Toxic cardiomyopathy: what is it and how to fight it
The causes and mechanism of development of toxic cardiomyopathy
Toxic cardiomyopathy is a myocardial pathology in which occur the anatomic and functional changes of the heart muscle. Thus the coronary arteries (the arteries and veins that feed the heart) are not subject to defeat. No structural changes are the valves of the ventricles and Atria, blood pressure rises.
The disease is inflammatory in nature. Develops in patients, regardless of their gender and age. When examining the ECG detects changes in heart rhythms, which indicate the rapid development of circulatory failure. In consequence decompensating mechanism of the heart is increased in size.
Causes of toxic injury to the heart muscle
Toxic cardiomyopathy develops due to exposure to toxic substances. Chemical elements can lead to disease:
In chronic alcoholism prolonged exposure to ethanol on the heart muscle also contributes to the development of pathology.
There are a number of infectious diseases, which affects the myocardium. As a rule, the signs of cardiomyopathy occur in a few months or years after the disease:
- typhoid and typhus;
- scarlet fever;
- parasitic infestation.
Also, the disease develops in people with drug dependence, in long-term care drugs. There is information that cardiomyopathy can occur due to chronic deficiency of vitamins of group B.
In some cases, the cause of the disease may be an increase in production in the body catecholamines – neurotransmitters, biologically active substances (serotonin, epinephrine, norepinephrine, dopamine).
The causes of the disease include inflammation in the pregnant woman’s body. As a result of influence of an infectious agent at birth a child is diagnosed with congenital cardiomyopathy.
The mechanism of the disease
As a result of violations of metabolic processes in the myocardium increases the heart chambers (ventricles and Atria). She hypertrophied heart muscle and increases in size. If the normal mass of the heart is from 250 to 500 g, when cardiomyopathy its weight can increase up to 1 kg.
Also thickened endocardium – the membrane that lines the chambers of the heart from the inside. In the myocardium observed in fibrotic foci.
Cardiomyocytes (myocardial cells) acquire an irregular shape, an uneven. Happens focal replacement of muscle tissue to fat. Fixed intracellular edema. Transverse striations of the myocardium is smoothed.
Signs of toxic cardiomyopathy
For pathology is characterized by a chronic blood disorder. This is expressed such complaints from patients:
- fatigue even with mild exercise;
- decreased performance;
- shortness of breath when walking and at rest;
- asthma attacks are similar to cardiac asthma.
Of the objective signs observed in patients with acrocyanosis (blue skin tone). Shortness of breath increases if the person takes a horizontal position (lying). Therefore, patients are forced to reside in a seated position, with raised head Department on a functional bed.
Minor movements of the swell neck veins. Because of the impaired circulation of the fluid not sufficiently excreted from the body. Patients often swollen lower limbs. In the most severe cases develops ascites – accumulation of fluid in the abdominal cavity. The liver is enlarged, recurrent, or continuous pain in the right hypochondrium.
Total defective blood circulation when listening to the heart is determined by such symptoms:
- muffled heart sounds;
- rhythms on the type of canter;
- systolic murmur.
In patients detected by the main symptom of chronic cardiac changes, cardiomegaly. This change all parameters of heart weight, volume, size and projection chest.
All patients with toxic cardiomyopathy suffer from cachexia – extreme exhaustion, characterized by such symptoms:
- painful, unnatural thinness;
- the decrease in body mass index – the disparity of height and weight;
- slow physiological processes in the body;
- General weakness, apathy;
- mental changes, emotional instability, frequent depression, disturbance of consciousness.
Symptoms in children
Infectious-toxic cardiopathy in children develops as a complication resulting from acute infectious diseases.
The reasons for the development of cardiomyopathy in childhood:
- General infection – mumps, encephalitis, polio.
- Septic processes in the body.
- Chronic disease with frequent exacerbations and relapses – sinusitis, tonsillitis.
In young children the disease may occur as a result of oxygen deficiency and metabolic disorders in viral infections.
Due to poor circulation pale skin. Children are listless, sluggish, inactive. Babies may lag in physical development from their peers. Heart palpitations, the severity of the veins of the neck and face. Blood pressure is lowered. The pulse on the ulnar or subclavian Vienna felt weak. The amount of produced urine per day reduced.
Babies often develops collapse – the sudden and rapid development of cardiovascular failure, which leads to loss of consciousness. Her previous features:
- cold and moist skin to the touch, marble color;
- cold hands and feet due to the outflow of blood;
- severe weakness;
- high heart rate;
- chills, decreased body temperature;
- the sluggish reaction of pupils to light.
The kids have a loss of consciousness is preceded by tremors of the fingers, twitching of the limbs and body. Symptoms of disease of the heart muscle – chest pain.
Diagnosis of cardiomyopathy
Mandatory prescribed laboratory tests of blood and urine.
In General, the analysis of blood no changes until then, until the inflammatory complications and formation of microscopic clots. Only in this case will change parameters of creatinine, electrolytes, thrombin time.
According to the testimony conduct biochemical research of blood. Consider urea, hormones and protein.
Instrumental methods of diagnostics:
- ECG – electrocardiogram 1-2 times a day. Detected conduction and heart rhythms. The results of the study should not be myocardial ischemia (decreased blood supply).
- X-rays of all the chest. Helps to determine the stagnation of venous blood in the pulmonary circulation, the ratio of the size and borders of the heart against the thorax.
- Coronary angiography coronary vessels examination, prescribed for the purpose of confirmation or exclusion of coronary heart disease.
- Radionuclide ventriculography – to assess cardiac function and myocardial contractility.
Also prescribed for the patients endomyocardial biopsy. This method allows to give a precise morphological assessment of the condition of the tissues of the heart. The indications for the procedure:
- progressive cardiovascular insufficiency, the cause of which cannot be ascertained;
- cardiomyopathy of unknown etiology;
- a heart rhythm disorder;
- the toxic destruction of the myocardium;
- heart damage after long-term treatment with cytostatic drugs for chemotherapy.
For differential diagnosis it is important to exclude such diseases are: ischemic heart disease (coronary artery disease), hypertension, valvular heart disease congenital or acquired, chronic alcoholism, pericarditis, rheumatism.
Treatment toxic cardiomyopathy
Patients are strongly advised to limit any physical activity. You should also reduce the amount of salt per day. Drug treatment is complex and includes several areas.
To reduce edema, improve renal function and excretion of accumulated fluid in the body prescribed diuretics – furosemide, gidrokhlorisiazit, ethacrynic acid, spironolactone (retains potassium in the body).
Regardless of the stage of heart failure all patients are prescribed ACE inhibitors. It’s the drugs that are prescribed for the treatment of heart failure and kidney failure – carvedilol, metoprolol, bisoprolol, nadolol, timolol, and nebivolol.
Peripheral vasodilators – drugs that affect the blood flow in small vessels (arterioles and venules).
For the prevention and relief of thickening of blood and blood clots patients are prescribed indirect anticoagulants – singular, warfarin, and fenilin, dicoumarin.
Criteria for successful treatment of patients:
- The reduction or disappearance of subjective signs of heart failure is shortness of breath and asthma, increase physical activity, eliminate the symptoms of the excess fluid in the body.
- Significantly improves the quality of life of the patient.
- Reduced the number of subsequent hospitalizations.
Cardiomyopathy is a serious disease that often give complications. People develop persistent heart failure, impaired function of the valves. Appears arrhythmia and permanent swelling of the legs.
Risk factors of sudden death:
- the age of 16;
- genetic predisposition (cases of sudden death were in the family);
- a sharp change in blood pressure during exertion;
- frequent fainting.
Ifection-toxic cardiopathy in General has a poor prognosis. Survival in 70% of cases is 5 years. Sudden death dying every second patient. If the disease diagnose at an early stage, it gives a chance to the patient under constant observation and treatment to live a long life. People with a diagnosis of «cardiomyopathy» should be observed every 2 months. Almost all patients incapacitated and are transferred to disability status.