

Ventricular dysfunction is more often an age-related disorder and occurs mainly in older people. 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 period of diastole is characterized by muscle relaxation and the 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 abruptly expelled into the ventricle.

In case of violation of one of the stages, insufficient blood flow is observed, which contributes to the development of left ventricular failure.

Diastolic ventricular dysfunction can be caused by certain diseases that can significantly disrupt the hemodynamics of the heart:

  • Diastolic dysfunction of the left ventricle is a consequence of thickening of the heart muscle tissue (myocardial hypertrophy). As a rule, hypertrophy develops in people with hypertension, aortic stenosis and hypertrophic cardiomyopathy.
  • It can develop under the influence of pericarditis, due to which the thickened walls of the pericardium compress the chambers of the heart.
  • With pathological changes in the coronary vessels that cause coronary heart disease due to coarsening of the heart tissue and the appearance of scars.
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Especially often, the disease develops in people with diabetes or obesity. In this case, the pressure on the heart chambers increases, the organ cannot fully function and ventricular dysfunction develops.

Diastolic dysfunction of the left ventricle over time may practically not bother the patient. However, this pathology is accompanied by certain symptoms:

  • cardiopalmus;
  • cough, manifested more often in a horizontal position;
  • fatigue with habitual physical exertion;
  • shortness of breath at first accompanies only during physical exertion, then sharply arises even at rest;
  • heart rhythm disturbances, manifested by atrial fibrillation;
  • difficulty breathing (dyspnea) at night.

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

Since the disease gradually worsens the hemodynamics of the heart, several stages are distinguished:

  • Stage 1 is characterized by minor hemodynamic disturbances. Diastolic dysfunction of the left ventricle of type 1 causes a slowed down process of the transition of chambers from systole to diastole, the main volume of blood enters the ventricle during relaxation of its chambers.
  • 2nd stage – the filling of the ventricle is carried out due to the pressure difference, since at this stage the pressure rises reflexively in the left atrium.
  • Stage 3 – the pressure in the left atrium remains high, while the left ventricle becomes stiff, losing the elasticity of the fibers.

Diastolic dysfunction of the left ventricle type 1 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 consult a doctor at the first manifestation of the symptoms of the disease.

To identify physiological changes and disorders of the hemodynamics of the heart, it is necessary to conduct a full examination, which includes several diagnostics:

  • Echocardiography with additional dopplerography is the most accessible and informative method for examining the cardiovascular system. Using it, you can quickly />

Using the above methods, the types of diastolic dysfunction of the left ventricle are also determined.

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Treatment of the disease

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

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

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 the necessary trace elements.

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

There are two types of dysfunction, namely diastolic and systolic. With a diastolic deviation from the norm of dysfunction, the inability of the myocardium to relax in order to get the necessary amount of blood appears. Usually only half is ejected. In its original form, diastolic function occurs in 15% of cases.

Ventricular dysfunction is divided into three types, namely:

  • Deviation of relaxation.
  • Pseudo-normal.
  • Restrictive.

With systolic deviation, a decrease in contractility of the main muscle of the heart system and a small amount of incoming blood to the aorta is characteristic. According to the observations of ultrasound (ultrasound), the reduction in the ejection of the fraction of the main criterion is more than 40%.

The heart is normal and with dysfunction

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.