Ischemic heart disease

It is a disease without specific clinical events, but with undoubted ECG signs of scarring after myocardial infarction or signs of ischemic cardiac muscle.

Common causes of disorders: 

• occlusion of coronary arteries - atherosclerosis, arteritis,

• narrowing the mouth of the coronary arteries - syphilitic aortitis,

• heart defects that reduce cardiac output - aortic stenosis, mitral stenosis, rarely,

• a sudden drop in blood pressure in the aorta - a state of shock, massive pulmonary embolism,

• reduction of O2 in the blood - anemia, hypoxia in pulmonary insufficiency.

Syphilitic aortitis may also lead to ischemic heart disease due to narrowed coronary mouth. Detection of aortic insufficiency and other signs of late syphilis indicate the correct diagnosis.

Polyarteritis nodosum, or narrowing of coronary arteries  obliteran smay create a clinical picture of ischemic heart disease. The varied symptomatology, and biopsies of skin and muscle can not solve the real nature of the disease.

The gradual narrowing of the coronary arteries leads to the formation of collateral circulation, which plays an important role in the further course of disease and the consequences.

CARDIOMYOPATHIA

• Introduction • Symptoms • Diagnosis and Forecast

Introduction

Under the name implies cardiomyopathy is a primary myocardial disease, which can monitor and endocardial disease, and to exclude secondary diseases: congenital heart defects, coronary insufficiency, arterial hypertension and rheumatic valvular defects or nonrheumatic nature.

Described under various synonyms, such as cardiomyopathy unspecified nature, congestive cardiomyopathy, constrictive cardiomyopathy, idiopathic cardiomyopathy, obstructive cardiomyopathy, endocardial fibrosis, familial hypertrophic cardiomyopathy, a hidden African cardiomyopathy (Becker type), etc..

Types of diseases

The variety of synonyms indicates the still insufficient knowledge and systematization of these diseases.

Recently, the disease in this group is trying to introduce the distinction:

• Symmetrical and

• Asymmetric cardiomyopathy

In that last allocated this local damage of the myocardium, in terms of hypertrophy, localized in the output of the aorta as described subaortic hypertrophic stenosis.

Symptoms and diagnosis

Symptoms appear between thirty and fifty years of age, although quite often occur in early adolescence.

The initial symptoms were mainly dyspnea on effort and the occurrence of heart failure.

Signs

Quiet tones, galopni rhythm, usually without a heart murmur. In some cases it can be heard at the top or mouth of the tricuspid systolic murmur of varying intensity.

The signs of venous stasis: the swollen veins in the neck, enlarged liver and edema.

In the subacute form of hypertrophic stenosis of the characteristic finding of the sharp systolic ejectional forest type, localized between the top of the heart and the sternum, followed by systolic fremissementom.

Rtg heart

Indicates an increase in whole heart.

ECG

It shows the different nature of the rhythm disorders: atrioventricular block, ectopic rhythms, atrial fibrillation and the like.

There are usually signs of left ventricular hypertrophy, with changes in T wave, which is flattened or negative.In addition, there is a bundle branch block, and often low QRS complex.

Cardiac catheterization

Cardiac catheterization showed a fixed low cardiac output, increased arteriovenous difference oxygenated blood, increasing end-diastolic and mean systolic pressure in the right chamber, increasing the value of the intermediate pressure in the pulmonary artery. The characteristic curve of the right ventricle, showing the sudden disappearance of the ejection phase and lowering postsistolic curves as in pericarditis.

Venous pressure is increased.

Angiocardiography

Angiocardiography shows an increase of cavities of the heart. It is not typical.

Biochemical analysis

Not characteristic. There may be changes in electrolytes and in other diseases with chronic heart failure.

Histopathological Findings

In order to confirm or exclusion, diagnosis is sometimes necessary to do a biopsy of the heart. Usually this is done via thoracotomy. Histopathological findings showed mostly hipetrophy and myocardial fibrosis.

Functional characteristics of

Because of diffuse myocardial damage myocardial effective propulsive force is reduced. There is a small output, causing a delay in the left, and consequently that in the right chamber, with an increase in venous pressure and delay in venous circulation - stagnans heart failure.

Forecast

The prognosis is bad.  The disease and leads to death. Treatment is symptomatic.

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