What is type 1 diastolic dysfunction of the left ventricle

Diastolic dysfunction of the left ventricle of the 1 type is caused by a drop in the ejection fraction, which further leads to a marked decrease in stroke volume. To prevent stagnation of blood in the lungs and compensate for dilatation, an increase in the systolic volume of the ventricle begins. If such a protective reaction of the body does not follow, then there is a clear threat of pulmonary hypertension (repeated), and the load on the other ventricle (right) also increases significantly, which subsequently leads to a decrease in its volume. As a result of diastolic pressure, venous hyperemia may occur. If acute dysfunction occurs, pulmonary edema easily develops.

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

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.

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.

Features of diagnosis and treatment

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.
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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.

    • What it is?
    • Classification
    • Treatment
    • Forecast

    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.

    Evidence of deviation

    This condition very often leads to the development of secondary pulmonary arterial and venous hypertension. This pathological condition can manifest itself in the following:

    • persistent cough (often paroxysmal);
    • night dyspnea (paroxysmal);
    • dyspnea.

    What other signs determine the diastolic dysfunction of the left ventricle 1 type? Symptoms of such a deviation can not manifest a large amount of time. However, with the development of the disease, patients begin to observe signs such as:

    • regular pains in the heart, which are paroxysmal in nature (as in ischemic disease);
    • swelling of the lower extremities;
    • shortness of breath (may occur even at rest);
    • spastic phenomena;
    • feeling short of breath.
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    With such signs, you should definitely consult your doctor. Indeed, the sooner this pathological condition is revealed, the easier it is to take control. If the presented disease is detected too late, then its treatment will last a very long time, with the use of a large number of drugs and all the necessary procedures.

    Ventricular myocardial dysfunction: causes, symptoms, treatment

    Two-dimensional echocardiographyThis procedure is the main character during the examination.
    ElectrocardiographyRefers to additional procedures that have the ability to detect myocardial hypertrophy
    Radionuclide VentriculographyIt is used for inferior informational content of echocardiography.
    Chest x-rayTo identify lung complications

    It is worth saying that diagnosis in the early stages of the disease helps prevent unwanted consequences.

    ECG is used as an auxiliary diagnostic examination

    Important! When conducting therapeutic measures, not only medical therapy is used, but also auxiliary, which completely corrects the lifestyle. Without this complex, the effectiveness of the result is reduced by an order of magnitude.

    1. adrenergic blockers (heart rate and blood pressure are adjusted);
    2. diuretics (positively affect the elimination of shortness of breath);
    3. inhibitors (effect on myocardial elasticity);
    4. calcium antagonists (these drugs are preferred if intolerance to adrenergic blockers occurs);
    5. nitrates (additional drugs).
    • overweight solution;
    • the use of proper nutrition;
    • rejection of bad habits;
    • balanced physical activity.

    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 to cure?

    Currently, a single treatment regimen that would be recognized by a majority of specialists does not exist. This is partly due to the fact that the disease is poorly difficult to diagnose. As mentioned above, such a deviation is asymptomatic for a very long time, as a result of which the patient seeks medical help too late.

    So what to do if you have a 1 type left ventricular dysfunction? The treatment of such a disease is reduced to the elimination of causes that provoke negative trends. Thus, patients need to:

    • cure existing ischemia;
    • do normal heart rate;
    • lower blood pressure.

    In addition, upon detection of such a pathological condition, the patient is prescribed drugs of the ACE blocker group. Most often, the choice of specialists falls on Lizonopril. It is prescribed in the form of tablets of 20-40 milligrams per day (in two divided doses).

    Good results in the treatment of this deviation can be achieved through the use of calcium blockers. Thus, both drug groups lower blood pressure, significantly reduce the oxygen demand of heart tissues, and also stop and reduce left ventricular hypertrophy. By the way, due to the intake of these drugs, the work of the diastole of the heart improves, which further leads to the normalization of hemodynamics.

    The best results of the treatment of such a disease were observed with a combination of potassium-saving diuretics with cardiac drugs. If absolutely necessary, other antihypertensive drugs may be used.

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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.

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