Hypokinesia of the heart

Some patients with electrocardiography have a condition such as hypokinesia of the heart - for most patients this term is incomprehensible and raises a lot of questions. If you look at this concept verbatim, it means: " hypo - little, kinesis - movement", that is - lack of mobility - in this case, the heart muscle. In many people, this pathology is associated with changes in the myocardium after a heart attack. In this case, the passage of the contractive wave worsens on the scar site, which leads to the appearance of hypokinesia.

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Epidemiology

Absolutely in all patients who suffered a myocardial infarction, subsequently on a cardiogram they detect hypokinesia of the heart. As a rule, this happens about two months after the infarction.

Hypokinesia can be detected with equal frequency, both in male and female patients, mainly after 50 years.

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Causes of the zones of hypokinesia of the heart

The causes of hypokinesia may be different. This condition is almost never independent: as a rule, this is a consequence of other heart problems.

The main reasons can be considered:

• atherosclerosis of the coronary vessels, followed by the development of myocardial ischemia;
• inflammatory process, myocarditis;
• myocardial infarction, acute heart failure.
• The listed reasons are considered the most widespread. Among the relatively rare causes can be identified as follows:
• exposure to radiation;
• cardiac sarcoidosis;
• gemochromatosis;
• systemic scleroderma.

Doctors conclude that due to the complexity of the disease and the presence of a mass of reasons for its appearance, it is difficult to dwell on any one factor. Therefore, physicians place emphasis on the treatment of inhibition of the further spread of the process.

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Risk factors

The risk factors for the development of hypokinesia of the heart can be considered:

• disorder of fat metabolism, high cholesterol in the blood;
• long-term high blood pressure, hypertension;
• long-term smoking, including passive;
• overweight;
• adverse heredity, genetic abnormalities (eg, narrowing of the heart vessels);
• frequent and deep stresses, hormonal disorders;
• viral, microbial, fungal infections (rubella, meningitis, aspergillosis, etc.);
• allergic processes;
• systemic inflammatory processes;
• chronic intoxication, including alcohol or drugs.

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Pathogenesis

With stenosis, ischemia or metabolic changes in the myocardium, there are increasing dystrophic, atrophic changes or death of muscle fibers. In damaged areas remain necrotic foci or micromicles.

Damage to the receptors leads to a decreased sensitivity of the heart tissues to oxygen, which only aggravates the state of hypokinesia.

Since there are several pathogenetic variants of development of the pathological process, it is possible to distinguish several types of hypokinesia of the heart. Thus, ischemic hypokinesia occurs with prolonged inadequate circulation: the myocardium is almost completely affected. Postnecrotic hypokinesia is formed in the area of an earlier infarction. In addition, a mixed version of the development of hypokinesia of the heart is possible.

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Symptoms of the zones of hypokinesia of the heart

Since hypokinesia of the heart is not an independent pathology, but is considered only a sign of other cardiac problems, its symptoms are usually associated with the underlying pathology. If the elasticity of the vessels is not compromised, the conducting system is not damaged, then hypokinesia can proceed without any obvious symptoms. Symptomatology may be absent in the case when the degree of hypokinesia of the heart is small and has a superficial character.

In other situations, the first signs of cardiac hypokinesia may occur:

• shortness of breath, especially with physical exertion;
• unexplained periodic coughing attacks (so-called "cardiac bronchitis");
• heart rhythm disturbances;
• a strong heartbeat that the patient feels;
• feeling of constant or severe fatigue;
• "Heart" edema;
• periodic dizziness;
• chest pains.

Forms

Differences in the intensity and location of hypokinesia make it possible to identify certain types of pathological conditions:

• focal hypokinesia - for example, after a heart attack or a localized inflammatory process;
• diffuse hypokinesia, in which all the muscle fibers of the heart are evenly affected, without the definition of clear affected foci.

Hypokinesia of the left ventricle of the heart

With hypokinesia of the left ventricle, no characteristic symptoms are present. There is only a clinical picture of the main cardiac pathology. In most patients, the compensatory period can last long enough for several years, and the patient learns about the state of hypokinesia with the planned passage of diagnostic procedures.

It is possible to suspect left ventricular hypokinesia by such signs:

• constant feeling of weakness, fatigue;
• interruptions in cardiac activity, ventricular tachycardia, arrhythmia;
• swelling of the extremities in the evening;
• dry cough and breathing disorder;
• cyanosis of the nasolabial triangle, finger phalanges;
• pain in the heart;
• dizziness.

At the first signs of deterioration of the state of health, you should immediately contact the doctor for diagnostic and treatment procedures.

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Hypokinesia of the apex of the heart

About this localization of hypokinesia, we can say that it is relatively rare. Postnecrotic hypokinesia occurs after a heart attack noted in V4 leads, either from V3 to V5, and Anterior over the Sky.

With an electrocardiogram V4 lead can have a QS variant - this indicates a transmural myocardial infarction.

Postnecrotic hypokinesia after myocardial infarction in the apex of the heart is most often provoked by occlusion of the terminal branches of the left anterior descending artery.

Hypokinesia of the interventricular septum of the heart

This type of hypokinesia most often has a connection with a congenital defect of the interventricular septum, when there is an opening in the septum separating the left ventricular and right ventricular cavity. Through it there is a pathological shunting of blood. A similar anomaly is more common among all congenital heart defects (frequency - up to 25%).

The interventricular septum, simultaneously with the ventricular walls, provides contractile and relaxing movements of the heart.

Symptoms for lesions of the interventricular septum depend on the degree of defect and the severity of hypokinesia.

Diffuse hypokinesia of the myocardium

With diffuse hypokinesia, the motor ability of all myocardial fibers suffers. As a rule, this process is gradual:

• anginal episodes occur more often, becoming more pronounced;
• lost performance;
• there is an arrhythmia, or an aneurysm.

Symptoms characteristic of heart failure are observed. The severity of these symptoms depends on the stage at which the pathology is located.

If you do not take measures to stop the process, then the defeat of the myocardium can lead to severe disability and death.

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Complications and consequences

The condition of hypokinesia of the heart can not be cured completely: the goal of the doctors is to stop further damage to the muscle fibers. However, even timely medical measures do not guarantee complete prevention of unpleasant consequences that may occur with time.

The most frequent consequences of hypokinesia of the heart are:

• chronic course of cardiac insufficiency;
• formation of cardiac aneurysm;
• failures in the rhythm of the heart;
• acquired form of heart disease;
• thromboembolic complications;
• development of chronic fatigue syndrome.

For most patients, the appearance of complications entitles them to a disability. To do this, it is necessary to provide medical proof of the problem: most often the results of electrocardiography, echocardiography in dynamics, scintigraphy, as well as advisory findings of physicians of other specialties are required.

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Diagnostics of the zones of hypokinesia of the heart

Hypokinesia of the heart can not be determined by routine examination, even if the anamnesis indicates the presence of provoking factors. To diagnose hypokinesia of the heart and pathologies associated with this condition, you need to conduct a number of additional studies.

Analyzes of blood and urine can not provide any necessary information regarding the development of hypokinesia of the heart. But the tests in some cases allow us to discover other pathologies in the body that could become the root cause of hypokinesia. For example, the inflammatory process in the heart muscle will be reflected in the blood picture signs of inflammation, and atherosclerosis - high cholesterol. Of course, such information does not directly point to the presence of hypokinesia of the heart, but will only become an auxiliary kind of diagnosis.

General tests are always prescribed to all patients before prescribing the treatment regimen to take into account possible contraindications and avoid negative consequences.

Instrumental diagnostics is prescribed for suspected cardiac pathologies, including hypokinesia of the heart. The most indicative are the following types of research:

• Chest X-ray - can visualize changes in the shadow of the heart and aorta, as well as other disorders.
• Electrocardiography - is the main method that allows you to determine the hypokinesia of the heart.
• Ultrasound, echocardiography - helps to accurately view the heart and its internal structure on the monitor.
• Load test and stress echocardiography - provides information on endurance of the myocardium and response to physical exertion.
• Daily monitoring of cardiac activity - is used mainly for heart rhythm disturbances and allows to follow the work of the heart at different times of the day and under different conditions.
• MRI - used to clarify the diagnosis and for more detailed visualization of the intracardiac structure.

[21], [22], [23], [24]

Differential diagnosis

Differential diagnosis usually relates to the underlying cause of hypokinesia of the heart and is built by the elimination of other chronic heart diseases. First of all, it is necessary to exclude the atherosclerotic and myocardial form of cardioskerosis, chronic myocarditis, cardiomyopathy, and also the so-called "myocardial infarction". It is not difficult to detect hypokinesia in diagnosis: it is much more difficult to find the original cause of this disorder.

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Treatment of the zones of hypokinesia of the heart

At present, it is not possible to completely restore muscle tissue and eliminate hypokinesia of the heart. It is important not to allow the process to worsen and prevent the development of complications.

Treatment of hypokinesia of the heart is carried out by the doctor of cardiology. The main goals of therapy are as follows:

• eliminate the root cause of hypokinesia;
• eliminate factors that may exacerbate the problem in the future;
• support heart activity;
• prevent complications;
• if possible, improve the patient's quality of life.

Treatment of patients with cardiac hypokinesia is carried out taking into account the degree of organ damage, as well as taking into account the existing symptoms.

The most commonly prescribed drugs are:

• ACE inhibitors;
• glycoside cardiotonic drugs;
• blockers of β-adrenergic receptors;
• aldosterone receptor blockers;
• diuretics.

The purpose of the regimen based on these drugs allows to stabilize the cardiac activity and normalize the load on the heart muscle. All appointments are conducted exclusively by a cardiologist. Self-administration of medicines is unacceptable.

	Dosage and route of administration	Side effects	Special instructions
Captopril	Take 6.25-50 mg, up to 3 times a day, with the maximum daily dose of 150 mg.	Dizziness, orthostatic lowering of blood pressure, changing taste sensations.	Captopril belongs to ACE inhibitors. It reduces the burden on the myocardium, lowers blood pressure.
Bisoprolol	Take 1.25-10 mg once a day.	Redness of the face (hot flashes), dizziness, bradycardia.	Bisoprolol normalizes cardiac activity, reduces hypoxia.
Furosemid	Take from 20 to 500 mg per day, on an empty stomach.	Nausea, itching, temporary hearing loss, headache, depression, dry mouth.	Furosemide eliminates swelling, reduces exercise and facilitates heart function.
Digoxin	Take 0.125 mg to 2 times a day, with the maximum daily dose of 0.25 mg.	Dyspepsia, a sense of fatigue, headaches, heart rhythm disturbances.	Digoxin refers to cardiac glycosides, but it is prescribed only for a short time - only to relieve symptoms.
Spironolactone	Take 25-50 mg per day, in the morning or in the afternoon, for 1-2 reception.	Dyspepsia, drowsiness, inhibition, menstrual dysfunction in women and erectile dysfunction in men.	Spironolactone improves the compensation of cardiac activity. It is an antagonist of aldosterone.

When hypokinesia of the heart must prescribe vitamins - especially useful complex preparations with the mandatory content of vitamins of group B in the composition. The drugs of choice can be Angiovit, Centrum, Neurobeks, Vitrum centuri: these vitamin supplements can improve the nerve conduction to prevent complications from the cardiovascular system.

Physiotherapeutic treatment

With various violations from the heart - for example, with cardiosclerosis or hypokinesia of the myocardium, doctors advise to practice balneotherapy, using carbon dioxide, sodium chloride, iodine-bromine baths. If there is no arrhythmia, then use also of baths with hydrogen sulphide.

To improve immune protection, inductothermia is used with an effect on the adrenal glands.

If the cause of hypokinesia was atherosclerosis (cardiosclerosis), then the doctor can prescribe procedures for electrophoresis with novocaine on Zakharyin Ged's zones. The duration of one session is from six to 15 minutes, the frequency of each day, or every other day. For one course, it may take from 8 to 20 sessions. Such procedures will improve the blood circulation and the functional capacity of the myocardium.

With mild forms of hypokinesia, patients are shown sanatorium treatment.

Alternative treatment

When hypokinesia of the heart without alternative methods of treatment is indispensable. There are a lot of drugs and medicinal plants that help to ease the patient's condition, improving the work of the cardiovascular system. For example, it is worth paying attention to such recipes.

• Mix 1 tbsp. L. Crushed rhizomes of hawthorn and 1 tsp. Seeds of cumin, brewed in a thermos in 300 ml of boiling water, overnight. In the morning, the infusion is filtered and drunk throughout the day.
• Prepare a kind of cocktail of two raw chicken proteins, 2 tsp. Sour cream and 1 tsp. Honey. This cocktail should be drunk every morning on an empty stomach.
• Every day, eat 150 grams of fresh home-made cottage cheese.
• Prepare juice or compote of berries of mountain ash (both red and black-berry). You can also use the rhizome of the plant.
• Prepare a two-hour infusion of buckwheat flowers (1 tablespoon of flowers for 500 ml of boiling water). Drink infusion of 100-150 ml 3-4 times a day.
• Every morning, one lemon, ground in a meat grinder and mixed with honey and sugar, is eaten.

When hypokinesia of the heart will benefit berries and currant leaves, blackberries, cranberries, as well as flowers of bird cherry and garlic.

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Herbal Treatment

• Prepare a mixture of crushed herbs: 1 tbsp. L. Yarrow, one and a half spoons of hawthorn, mistletoe and foliage vinca. Pour 1 tbsp. L. Of the resulting mixture of 300 ml of boiling water is insisted for about an hour. Drink the resulting infusion during the day.
• Prepare a herbal mixture of 20 g of lemon balm, 10 g of lily of the valley, 30 g of cotton noodles and the same amount of rue. One tablespoon of the resulting mixture is poured into 200 ml of boiling water, filtered through an hour. Drink three times a day for 1 tbsp. L. Before meals.

To strengthen the heart can be used and more complex herbal mixtures. As ingredients, sage, peppermint, letter, clover, calendula, chicory, cowberry leaves, oregano, sweet clover are usually used.

Depending on the indications, after consulting a doctor, using infusions based on rhizome valerian, motherwort - these drugs are particularly relevant in the presence of spasms and cardioneurosis.

Homeopathy

There are reviews about the positive effects of homeopathic remedies on the health of patients with cardiac hypokinesia. What kind of drugs are they talking about, and when can they be taken?

• Arnica 3x, 3 - with an overload of the heart muscle;
• Aurum - if hypokinesia is caused by hypertension or atherosclerosis;
• Barite carbonate in the dilution 3, 6, 12 - if hypokinesia of the heart is provoked by age-related cardiosclerosis;
• Phosphorus 6, 12 - with hypokinesia caused by myocardial dystrophy;
• Calcaria arsenicosis 3, 6 - with hypokinesia due to cardiosclerosis;
• Graphite 6, 12 - with cardiac muscle dystrophy;
• Krategus 0, 2x - with arrhythmia on the background of hypokinesia of the heart;
• Adonis 0, 2x - in violation of the heart rhythm, dyspnea and swelling;
• Ammonikum carbonicum 6 - with hypokinesia of the heart, with symptoms such as blueing of the nasolabial triangle, coughing and shortness of breath during physical exertion.

Homeopathic remedies are used along with drug therapy, as an auxiliary type of treatment. These drugs are harmless and effective enough if properly selected by a qualified homeopath physician.

Surgery

Surgical intervention in cardiac hypokinesia refers to cardinal types of treatment and is performed only in severe and life-threatening situations. In this case, the most effective way to eliminate painful symptoms and restore adequate trophism is heart transplant.

Usually, transplantation is recommended for diffuse myocardial damage, or for severe cardiac failure in the background of deep myocarditis. With a relatively light cardiac hypokinesia, transplantation is considered impractical: enough medical therapy.

The transplant is prescribed:

• with a reduction in cardiac output less than 20% of normal values;
• patients under the age of 65;
• in the absence of the effectiveness of conservative treatment.

The operation is not prescribed unless the true cause of hypokinesia is established.

In addition to transplantation, in some cases, palliative surgery can be used:

• Coronary bypass grafting is performed when there is a violation of the coronary circulation and a narrowing of the vascular lumen.
• Correction surgery for an aneurysm - involves removing the damaged portion of the vessel or strengthening it.
• Installation of a pacemaker - is used for severe violation of the heart rate.

Prevention

Prevention of hypokinesia of the heart is the prevention of other cardiac pathologies. At the same time, the rule number one is the observance of a healthy lifestyle.

People who care about their own health can be given the following useful tips:

• quitting smoking will avoid coronary spasm and oxygen deficiency in the myocardium;
• moderate exercise will help strengthen the heart muscle - however, the load should be just moderate;
• systematically it is necessary to visit a doctor, including a cardiologist;
• it is necessary to treat any diseases in the body in time - in particular, infectious and hormonal pathologies;
• you need to avoid stress and conflict, properly and fully eat, watch your weight.

Regularly - about once a year, it is desirable to take a blood test for the content of cholesterol in it. As a preventive measure to increase this level, it is recommended to monitor the diet: do not eat too salty foods, avoid consuming large amounts of animal fat, do not abuse coffee, strong tea and spirits.

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Forecast

The prognosis of hypokinesia of the heart depends on many factors: the degree of damage to the muscle fibers, the presence of arrhythmia, the presence and stage of cardiac insufficiency.

With timely medical intervention, and also with observance of all necessary preventive and curative measures, the painful process can be stopped and prevent the development of serious complications.

If a patient is diagnosed with a condition such as hypokinesia of the heart, then he needs regular monitoring by a medical specialist, with a systematic examination of the entire cardiovascular system.

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