Symptoms of left ventricular diastolic dysfunction and treatment options

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.

calendar_today April 27, 2016

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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.

Statistics note that a key factor in the formation of the disease is the failure of the myocardial function to properly receive and push blood. Due to the limited elasticity of muscle mass, some diseases can form: left ventricular myocardial hypertrophy, coronary heart disease, heart attack.

The disease can occur in both adults and newborns. In infants, increased blood supply to the lungs causes a number of complications:

  1. an increase in cardiac compartments in size;
  2. atria are overloaded;
  3. the ability of the heart muscle to contract is impaired;
  4. tachycardia develops.

The child does not always require special treatment, because the condition does not belong to the pathological.

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 myocardial hypertrophy (thickening).

The following diseases lead to myocardial hypertrophy:

  • hypertrophic cardiomyopathy;
  • hypertonic disease;
  • aortic stenosis (narrowing of the mouth of the aorta).

In addition, diseases such as can cause hemodynamic disturbances:

  • constrictive pericarditis – is a thickening of the pericardium, as a result of which there is a compression of the heart chambers;
  • primary amyloidosis – deposition of amyloid causes atrophy of muscle fibers and a decrease in myocardial elasticity;
  • pathology of the coronary vessels, leading to the development of chronic coronary 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 heart is increased, diastolic dysfunction of both ventricles is formed.

How is diastolic dysfunction of the left ventricle manifested?

Functional disorder of the diastole of the left ventricle may be asymptomatic for a long time before the onset of the first clinical symptoms. The following clinical signs of left ventricular diastolic dysfunction are distinguished:

  • heart rhythm failure (atrial fibrillation);
  • severe dyspnea, which manifests itself a couple of hours after falling asleep;
  • cough, which is worse when lying down;
  • shortness of breath, which at first appears only during physical exertion, and with the progression of the disease – and at rest;
  • fast fatiguability.

The human heart is represented by four chambers, whose work does not stop even for a minute. For relaxation, the body uses the spaces between contractions – diastoles. At these moments, the heart departments relax as much as possible, preparing for a new compression.

In order for the body to be fully supplied with blood, a clear, coordinated activity of the ventricles and atria is necessary. If the relaxation phase is disturbed, the quality of the cardiac output worsens, and the heart wears out rather without sufficient rest.

One of the common pathologies associated with impaired relaxation function is called “diastolic dysfunction of the left ventricle” (LAD).

Thus, a huge load falls on the left ventricle. If the 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 absorb blood: the cardiac cavity is either not completely filled, or this process is very slow.

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Development mechanism

Diastolic dysfunction of the left ventricle develops when at least one of the successive stages of enrichment of the heart chamber with blood during diastole is disrupted.

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

In its development, left ventricular diastole dysfunction goes through several stages. Each of them has its own distinctive features and is characterized by a different degree of danger.

This is the initial stage of the pathology. Diastolic dysfunction of the left ventricular chamber according to the 1st type corresponds to a slightly delayed relaxation phase.

Most of the blood enters the cavity during relaxation while contracting the left atrium. A person does not feel the manifestation of violations, obvious signs can be detected only by echocardiography.

This stage is also called hypertrophic, as it occurs against the background of myocardial hypertrophy.

  • Pseudonormal stage of moderate severity (type 2).

The ability of the left ventricle to relax is further impaired. This affects the cardiac output. To compensate for the lack of blood flow, the left atrium works in an enhanced mode.

This phenomenon is accompanied by increased pressure in this cavity and an increase in the size of the muscle wall. Now the saturation of the left ventricle with blood is provided by the pressure difference inside the chambers.

A person feels symptoms that indicate pulmonary congestion and heart failure.

  • The stage is restrictive, with a severe degree of disturbances (type 3).

The pressure in the atrium, located on the left, increases significantly, the walls of the left ventricle become denser, lose their flexibility. Violations are accompanied by severe symptoms of a life-threatening condition (congestive heart failure). Possible pulmonary edema, an attack of cardiac asthma.

It should distinguish between the concepts of “diastolic dysfunction of the left ventricle” and “left ventricular failure”.

In the first case, there is no obvious threat to the patient’s life if the pathology is at the first stage.

The aggravation of the condition can be avoided with adequate treatment of diastolic dysfunction of the cavity of the left ventricle of the 1st type. The heart continues to work almost unchanged, systolic function is not impaired.

This is a more serious disease, it is impossible to cure it, the changes are irreversible, and the consequences are deadly. In other words, these two terms relate to each other as follows: dysfunction is primary, and failure is secondary.

symptomatology

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

  • Heartbeats become more frequent both in an active state and in a calm state.
  • A person cannot take a deep breath, as if the chest were constricted.
  • Attacks of dry cough indicate the appearance of stagnation in the lungs.
  • Any minor effort is difficult.
  • Shortness of breath occurs both when moving and at rest.
  • More frequent attacks of nocturnal apnea are also an indicator of malfunctions in the left ventricle.
  • Another symptom is swelling of the legs.

Causes

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 changes;
  • gender factor (women are more susceptible);
  • abnormal condition of the coronary arteries;
  • inflammation of the pericardium of the constrictive type;
  • overweight;
  • diabetes;
  • heart defects;
  • heart attack.

Treatment

The essence of the treatment of diastolic dysfunction of the wall of the left ventricle is reduced to the restoration of blood circulation. To do this, you must:

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

List of the main drugs used for medicinal purposes:

  • adrenal receptor blockers;
  • 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 echocardiography, echocardiography, supplemented by Doppler study, ECG, laboratory tests.

    Diastolic dysfunction of the left ventricle is a pathology that requires careful attention. Untimely access to a doctor can turn out to be an unpleasant prognosis for a person: disability or death.

    People with a history of cardiac disease should be especially careful about their health. Together with the main drug therapy, it is recommended to treat myocardial dysfunction with home remedies.

    Traditional medicine recipes can be found in large numbers on the Internet.

    Ventricular myocardial dysfunction: causes, symptoms, treatment

    Diastolic myocardial dysfunction is not considered an independent disease. As a rule, this in itself is a sign of an already developing disease. This pathology leads to heart failure and is manifested by the following symptoms:

    • swelling of the legs;
    • high fatigue;
    • the appearance of shortness of breath even with little physical exertion. If manifested in a state of rest, then the disease has already passed into a serious form;
    • rapid heart rate;
    • the skin turns pale, especially for areas of the body that are distant from the heart.

    Coughing can also be attributed to one of the symptoms of heart failure. Most often, he appears at night, indicating a congestion in the lungs.

    The internal and external manifestations of diastolic dysfunction depend on many factors, in particular, on the state of the heart muscle, or rather, on the elasticity of the walls and the success of relaxation of the main muscle of the body.

    Factors Affecting Left Ventricular Relaxation

    If the diastolic function of the left ventricle is violated for one reason or another, then the filling pressure increases to maintain indicators of the produced blood volume, which is necessary for the normal functioning of the organs. As a result of a malfunction, as a rule, shortness of breath occurs, which indicates the presence of stagnation in the lungs.

    If the pathology is in the moderate phase, then the symptoms appear periodically, and the heart gradually returns to normal, however, in severe cases, the rigidity reaches such a great value that the atria cannot compensate for the required volume. Based on the clinical picture and the degree of damage, these types of left ventricular diastolic dysfunction are distinguished:

    • Type I – is mainly the result of age-related changes in the structure of the ventricles, manifesting itself in a decrease in the fraction of blood pumping and a general decrease in blood volume with a simultaneous increase in systolic volume. The most serious complication is the development of venous stasis, although secondary pulmonary hypertension is also a danger;
    • Type II (restrictive) – is accompanied by a serious increase in rigidity, causing a significant pressure gradient between the chambers at the initial stage of diastole, which is accompanied by a change in the nature of the transmitral blood flow.

    The cause and the correct diagnosis directly determines how quickly left ventricular diastolic dysfunction can be cured. The treatment of this pathology is primarily aimed at neutralizing provoking factors, as well as getting rid of the underlying disease of the cardiovascular system, for example, ischemic heart disease or hypertension.

    Sometimes, in order to restore the myocardium, a surgical operation is performed to remove the damaged pericardium, although most often the therapy is limited to taking medications, namely:

    • ACE inhibitors, ARB;
    • beta blockers;
    • diuretics;
    • calcium channel blockers, etc.

    In addition, to maintain the normal state of the “internal engine”, patients with impaired diastolic function are prescribed a diet with a limited amount of sodium, physical controls are recommended (especially if there is excess weight), and restrictions on the amount of fluid used are also established.

    Types of pathology and their severity

    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.

    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.

    Today, the following types of diastolic dysfunction of the left ventricle are distinguished:

    • I-th, which is accompanied by a violation of the relaxation process (its slowdown) of this chamber of the heart in diastole. The required amount of blood at this stage comes with atrial contractions;
    • II-nd, characterized by increased pressure in the left atrium, due to which the filling of the neighboring lower chamber of the heart is possible only due to the action of the pressure gradient. This is the so-called pseudo-normal type.
    • III-nd, associated with an increase in pressure in the atrium, a decrease in elasticity and increased rigidity of the walls of the ventricle (restrictive type).

    Functional violation of diastole in this chamber of the heart is formed gradually, and is divided into 4 degrees of severity: mild (type I disease), moderate (type II disease), severe, reversible and irreversible (type III disease).

    How to come for treatment

    Diagnosis of diastolic heart failure

    Diagnosis in the early stages 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 accessible and informative methods for verifying the diagnosis;
    • radionucl >

    When the diastolic function of the left ventricle is impaired, the muscle tissues of the myocardium lose their ability to relax at the time of diastole. As a result, the ventricle does not receive the necessary amount of blood. To compensate for its lack, the left atrium is forced to intensify its work, trying to absorb more blood.

    All this negatively affects the state of the atrium, gradually leads to overload, its increase in size.

    Against the background of systolic dysfunction, stagnation in the venous system and lungs can occur, which entails interruptions in the blood supply to all organs of the human body.

    The transition of this pathological condition to a more severe form can lead to the occurrence of chronic heart failure.

    Diastole is important, because thanks to it, the heart muscle receives the necessary oxygen, which is carried through the circulatory system through the coronary arteries.

    If she is unable to fully perform her tasks, the left ventricle suffers from oxygen deficiency. This leads to metabolic disorders in the tissues of the myocardium and ischemia.

    Prolonged ischemia is detrimental to cells, instead of which connective tissue is formed. This process is called sclerosis or fibrosis. An altered tissue structure causes a difficult contraction of the left ventricle. Ultimately, systole failure occurs.

    Classification

    The first type of disease is the most common. It is fraught with serious danger, since at the initial stage of development it proceeds practically without any symptoms. It is characterized by a decrease in the ability to distill blood into the ventricle from a paired blood vessel of the pulmonary trunk. The reason for this is the lack of elasticity of the walls of the myocardium.

    The second type of ailment manifests itself against the background of increased pressure from the left atrium, which leads to impaired diastole function. It is also called pseudo-normal.

    The most severe is the restrictive type of pathology, when there is a threat to human life, in connection with serious violations in the heart. In such situations, a heart transplant is usually performed.

    If a person has type 1 diastolic dysfunction of the left ventricle, edema, which is observed mainly in the evening, may indicate this. This condition is due to stagnation of fluid in the body. Swelling is usually noted on the lower extremities.

    In this case, the patient may complain of heart pain caused by myocardial ischemia. Often after physical activity shortness of breath appears. Diastolic dysfunction of the left ventricle of type 1 should not be ignored, it requires medical correction.

    At the initial stage of development, the disease may not even manifest itself. In the absence of proper treatment, it will progress, as a result of which the following signs of left ventricular diastolic dysfunction may appear:

    • shortness of breath at rest or after minor physical exertion;
    • increased heart rate;
    • feeling of tightness in the chest area and lack of oxygen;
    • swelling of the lower extremities;
    • bluish color of the skin;
    • fatigue;
    • heart pain.

    It is extremely rare for patients to have a cough that occurs in the evening. Its appearance indicates the presence of congestion in the lungs.

    The blood flow in the heart goes through 3 stages:

    • muscle relaxation (diastole);
    • slow filling of the left ventricle with blood, provided by the pressure difference inside the atria;
    • filling the left ventricle with the remaining blood after contraction of the heart.

    We are talking about diastolic dysfunction when there is any failure in such a debugged system. Pathology of this type can occur due to the presence of the following factors:

    • old age;
    • myocardial infarction;
    • impaired blood flow in the cardiovascular system;
    • overweight;
    • hypertension;
    • myocardial dysfunction.

    Deviations in the work of the heart provoke addictions in the form of smoking and drinking alcohol. Not the best way on the condition of the heart muscle affects the love of caffeinated drinks.

    According to experts in the field of medicine, the main provoking factor of this disease is the deterioration of the contracting and relaxing ability of the myocardium. This is usually due to the poor elasticity of its muscle tissue. This condition can lead to a number of diseases, including myocardial infarction, myocardial hypertrophy, and arterial hypertension.

    Diastolic dysfunction can also affect newborns. If the child has an increased blood supply to the lungs, this may cause that:

    • heart size will increase;
    • there will be an overload of the atria;
    • tachycardia appears;
    • heart contraction worsens.

    This condition is not considered pathological, therefore, it does not require special treatment if it occurs in children immediately after birth. But if the child suffered hypoxia, or was born ahead of schedule, such a problem can persist for two weeks.

    Treatment

    The diagnosis of “diastolic dysfunction of the left ventricle” of type 1, 2 or 3 is possible only after the patient has undergone a series of examinations. For this, it will be necessary to pass a general urine test, blood biochemistry. You may also need to check the functioning of the thyroid gland, kidneys, and liver.

    The most informative way to study in the presence of heart abnormalities is an ECG.

    The duration of the procedure is only 10 minutes. During it, electrodes are attached to the patient’s chest area, which read the necessary information. It is important that the body is relaxed, and breathing is calm. The study is recommended after 2-3 hours after eating.

    Only after receiving the results of a comprehensive examination, the doctor makes a diagnosis and determines the further treatment tactics. The main objectives of therapy are as follows:

    • normalize heart rate;
    • prevent the occurrence of arrhythmias;
    • cure coronary heart disease;
    • to stabilize the pressure.

    Beta-blockers are used to normalize heart rate, which are represented by drugs such as Concor and Atenoll. Heart ischemia is treated with nitrates. Blood pressure allows you to normalize diuretics such as “Hypothiazide” or “Spironolactone.”

    With diastolic dysfunction, ACE inhibitors are also indicated. Their action is aimed at normalizing pressure. They are usually prescribed for hypertensive patients. Inhibitors, in addition to reducing pressure, protect the heart and contribute to the relaxation of the walls of the myocardium. The drugs of this group include Captopril and Fosinopril.

    For preventive purposes, the doctor may recommend taking “Aspirin Cardio.” With its help, blood is diluted, due to which the risks of clogging of blood vessels are minimized.

    Forecast

    Diastolic dysfunction of the left ventricle of type 1, in the vast majority of cases, has a favorable prognosis, which cannot be said about the transition of the disease to a restrictive form.

    It is accompanied by high pressure in the atria and is complicated by concomitant heart failure. The forecast in this case is not always comforting.

    To cope with the pathology, a heart transplant may be required.

    Cases of re-hospitalization of patients with a diagnosis of diastolic dysfunction are 50%. Mortality in this pathology is 3-7% per year.

    The diet should be dominated by fresh vegetables, lean meats, cereals, and dairy products. Dishes will be more useful if they are steamed or baked in the oven.

    It is also necessary to completely abandon fried and spicy foods, alcohol, and smoking.

    Diagnosing the disease at an early stage will help to avoid irreversible changes.

    To establish a diagnosis, as a rule, three conditions are necessary:

    • the manifestation of symptoms and signs of heart failure;
    • systolic function of the drug is normal or slightly reduced;
    • with instrumental diagnostic methods, LV malfunctions are detected, its rigidity is increased.

    Diagnosis in the early stages helps to prevent irreversible changes in the heart

    The main instrumental diagnostic methods include:

    • two-dimensional echocardiography with dopplerography is one of the most effective methods for determining the diagnosis;
    • radionuclide ventriculography will determine the failure of the myocardial contractility function;
    • Echocardiography reveals signs of myocardial ischemia;
    • chest x-ray will determine pulmonary hypertension.

    How can a disease be detected?

    If the diastolic function of the left ventricle is impaired and the disorder is detected in the early stages, then in this case the development of irreversible changes can be prevented. Diagnosis of this pathology is carried out by such methods:

    • two-dimensional echocardiography in combination with dopplerography, allowing to obtain a real-time image of the myocardium and evaluate its hemodynamic functions.
    • ventriculography using radioactive albumin to determine the contractile function of the heart in general and the desired chamber in particular;
    • ECG, as an auxiliary study;
    • chest x-ray to determine the first symptoms of pulmonary hypertension.

    The method of treatment of the disease

    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.

    How is a functional disorder treated?

    As already noted, diastolic dysfunction of the left ventricle, the treatment of which depends on the type of disease, is primarily reflected in the processes of hemodynamics. Therefore, the treatment plan is based on the correction of violations of this process. In particular, regular monitoring of blood pressure, heart rate and water-salt metabolism is carried out, with their subsequent correction, as well as remodeling of myocardial geometry (reducing thickening and returning the walls of its chambers to normal).

    Among the drugs that are used to treat functional diastole disorders in this heart department, the following groups are distinguished:

    • adrenergic blockers;
    • drugs to improve the elasticity of the heart muscle, reduce pressure, reduce preload and contribute to myocardial remodeling (sartans and inhibitors and ACE);
    • diuretic drugs (diuretics);
    • drugs that reduce the level of calcium in the cells of the heart.

    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.

    Evidence

    Diastole dysfunction may be asymptomatic for a long time before it begins to manifest clinically. The following symptoms are characteristic of such patients:

    • shortness of breath that occurs during physical exertion, then at rest;
    • cough worse in horizontal position;
    • reduced exercise tolerance, fast fatigue;
    • palpitations
    • paroxysmal night dyspnea;
    • rhythm disturbances are often present (atrial fibrillation).

    Diastolic dysfunction: causes, symptoms, diagnosis and treatment

    ”Alt =” ”>

    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 rigidity.

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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.

    Detonic