Aneurysm of the heart: how to recognize, treat with and without surgery

Aneurysm of the heart is a very dangerous pathology, consisting in the appearance on any of the cardiac walls or partitions of a weakened limited area of muscle tissue that is unable to resist the pressure of the blood and begins to swell outward or alternatively swell and fall alternately depending on the phase of the cardiac cycle.

[1], [2], [3], [4]

Diagnostics of the aneurysms of the heart

The formation of a cardiac aneurysm may be accompanied by the appearance of the following symptoms:

• an unusual weakness due to stagnant phenomena in the heart, as a result of which it pumps an insufficient amount of blood, which means that the nervous system and muscles are deficient in the oxygen they need, coming to them with blood,
• paroxysmal pain behind the breastbone (there are not always any),
• Increasing or slowing the pulse (more than 100 or less than 60 beats per minute),
• beaten heart rate with short-term stops,
• violation of the respiratory rhythm, called shortness of breath,
• pale shade of the skin (especially on the face and extremities), which is typical for heart pathologies, in which there is a violation of the blood supply of tissues,
• dry, non-expressed cough due to compression of the lung (with large aneurysms),
• sensation of a strong heartbeat due to impaired rhythm or increased contractions of the heart muscle (characteristic of an aneurysm of the left cardiac ventricle).

But the cunning of an aneurysm of the heart is that the above symptomatology can be present in full (with large aneurysms), partially or absent altogether. The latter not only makes diagnosis difficult, but also leads to the fact that doctors discover an aneurysm by chance, when it reaches already considerable sizes and its treatment becomes difficult.

It is difficult to blame doctors, because they are guided first of all by patients' complaints. But if the patient does not worry about anything, it's unlikely that he will want to go through an expensive examination just in case, suddenly something will come out.

In the overwhelming majority of cases, doctors have to deal with a diffuse form of aneurysm of small and medium size. The course of the disease in this case is not overshadowed by unpleasant and disturbing symptoms. Patients, not feeling sick, sometimes treat their disease lightly, allowing themselves to miss preventive examinations at the cardiologist.

Patient examination

But these are all nuances. In practice, when a patient comes to the doctor with or without complaints, the diagnosis of an aneurysm of the heart begins with a physical examination, and then the patient is offered to undergo further examination. If a person first turns to the therapist with disturbing symptoms, then later, if he suspects heart disease, he will be redirected to a cardiologist who will continue the examination, diagnose and, if necessary, prescribe appropriate treatment.

During the physical examination of the patient, the doctor conducts 4 mandatory procedures: palpation, percussion, ascultation and measurement of blood pressure.

Palpation with an aneurysm of the heart is justified by the fact that in most cases the aneurysm itself is located either on the anterior wall or in the apex of the left ventricle located in the immediate vicinity of the anterior wall of the thorax. During palpation, the doctor can feel the difference between the pulsation of a healthy part of the heart and an aneurysm (the so-called rocker symptom).

The blows of the upper part of the left ventricle about the chest wall are called apical thrust, which is determined only in 70% of healthy people. But here the role is played not only by the presence of the push itself, but also by its diameter. Aneurysm can be indicated by the appearance of an apical impulse, if it has not previously been felt, and an increase in its diameter (over 2 cm). In addition, the force of a thrust with an aneurysm is markedly reduced.

Percussion is nothing more than tapping a thorax with a finger to reveal the boundaries of the heart. In the area of aneurysms of considerable size, the boundaries will be somewhat shifted, and the sound in this area will be deaf.

Auscultation is listening to sounds in the heart with a stethoscope. An aneurysm can be indicated by noise during systole and so-called "murine" noise, when blood flows through the mouth of an aneurysm.

The measurement of blood pressure is relevant for various pathologies of the cardiovascular system. In the case of an aneurysm of the heart, blood pressure is usually elevated, and the prognosis of the disease depends to a large extent on the value of the BP indices.

During the physical examination of the patient, the doctor may find some signs indicating a possible development of an aneurysm. This gives him every reason to prescribe a more in-depth instrumental examination.

[5], [6], [7], [8], [9]

Instrumental diagnostics

The main methods of instrumental diagnostics for aneurysm of the heart include:

• Electrocardiography. Yes, such a widely used and fairly old diagnostic method as ECG in case of cardiac aneurysms has been one of the leading places for many years. Thanks to its universality and cheapness, anyone who cares, how his heart works can pass the examination.

The device registers the conductivity of bioelectric impulses in various parts of the heart muscle, which makes it possible not only to detect the appearance of an aneurysm, but also to determine its location.

ECG is necessarily performed for some time after myocardial infarction, which is a frequent cause of aneurysm. If there is a lack of normal dynamics during the first month (frozen cardiogram), a jump in the segment of the ST segment, a lack of the last negative tooth (denoted as T), signs of cardiac arrhythmia, this is likely to indicate an acute or chronic development more than 1.5 months) aneurysms.

• Echocardiography, which is otherwise called ultrasound of the heart. This method is considered the main diagnostic method for aneurysm of the heart, because it allows you to diagnose with 100% accuracy.

Due to the reflection of ultrasonic waves from barriers of different density, one can obtain on the screen a picture of the heart in the form of a simple or three-dimensional picture.

Thanks to this method, it is possible to visually assess the aneurysm (size and configuration), and also to reveal the coronaries inside it. Moreover, even small aneurysms can be revealed in thin sections of the myocardium and lagging behind the normal rhythm of the heart. You can see even small aneurysms that are visualized only in the phase of systole, and blood in the cavity of the heart bag. By echocardiography, it is possible to estimate the width of the isthmus (to exclude a false aneurysm), the work of the heart valves, the size and volume of the ventricles and atria, and the characteristics of the blood flow.

• PET scintigraphy of the myocardium, based on the introduction of a contrast agent into the bloodstream, which does not accumulate in the aneurysm cavity (or, conversely, accumulates only in this area), which makes it easy to detect a weakened region of the heart. This method is considered more complicated and expensive, besides it gives less information than ultrasound, so it is resorted to much more rarely.

To determine the viability of the affected area of the myocardium, this method can be used in parallel with stress echocardiography, when artificially creates a stressful situation due to the introduction of drugs or under the influence of physical exertion.

• Radiography, which is used only in cases where there is no way to conduct a more informative study. An x-ray picture will show the boundaries of the heart and large aneurysms, while the small ones will remain unnoticed. According to the results of the examination, one can see an increase in the size of the heart and stagnation in the small circle of the circulation.

In addition, the following studies can be assigned to a patient:

• Ventriculography (X-ray examination of the ventricles of the heart with the use of contrast agents).
• MSCT or MRI of the heart (scanning the heart with X-rays or radio waves).
• Probing the cavities of the heart with a cardiac catheter.
• Coronary angiography (assessment of blood flow).
• Electrophysiological study (EFI) of the heart.

In addition, the patient is assigned certain types of tests, such as general and biochemical blood tests (for necrosis markers present in myocardial infarction), a general urine test for diagnosing possible co-morbidities.

ECG with aneurysm of the heart

Since the method of electrocardiographic research is very popular with various diseases of the cardiovascular system, it makes sense to dwell on it in more detail. Let this method does not give a 100% guarantee of an aneurysm of the heart, but it allows to reveal violations in the work of the heart, which in itself is an occasion for a more thorough examination of the patient and further observation of it by a cardiologist.

The ECG procedure is inexpensive, but available in virtually all hospitals and clinics. A cardiogram person immediately gets in his hands, though, the decoding of the results will have to be entrusted to an experienced therapist or cardiologist, since for a non-professional they do not carry any useful information.

Indications for the procedure can be a suspicion of the pathology of the cardiovascular system, and examination in connection with diseases of the nervous system, various internal organs, skin, etc. It is also carried out with preventive examinations of patients who are registered with a cardiologist, as well as with complaints about the work of the heart.

Sometimes carrying out an ECG with the interpretation of the results requires professional activity. Then this item is included in the form of the medical examination.

ECG is recommended to be performed before surgery, especially if anesthesia is required.

With an aneurysm of the heart, the ECG is performed as usual. The patient undresses to the waist and releases the lower part of the legs from the clothes. After this, he lies on the couch, and the doctor fastens several electrodes to the body in the region of the heart, hands and lower legs, ensuring their full fit. The device records electrical impulses from electrodes located in different parts of the body and records them on paper.

The medical officer conducting the procedure tells the patient when it is necessary to breathe calmly, and when it is necessary to hold your breath.

The ECG is considered one of the safest and most affordable procedures that can not harm the body. The patient is not subjected to irradiation or high current force, so even the skin is not affected, let alone the internal organs.

Changes on the cardiogram enable the doctor to see how the patient's heart works and how violent and dangerous his work is.

[10], [11], [12], [13], [14], [15], [16], [17], [18], [19]

Differential diagnosis

Since the clinical picture of the heart aneurysm is very blurred, and its symptoms may indicate both the aneurysm itself and other diseases, it is necessary to carefully study the results of the conducted studies and compare them with the picture that is observed in other pathologies with similar symptoms.

Differential diagnosis for aneurysm of the heart is carried out with the following pathologies:

• A cystic pericardial cyst, when a thin-walled "sac" with liquid contents forms on the pericardium, which can burst and cause purulent processes in the heart.
• Myortic heart disease. In other words, it is a defect of the mitral (bivalve) valve that connects the left atrium and the ventricle, which affects the blood flow. Narrowing of the mitral valve causes symptoms similar to aneurysm of the heart.
• Tumor processes in the mediastinum. If the tumor is located near the heart, it can distort the information that the doctor receives when palpating and tapping. But her symptoms may indicate an aneurysm of the heart: shortness of breath, cough, chest pain, weakness, etc.

Usually the situation is clarified by radiography and tomography of the heart, which help to identify other pathologies, even those that are not directly related to the work of the heart. The final diagnosis is made by the doctor based on the results of the physical examination of the patient and the studies carried out after this.

Treatment of the aneurysms of the heart

Drug therapy is relevant if it is a diffuse flat aneurysm, which is not prone to rupture. It is also carried out for preventive purposes in order to prevent the rupture of the heart aneurysm, as well as during the preoperative period.

In principle, if the aneurysm does not grow, and clots are not formed in its cavity, one can not rush with the operation. Usually, symptomatic treatment, prevention of complications and regular examinations of the cardiologist are avoided.

Do not rush to the operation and in case of an aneurysm in newborns. Surgical treatment in this case is carried out after the baby turns a year old. Up to this time, supportive therapy can be practiced.

Medical treatment of heart aneurysm is indicated even if the patient can not undergo an operation due to various reasons (for example, a person does not tolerate anesthesia or is diagnosed with severe mitral insufficiency) or he himself refuses surgical treatment. In this case, a person will have to take medication prescribed by a doctor for life.

Drug treatment, as a rule, has 2 goals: reducing the load on the heart cavity in the wall of which an aneurysm was formed, and preventing thrombosis.

Treatment of an aneurysm of the heart without surgery implies the following groups of medicines:

• β-adrenoblockers, regulating the strength and rhythm of the heart,
• thrombolytic drugs, preventing the appearance of thrombi due to the dilution of blood and the prevention of clumping of platelets,
• diuretic (diuretic) drugs that help reduce the elevated blood pressure, dangerous in terms of a provoking factor of aneurysm rupture,
• nitrates, popular as effective medicines for angina pectoris, dilating coronary vessels, improving myocardial nutrition and preventing the development of heart failure.

What exactly the drug from each specific group will be prescribed by a doctor depends on the age and condition of the patient. Councils and recommendations in this case can only do harm, complicating the situation by rupture of an aneurysm or the development of heart failure, which will make surgical intervention mandatory.

There have been cases that doctors did not have to apply any treatment, because the aneurysm was not diagnosed after a while. There is a fair question: can an aneurysm of the heart disappear? But there is no unequivocal answer to it.

Usually the disappearance of an aneurysm is associated with childhood. If the aneurysm appeared in the intrauterine period, it is unlikely that it will disappear with time. If a child is just born with a violation of the development of the heart tissue, and the occurrence of an aneurysm is associated with the need to breathe, scream and perform other actions that promote pressure in the vessels and the heart, the weak tissues bending under the load may eventually come into tone. So, the aneurysm will disappear. True, there will be a risk of re-emergence, for example, if the child is periodically ill with viral or bacterial infectious diseases.

In adult patients who underwent myocardial infarction, an aneurysm can develop in the acute period of the disease. And when there is a scarring of the affected tissues of the aneurysm either disappears or becomes chronic.

Physiotherapy treatment for aneurysm of the heart is usually performed after surgical intervention. Most physical procedures are contraindicated in case of an aneurysm of the heart, especially in its acute form, therefore, the physician should approach the choice of methods of physiotherapeutic treatment with extreme caution.

After surgical removal of the heart aneurysm, procedures such as electrosleep, galvanotherapy and electrophoresis with the use of vasodilating and anesthetizing drugs can be prescribed.

To prevent the occurrence of an aneurysm and other complications after a myocardial infarction, magnetotherapy and various balneological procedures (mineral, nitrogen and oxygen baths) can be used.

Medication

So, we already know that several types of drugs are used to treat the dangerous symptomatology of heart aneurysms. These are beta-blockers, thrombolytics, diuretics, nitrates and, of course, vitamins that support our body during illness.

The choice of effective drugs in the case of an aneurysm of the heart that is not operated is always left for the attending physician, so to say which of the preparations is better and which is worse is definitely impossible. Here are just a few names of drugs from each group that can be prescribed for the treatment of rhythm disturbances, lowering blood pressure, preventing thromboembolism, and improving blood circulation in heart aneurysm.

Beta-blockers: Propranolol or Anaprilin, Bisoprolol or Bikard, Nebivolol or Nebilet, Karvedilol, etc. These drugs reduce the manifestations of heart failure and blood pressure. They are not prescribed for bronchial asthma, bradyarrhythmia, symptomatic hypotension, atrial-ventricular blockade of grade 2, acute heart failure, and pregnancy. Not used in pediatrics.

Thrombolytic: "Alteplase", "Fibrinolysin", "Tenteplase", "Urokinase-plasminogen", "Eminase", etc. Contraindicated in bleeding, suspected pericarditis, stratification of the aortic aneurysm, uncorrected rise in blood pressure and some other pathologies. Do not apply in pregnancy.

Diuretics: Furosemide, Torasemide, Spironolactone, Xipamid, Etacrynic Acid, Indapamide, Ezidrex, Arifon, etc. Preference is given to thiazide preparations that maintain pressure at the desired level, if necessary go on loop diuretics. Contraindications may be violations of the liver and kidneys, as well as the period of pregnancy.

Nitrates (nitrovazodilatatory): "Nitroglycerin", "Isosorbide dinitrate", "Molsidomin", "Isosorbide mononitrate". Contraindicated with low blood pressure and pulse rates, severe tachycardia and contractile dysfunction of the right ventricle of the heart.

Surgery

The main and most preferred way to combat heart aneurysm is its surgical treatment. But we need to understand that the plasticity of an aneurysm of the heart has nothing to do with suturing a wound on the skin. This is a serious and rather dangerous operation, the lethality of which can vary from 5 to 10%. Therefore, in the case of asymptomatic left ventricular aneurysm, doctors do not insist on surgery.

Indications for the appointment of surgical treatment of aneurysms are:

• the emergence of dangerous symptoms associated with rapidly developing heart failure,
• not medically corrected severe disorders of the heart rhythm,
• the formation of an aneurysm of blood clots in the cavity (especially if there was already a situation with the separation of the thrombus and the obstruction of the blood vessels)
• akinetic aneurysm, at which the end-systolic index greater than 80 ml per m ², and end-diastolic more than 120 ml per m ²,
• an increased risk of developing a false aneurysm, dangerous because of the high probability of bleeding,
• Aneurysm rupture, considered the most dangerous complication of an aneurysm of the heart and leading to oxygen starvation of the whole organism due to severe bleeding, which often ends in the death of the patient.

All of the above situations are potentially dangerous for human life, not to mention the fact that they greatly complicate the work of the heart and negatively affect the health of patients. If we compare the asymptomatic aneurysm with the pathology accompanied by the above-described symptoms, the risk of dying from an aneurysm of the heart in the latter case is higher in 5, and according to some data, even 7 times.

An obligatory measure is considered a surgical operation with saccular and mushroom-shaped aneurysms prone to rupture, while a flat aneurysm that does not represent such a danger may not be operated for a long time, although the control of the dynamics of its development in a cardiologist is mandatory for such patients.

The need for surgical treatment of aneurysm in patients with myocardial infarction is due to high mortality. More than 2/3 of these patients die within the first 3 years, and after 5 years this figure increases by another 20-30%. The operation to remove the heart aneurysm should be performed at least 3 months after the infarction, when a dense scar tissue forms on the site of the rupture, which can withstand further manipulations.

Contraindications to surgery may be the age of the patient (over 65 years) or the development of severe heart failure (grade 3).

Types of operations for aneurysm of the heart

Reinforcement of the walls or removal of the heart aneurysm with subsequent plastic can be carried out in various ways. The choice of the type of surgery depends on the type, shape and size of the aneurysm.

With the least dangerous diffuse aneurysms, serious interference in the structure and work of the heart can be avoided. In this case, the aneurysm wall is often strengthened by various tissues. Such materials can be skin flaps, a large omentum, pectoral muscle and other types of autografts.

Another type of surgical operation - immersion of an aneurysm inside the heart of sutures - is effective in saccular aneurysms of small sizes not prone to thrombosis. Such an operation helps eliminate paradoxical pulsation.

Immersion of an aneurysm can be carried out and with the help of a diaphragm flap on a pedicle with a large vessel passing through the center. Such a flap is well established and after a time sprouts vessels into the myocardium of the heart. It is quite sturdy and does not allow the aneurysm to protrude outward under the pressure of blood.

Other methods of surgical treatment of heart aneurysms are classified as radical interventions requiring the dissection of an aneurysm located on one of the cardiac walls.

With small saccular aneurysms (preferably without parietal thrombi), their removal can be carried out in a closed manner. The aneurysm base is pinched by special terminals, after which the aneurysm bag is removed.

So they did before, but later the operation changed a bit. First, the aneurysm tissue was cut and the blood clots were washed out inside it, and then the aneurysm base was clamped to the terminals to resect it. The disadvantage of surgery is the remaining risk of developing arterial thromboembolism.

Removal of an aneurysm by the open method requires not only the opening of the chest and heart, but also the use of a special device that joins the main blood vessels and carries out artificial circulation. The operation itself begins only after the complete cessation of blood flow through the chambers of the heart.

During the operation, the cardiosurgeon can not only remove the aneurysm itself and the parietal thrombi in the heart, but also assess the condition of the remaining chambers of the heart and its valves, as well as the blood flow in the coronary vessels. If there is a violation of the coronary blood flow, in parallel with the resection of the aneurysm, shunting of the vessels is carried out.

Plastic aneurysm of the heart by the open method can be carried out by various methods:

• Linear plastic (an aneurysm is resected after removal of thrombi and a linear seam in 2 rows is superimposed on the site of the cut).
• Kisetnaya plastic (after opening a small aneurysm along its edge, a suture stitch is laid and tightened).
• Circular plasty with the help of a patch (a patch of synthetic material is applied to the site of excision of the aneurysm).
• Endoventricular plasty (a patch sufficient to preserve the volume of the ventricle of the size is placed inside the aneurysmal sac that stitches over it).
• Plastic with the help of an intraventricular balloon.

Which method to use in this or that case is decided by the surgeon who performs the surgery, taking into account the patient's condition and postoperative risks.

To say that heart surgery will solve all the problems of patients with an aneurysm of the heart would be wrong. Some complications are possible after the operation. The most common complications include: blood accumulation in the heart bag, development of heart failure, arrhythmias, blood clots. There are also cases of a lethal outcome on the background of a clearly performed operation.

Nevertheless, the removal of the aneurysm makes the drug treatment more effective and gives patients a few more years of quite decent life.

Alternative treatment

Proceeding from the seriousness of the problem and the features of the heart aneurysm, it becomes clear that alternative treatment is unlikely to cause the disappearance of an aneurysm, which is beyond the power even of medical therapy. Nevertheless, it can usefully complement the medication prescribed for small diffuse aneurysms or in preparation for surgery. It will also be useful for those patients who, due to various circumstances, are forced to depend on drugs for life.

Here, treatment with herbs comes to the forefront, which normalizes the heart rhythm, pressure, and general condition.

With weakness of the myocardium, broth of dogrose helps (2 tablespoons of boiled water take 1 tablespoon of rose hips seed). To the finished cooled broth add a spoonful of honey. Take a delicious medicine for half an hour before meals 3 times a day for a quarter of a glass.

When tachycardia is useful, infusion of young shoots of asparagus (3 tsp shredded raw material pour a glass of boiling water and insist 2 hours). Take the drug you need 3 times a day for 2 tablespoons. Within a month.

Normalize the heart rhythm will help and infusion of calendula flowers (2 tsp of raw materials for 2 tbsp boiling water, insist for about an hour), which should be taken 4 times a day for half a cup.

Instead of synthetic diuretics that help reduce blood pressure, you can use the usual and delicious food (seasonal): watermelon, melon, cucumber, pumpkin, beet, parsley. In winter, you can use diuretics of herbs and plants. Only before you need to consult a doctor, because the simultaneous intake of synthetic and natural diuretics can lead to dehydration of the body.

As vegetative beta adrenoblockers, alternative healers use such herbs as mountain arnica, marsh swine, motherwort, lemon balm, and Baikal purifier.

[20], [21], [22], [23], [24], [25], [26]

Homeopathy

Homeopathy with aneurysm of the heart is also shown as an adjunct to medical treatment, and therefore the possibility of its use should be discussed with the doctor who is treating. Homeopathic treatment helps to remove unwanted symptoms and prevent some complications of the disease, but it can not get rid of the aneurysm itself.

In the end, homeopathic treatment, like traditional conservative treatment, can end in an operation for the plastic or the removal of an aneurysm. But on the other hand, a person with disabilities in terms of surgical intervention, too, has the right to the feasible help that homeopathy can give him. Thanks to her, the patient can safely and reliably normalize the heart rate, cope with high blood pressure and prevent the formation of blood clots.

The most popular homeopathic preparation of this genus is Arnica, which acts both as a thrombolytic and as a beta-blocker.

In addition, depending on the situation and the constitutional features of the patient, preparations may be prescribed: Calcarea fluorica, Carbo vegetabilis, Arsenicum album, Gloninum, Yodum, Ignacia, Natriumum Muriatikum, Rus toxicodendron, Krategus, etc.

The choice of drugs, as well as the appointment of an effective and safe dosage should be entrusted to an experienced homeopathic physician and must discuss the possibilities of their application with your doctor.