Postinfarction cardiosclerosis

Description:

Postinfarction (postnecrotic) cardiosclerosis – the damage of a myocardium caused by substitution of the died myocardial fibers connecting fabric that leads to disturbance of functioning of a cardiac muscle. In cardiology the postinfarction cardiosclerosis is considered as the ischemic heart disease independent form, along with sudden coronary death, stenocardia, a myocardial infarction, disturbance of a cordial rhythm, heart failure. The postinfarction cardiosclerosis is diagnosed in 2 — 4 months after the postponed myocardial infarction, i.e. after completion of processes of scarring.

Reasons of a postinfarction cardiosclerosis:

Owing to a myocardial infarction the focal necrosis of a cardiac muscle which recovery happens due to growth of cicatricial and connecting fabric (cardiosclerosis) is formed. Cicatricial sites can have various size and localization, causing character and extent of disturbance of cordial activity. Neogenic fabric is not capable to carry out sokratitelny function and to carry out electric impulses that leads to decrease in fraction of emission, disturbance of a cordial rhythm and endocardiac conductivity. The postinfarction cardiosclerosis is followed by dilatation of cameras of heart and a hypertrophy of a cardiac muscle with development of heart failure. At a postinfarction cardiosclerosis cicatricial processes can affect also valves of heart.
Except a myocardial infarction, the myocardial dystrophy and injuries of heart can lead to a postinfarction cardiosclerosis, however it happens much less often.

Symptoms of a postinfarction cardiosclerosis:

Clinical manifestations of a postinfarction cardiosclerosis are caused by its localization and prevalence in a cardiac muscle. The more the area of connecting fabric less than the functioning myocardium, the is more probable development of heart failure and arrhythmias.
At a postinfarction cardiosclerosis of patients the progressing short wind, tachycardia, decrease in tolerance to an exercise stress, an orthopnea disturbs. Paroxysmal attacks of night cardiac asthma force to wake up and accept vertical position - sitting an asthma disappears 5-20 minutes later. Otherwise, especially at the accompanying arterial hypertension, the acute left ventricular failure – a fluid lungs can develop. Similar states at patients with a postinfarction cardiosclerosis can develop against the background of a heavy attack of spontaneous stenocardia. However the pain syndrome as stenocardia is present not always and depends on a condition of coronary circulation of the functioning departments of a myocardium.
In case of right ventricular insufficiency there are hypostases on the lower extremities, a hydrothorax, a hydrocardia, a Crocq's disease, swelling of cervical veins, a hepatomegalia.
Disturbances of a rhythm and endocardiac conductivity can develop even at formation of the small sites of a postinfarction cardiosclerosis mentioning the carrying-out system of heart. Most often different blockade are diagnosed for patients with a postinfarction cardiosclerosis a ciliary arrhythmia, ventricular premature ventricular contraction. As dangerous manifestations of a postinfarction cardiosclerosis serve Bouveret's ventricular disease and a total atrioventricular block.
Adverse predictive sign of a postinfarction cardiosclerosis is formation of the chronic aneurism of a left ventricle increasing risk of a thrombogenesis and tromboembolic episodes, and also a rupture of aneurism and a lethal outcome.

Diagnosis:

The algorithm of diagnosis of a postinfarction cardiosclerosis includes the analysis of the anamnesis, carrying out an electrocardiography, ultrasonography of heart, a ritmokardiografiya, PET of heart, coronary angiography, etc.
Physical inspection at a postinfarction cardiosclerosis reveals the shift of an apical beat to the left and down, easing of the first tone on a top, sometimes – a cantering rhythm and systolic noise on the mitral valve. At a X-ray analysis of bodies of a thorax moderate increase in heart is defined, it is preferential at the expense of the left departments.
Data of an ECG are characterized by focal changes after the postponed myocardial infarction (in the absence of increase in activity of enzymes), and also diffusion changes of a myocardium, a hypertrophy of a left ventricle, blockade of legs of a ventriculonector. For detection of passing ischemia load tests (a veloergometriya, the tredmil-test) or holterovsky monitoring are used.
Informational content of an echocardiography concerning a postinfarction cardiosclerosis is extremely high. The research finds chronic aneurism of heart, dilatation and a moderate hypertrophy of a left ventricle, local or diffusion disturbances of contractility. At a ventrikulografiya the disturbance of the movement of shutters of the mitral valve testimonial of dysfunction of papillary muscles can be defined.
By means of heart positron emission tomography at a postinfarction cardiosclerosis the resistant centers of hypoperfusion, quite often multiple come to light. For the purpose of assessment of a condition of coronary circulation at patients with a postinfarction cardiosclerosis coronary angiography is carried out. At the same time the X-ray pattern can vary from not changed coronary arteries before three-vascular defeat.

Treatment of a postinfarction cardiosclerosis:

As the purposes of conservative therapy of a postinfarction cardiosclerosis serve delay of progressing of heart failure, disturbances of conductivity and a heart rhythm, prevention of growth of connecting fabric. The mode and a way of life of the patient with a postinfarction cardiosclerosis has to provide restriction of exercise and emotional stresses, a dietotherapy, constant reception of the medicamentous drugs appointed by the cardiologist.
For treatment of a postinfarction cardiosclerosis APF inhibitors (энап, капотен), nitrates (Nitrosorbidum, kardikt, изомонат, monopoppy), b-adrenoblockers (propranolol, атенолол, метопролол), dezagregant (acetylsalicylic acid), diuretics, drugs of metabolic action are used (inosine, Pananginum. ATP, etc.)
At heavy disturbances of a rhythm and conductivity implantation a cardioverter defibrillator or an electrocardiostimulator can be required. At the angina of exertion remaining after a myocardial infarction after performance of coronary angiography (KT-coronary angiography, multispiral KT-coronary angiography) indications for AKSh, angioplasty or stenting of coronary arteries are defined. When forming aneurism of heart its resection in combination with aortocoronary shunting is shown.