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Obesity of the heart

 

This formulation suggests excessive accumulation of lipids in the heart muscle or an abnormal growth of fatty tissue under the epicardium, leading to dystrophic changes in muscle tissue. The disease develops in people who are obese. It is this that causes the heart muscle to constantly work in the regime of overloads, and not cardiac pathology, with the passage of time leads to cardiac and respiratory failure.

Epidemiology

In the modern world, the problem of overweight, which negatively affects the health status and, in particular, causes this type of fatty myocardial dystrophy, is quite acute. The first twenty countries, in which obesity suffers from a quarter to a third of the population, are headed by Mexico, the United States of America and Syria. Among Mexicans, about 70% are overweight, almost 33% are obese. They are catching up with the Americans and the Syrians (about 32%). In the top twenty, mainly Latin American and Asian countries, as well as Australia and New Zealand, were named. On the twentieth place is Hungary, and the line above it is occupied by Britain and Russia. In these countries, about a quarter of their residents are overweight in the stage of obesity.

The probability of a child with a predisposition to a set of excess weight from obese parents is 80%, if one of the parents suffers obesity, then the risk of inheriting this condition from the mother is 50%, of the father - 38%.

Causes of the obesity of the heart

The main etiological factor is genetic, the tendency to excessive obesity is often observed in members of the same family. Family traditions in relation to the diet - a preference for fatty dishes, the encouragement of overeating, insufficient intake of vitamins, minerals, fiber leads to a slowing of metabolism and the accumulation of excess body fat in the body tissues. And this type of fatty myocardial dystrophy, called obesity of the heart, develops against the background of a significant excess weight of any genesis.

Risk factors become fat, and, consequently, "earn" obesity of the heart are numerous. This is the age (with the passage of years more and more muscle cells are replaced by fat cells), and stressful situations that cause many to "seize" the troubles that have arisen; nerve diseases, in particular, bulimia; some mental pathologies; hormonal bursts (pubertal period) and extinction of their activity (menopause).

The risk of developing obesity of the heart is much higher in people who have a sedentary lifestyle; at the sportsmen who have finished career and have sharply lowered physical activities; beer lovers; at endocrine and genetic disorders; diseases of the digestive system, circulation, liver and kidneys. Among the risk factors called long-term use of psychotropic drugs. There is a high probability of gaining excess weight in people who have long been exhausted by a strict diet - the body is intensively replenishing fat stores after the stress caused by prolonged malnutrition.

Fatty dystrophy of the myocardium, caused by primary (alimentary) obesity, is always associated with overeating and sedentary lifestyle, in which energy consumption does not correspond to its consumption. With secondary obesity, which develops as a result of diseases, the association of obesity with high-calorie diet and hypodynamia can not be traced.

Pathogenesis

In the mechanism of the development of cardiac obesity, the leading pathogenetic links are the oxygen starvation of cardiomyocytes, as a result of diseases that lead to metabolic disturbances, or a disturbance in the diet (the preference for hydrocarbon-containing foods against a deficit of vitamins and proteins).

Dystrophic changes in the heart muscle occur as a result of the replacement of myocardial lipid muscle tissue. With obesity, mainly phospholipid metabolism is disturbed. Being the basic fatty element of cell membranes, phospholipids provide their elasticity and fluidity. With their help, molecules of fats, fatty acids, cholesterol are transported. Disorders of phospholipid metabolism between plasma and erythrocytes cause in the blood excess fatty compounds deposited in the main tissue of the heart, liver, kidneys.

In the myocardial cells appear microscopic droplets of fat, gradually completely replacing the cytoplasm of muscle cells. Fatty degeneration of the heart muscle is detected by foci of fat cells, which replaced cardiomyocytes. Substitution of cells occurs in different functional systems of the heart muscle, which causes violations of the rhythm and heart rate, cardiac conduction. The automatism of the myocardium is upset.

With the growth of adipose tissue under the external serous cardiac membrane (epicardium), it penetrates deeply into the layers of the heart muscle, which because of this becomes non-uniform, permeated with bundles of adipose tissue of different thickness. Because of the pressure of the fat cords, the atrophy of the muscle fibers develops and progresses. Over time, the epicardium turns into a layer of fatty tissue, permeated with blood vessels.

Symptoms of the obesity of the heart

Fatty degeneration of the myocardium itself does not have a clear symptomatology. It is typical for many disorders of cardiac activity. The first signs, which are worth paying attention to, this is shortness of breath, which appears after an unusual and more intense exercise. A person feels that he does not have enough air, difficulties arise when inhaling. Breathing becomes more frequent, noisy and less deep. As a rule, dyspnea is noticed by others. Cardiac dyspnea is caused by hypoxia, which occurs when heart failure is insufficient for normal blood supply to the brain and lungs. To compensate for the lack of oxygen, breathing becomes quicker. At the beginning of the disease, dyspnea occurs against the background of physical exertion. Lack of proper treatment leads to the fact that in later stages of dyspnea appears even in a patient who is at rest. The higher the body mass index of a person, the more noticeable that he suffers from shortness of breath.

The further process of degeneration of muscle tissue into fat causes the violation of myocardial functions (a decrease in rhythm, frequency and a violation of the sequence of its contractions, electrical conductivity). Symptoms of heart failure occur. To shortness of breath, pain in the heart, arrhythmia, tachycardia and hypertension are added. Clinical picture is supplemented with tinnitus and dizziness, headaches and fainting are possible, as well as an increase in the liver, swelling of the legs.

Obesity of the heart in children is also associated with overweight and can cause symptoms of cardiac disorders: shortness of breath, heart rhythm and heartbeat disorders, fluctuations in blood pressure.

Types of obesity of the heart - is the growth of fat, under the epicardium, or focal fat deposits in the heart muscle. Both these species lead to serious dystrophic changes in the myocardium.

By localization of fatty deposits, obesity is symmetrical, and also - distinguish the upper, middle and lower.

In the initial stage, obesity of the heart does not cause significant symptoms and the presence of lipids in cardiomyocytes can be seen only under a microscope. With a more neglected process, the heart grows in size, its chambers stretch. Myocardial tissue becomes flabby and acquires a striped yellow-and-white coloration called "tiger skin". In the outer serosa of the heart, especially on the right, there is a growth of fatty tissue, which covers the heart like a case. Simple obesity of the heart, when there are no gross destructive changes in the cells, is reversible in the presence of adequate treatment. In the absence of treatment, cardiac insufficiency develops mainly right ventricular. More advanced stages of fatty degeneration can lead to death due to myocardial thinning and its rupture.

Complications and consequences

The consequences and complications of cardiac obesity are chronic heart failure, myocardial ischemia, atherosclerosis, persistent hypertension, and the pressure rises very significantly. These pathologies are usually observed in the elderly, but with obesity, the heart can also occur in childhood.

For the life of the patient, the risk of possible complications of cardiac obesity is a right ventricular paroxysmal tachycardia and an atrioventricular blockade of the third degree.

Diagnostics of the obesity of the heart

When examining a patient who is overweight and complaining of shortness of breath, chest pain, attacks of rapid heartbeat, a doctor may suspect obesity of the heart.

The earliest stages, when instrumental diagnostics are not yet able to detect it, practically never fall into the field of view of doctors. If the patient has complaints of a cardiac disorder, then instrumental studies can already record some changes.

An electrocardiogram will show a decrease in electrical conductivity, a violation of the heart rhythm, a deviation of the axis of the heart.

Ultrasound examination of the heart will allow to assess the size of the heart, the thickness of the walls of the heart chambers, the contractile ability of the myocardium. One ultrasound may not be enough, the doctor can prescribe phonocardiography, X-rays, coronary vascular examination, cardiac ESI and other diagnostic procedures for additional information. Magnetoresonance tomography with the use of contrast can be very informative for determining the degree of heart damage.

In addition, the doctor must establish the primary cause, which led to obesity of the heart. The patient is assigned blood tests - clinical, glucose level, hormones of the thyroid gland, adrenal glands, female sex hormones. Instrumental diagnosis is prescribed depending on the expected diagnosis of the underlying disease.

Based on anamnesis and careful examination, differential diagnosis is performed to identify the primary disease and differentiate the obesity of the heart from other cardiovascular diseases that can develop in a patient suffering from overweight.

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Treatment of the obesity of the heart

The main directions of this process are the gradual reduction and normalization of the patient's weight; elimination of oxygen starvation of organs and tissues; correction of symptoms of cardiac disorders. Parallel to this, a primary disease that facilitates the recruitment of excess weight is treated. It is established that the foci of fatty deposits in the heart, as well as atrophic changes in muscle fibers, can not be corrected. Treatment can be aimed at slowing down the process of growth of the fat layer and normalization of the functions of the remaining areas of the heart muscle.

The fight against overweight and oxygen starvation is impossible without changing the habits and lifestyle of the patient, which includes, mainly, the rejection of bad habits, increasing physical activity in combination with compliance with the dietary diet and diet.

At the beginning of the treatment process, a loss of no more than two kilograms per month is considered acceptable, more intensive weight loss is dangerous for the body. For the entire course of treatment sufficient to prevent the development of cardiac pathologies is a weight loss of 10%.

Obesity of the heart is accompanied by shortness of breath and swelling of the lower extremities. To reduce these symptoms, patients are prescribed diuretics. They can reduce the burden on the heart, freeing him from the need to pump over the body of excess fluid. With stagnant phenomena, hypertension caused by cardiac dysfunction, Furosemide is prescribed  ,  which is characterized by rapidity, which works well both under conditions of acidification of blood and alkalization. It can be administered to patients with impaired renal function, since it does not affect glomerular filtration. Contraindicated in the terminal phase of kidney dysfunction and in the presence of mechanical obstruction to urination. It is not prescribed in the first three months of pregnancy. Can cause skin and gastrointestinal side reactions, promotes the excretion of potassium and increases blood sugar. Orally appoint a daily one-time morning intake of 40 mg of the drug, if necessary - dosed to 80 mg.

Loss of potassium, which is necessary for the normal operation of the heart muscle, can be prevented by using the complex diuretic  Furesisis compositum, the  active ingredients of which are furosemide and triamterene, which stores potassium in the body. Therefore, patients without hyperkalemia can be prescribed this diuretic. The standard dosage assumes taking one or two tablets once in the morning, if necessary, you can take two pieces (in the morning and in the daytime). After reducing puffiness, they switch to supporting treatment (one or two pieces at intervals of two to three days).

The use of diuretics alone can contribute to both lowering blood pressure and reducing weight.

With persistent hypertension, drugs from the group depressing the enzymatic activity of the catalyst for the synthesis of angiotensin II (a hormone produced by the kidneys) are prescribed. They help to relax the blood vessels, reduce blood pressure in them and strain the heart. Enalapril belongs to this group  . Once ingested, it is hydrolyzed into enalaprilate, which inhibits this enzyme. The drug also has a slight diuretic effect. In addition to the hypotensive effect that relieves the heart muscle, the drug improves respiratory function and circulation in a small circle and in renal vessels. The duration of antihypertensive action after a single oral intake of the drug - about a day. The drug can cause side effects from the skin and vegetative-vascular system, often cause a dry cough, very rarely - angioedema. Contraindicated hypersensitive to the drug, pregnant and lactating women, in childhood. Overdose can cause a sharp decrease in blood pressure, myocardial infarction, hemorrhage or blockage of cerebral vessels, thromboembolism.

If the previous group of drugs is intolerant, drugs directly blocking the receptors of the kidney hormone are prescribed. The action is similar to the effect of angiotensin-converting enzyme inhibitors. Side effects of these drugs are very rare and do not cause a dry cough

This group of drugs includes  Valsacor , an antihypertensive agent that acts on the renin-angiotensin-aldosterone system. Its effect does not affect the heart rate, effectively with swelling, contributes to the normalization of respiratory function.

Variants of Valsacor H and HD are complex, having the second active ingredient - diuretic hydrochlorothiazide, which has antihypertensive activity and removes Na, Cl, K and water from the body. Active substances, hypotensive and diuretic, synergistically supplement each other's effects and reduce the likelihood of negative reception results.

Half a month after the start of treatment, there is a significant decrease in blood pressure. The maximum effect of the drug is observed about a month later. One-time oral medication provides a 24-hour effect.

Planning pregnancy, nurturing a child for women and nursing mothers is not recommended, as well as for minors who are close to the terminal stage of renal failure.

First, the drug is dosed at 80 mg per day and divided into one or two doses. A month after the start of treatment (during the period of maximum hypotensive effect), the dosage can be changed.

Maximum can be appointed 160mg / day, which is taken at a time or divided into 80mg for the morning and evening reception. If the therapeutic effect is unsatisfactory, then the monopreparation is replaced by a complex variant h or hd.

To correct the heart rate , Koraxan  containing ivabradine, which opened a new group of drugs that oppress the If-channels of the sinus node, can be assigned  , which leads to a selective and dose-dependent decrease in the frequency of its rhythm. Ivabradine-based medications are prescribed for patients whose heart rate is higher than 70 beats / min, regardless of their intake of β-adrenoblockers. This substance practically does not cause side effects, except for a photopsy.

The use of standard therapeutic dosages - from 5 to 7.5 mg twice a day during meals leads to a decrease in the heart rate by approximately 10 beats / minute, both at rest and during physical exertion. This relieves the heart muscle and reduces its need for oxygen. The active substance does not affect intracardiac conductivity, does not cause inotropic effect and ventricular repolarization syndrome.

Vasodilators or vasodilators, the most famous of which is  Nitroglycerin,  which has a short action and is used, if necessary, to stop the pain syndrome and eliminate vasospasms. They can be used topically, since they are available in the form of ointments or patches.

With arrhythmia, symptomatic patients are assigned ß-adrenoblockers of II-V classes. Antiarrhythmic drugs are prescribed for correction of the heart rhythm. For example,  Cordanum belonging to the second class of this group. The medicine normalizes the heart rhythm, slows intracardiac conduction, relaxes the musculature of the heart, reducing its contractions, reduces oxygen consumption. Begin treatment with taking one tablet once a day for half an hour or an hour before a meal, if necessary, adjust the dosage to increase the portion or the frequency of reception. May cause adverse reactions and withdrawal syndrome.

Side effects of antiarrhythmic drugs depend on their belonging to one of the classes. At appointment this should be considered by the doctor.

To normalize the weight and condition of the patient's body, vitamins are prescribed. For example, vitamin B6 is necessary for the normalization of the work of the muscle tissue of the heart and nervous system, promotes the assimilation of polyunsaturated fatty acids, accelerates the synthesis of proteins and amino acids. In vitamin B9 (folic acid) people needing to take diuretics, without it is impossible quality hematopoiesis. Overweight is often accompanied by a deficiency of vitamins D, A, E. When obesity often develop iron deficiency anemia, diuretics remove from the body many trace elements. Therefore, the doctor can prescribe the reception of vitamin-mineral complexes.

Also, according to the doctor's prescription, physiotherapeutic treatment is performed:

  • laser therapy, stimulating blood circulation and cellular immunity;
  • the effect on the fat tissue by pulses of electric current, accelerating the metabolic processes;
  • cardiostimulation;
  • balneotherapy, which activates metabolic processes;
  • mud therapy, which activates the respiratory function of tissues;
  • ozonotherapy, strengthening immunity and enriching tissues with oxygen.

Alternative treatment

Since obesity of the heart is accompanied by a significant excess weight, which is often caused by nutritional excesses, alternative medicine can have an undoubted effect. When treating herbs, especially at the beginning of their use, the weight decreases quite actively. It should be noted that most alternative means for weight loss include cleansing components, in other words, natural diuretics and laxatives. Therefore, it is necessary to consult a doctor so as not to harm the body, washing out with toxins and toxins and useful vitamins and trace elements.

Purifying teas are brewed from a mixture of herbs:

  • mix 10 g of fennel and mint, add senna, parsley leaves, dandelion, nettle to the collection for 20 g of ground grass, brew a teaspoon of a mixture of 200 ml of boiling water, strain and drink in a few minutes during a day in small sips;
  • mix 10 g of leaves of heather, mallow, nettle, yarrow and St. John's wort, add 15 g of raspberry and blackberry leaves, bark of buckthorn, brew a teaspoon of a mixture of 200 ml of boiling water, after three minutes strain and drink during the day in small sips.

In spring it is recommended to drink birch sap, all year round in the morning - green tea. Improves the digestion of fresh cranberry juice, mixed in equal parts with beetroot. This mix also reduces pressure and relieves spasms of blood vessels. It is recommended to drink three times a day for a quarter of a glass.

Grind the hips and lingonberries (quantity equal in weight). Take a tablespoon of the mixture, brew with boiling water and insist to a saturated color. Take half a cup before breakfast and dinner. In the same way, you can prepare an infusion of equal weight parts of berries of red mountain ash and nettle leaves.

You can make baths with herbs, adding sea salt to them. For baths use: juniper, wormwood, horsetail, chamomile, burdock, thyme, string. You can choose any combination of these herbs. The bath is taken at night. After the bath, dryness is not wiped, gently wetting the body with a towel, putting on a shirt made of natural cloth and wrapped in a blanket.

Homeopathy

Treatment with homeopathic remedies can benefit the sick with obesity of the heart. Means that can be prescribed for discomfort in the heart area:

  • Arnica Montana - appointed with increased arterial pressure, sclerotic changes in the arteries, fatty degeneration, swelling, angina, has a pronounced analgesic effect;
  • Cactus grandiflorus - has a beneficial effect on the entire body, and especially on the cardiovascular system, in particular, it is prescribed with rapid heartbeats in motion and at rest, heart pain, atrial fibrillation;
  • Natrium muriaticum - tachycardia, rhythm and conduction disorder, atrial flutter in patients with eating disorders who eat all the time, which catches their eye, even when not hungry (this drug can be shown to patients with endocrine obesity);
  • Lycopus - dyspnea, paroxysmal ciliary arrhythmia, high blood pressure, heart failure; cardiac symptoms in diseases of the thyroid gland.

In cases of abnormal function of the predominantly right ventricle, Kalium Carbonicum, Phosphorus, Digitalis, Convallaria majalis are prescribed.

Homeopathic treatment is prescribed by a physician of appropriate qualification, considering many factors, so he can choose any homeopathic remedy that is constitutionally or symptomatically suitable for his patient.

Surgery

Obesity of the heart is mainly caused by a significant overweight, therefore, the main treatment is to normalize the weight.

The question of surgical intervention for obesity is solved in cases of decompensated hypertension, which can not be medicated and other serious complications individually. Laparoscopic operations (more often - gastric banding) are performed by a patient with a body mass index above 35. Liposuction is not applied, since it is a cosmetic operation, for health, from the point of view of modern medicine, is absolutely useless.

By itself, obesity of the heart is not treated operatively, with full replacement of muscle fibers with fat tissue and loss of cardiac muscle function is recommended organ transplantation.

Diet for obesity of the heart

Modern medical research suggests that a diet, especially with a sharp decrease in calories, although it gives a quick result in weight loss, but after its termination, obesity is often increased. Each subsequent attempt to lose weight with a strict diet leads to the fact that it becomes more difficult to lose weight with each time, and it becomes easier to gain extra pounds, and the gain with each subsequent attempt increases. Therefore, the orientation towards a quick result is a bad practice.

Nevertheless, it is necessary to control the caloric content of the diet and take into account its relationship with physical activity. The World Health Organization recommends for the successful normalization of weight to calculate the calorific value of a normal daily diet and reduce it every month by 500 kcal. It should be stopped when caloric content is lower than the need for a specific patient in energy resources by 300-500 kcal (for people not engaged in intensive physical activity, it is considered necessary to consume an average of 1500 to 2000 kcal per day).

With obesity of the heart, the basic principles of the diet are used to reduce the significant excess weight, the basis can be taken table number 8.

It is allowed to use the following foods and dishes from them: all varieties of cabbage, cucumbers, tomatoes, peppers, zucchini, eggplants, carrots, beets, radish, turnips and radishes, fresh green peas, leaf salad of all sorts, spinach, sorrel. Proteins provide the body with fatty meat (fish) dishes. It is allowed to eat mushroom dishes. Drinks - mineral water, not sweetened tea and coffee without cream. These products will not cause excessive fatty deposits, but they need to be used taking into account individual tolerance and concomitant diseases. Dishes for daily use are recommended to cook for a couple, stew, cook and bake.

Products, the use of which must be reduced by half from the usual portion:

  • skimmed milk and sour-milk products, not fatty sorts of cheese (less than 30%) and cottage cheese (less than 5%);
  • potatoes, peas, beans, lentils, cereals from cereals, pasta - portions of not more than six tablespoons are allowed;
  • bakery products from whole-grain flour, with bran (maximum 150 g per day);
  • fruit;
  • eggs.

Exception (strict limitation) is subject to:

  • alcohol and sweet drinks;
  • butter, sour cream, cream;
  • vegetable oil - no more than one tablespoon per day;
  • mayonnaise, fatty (> 30%) cheeses and cottage cheese (> 5%);
  • fatty meat and fish, lard;
  • fried food;
  • smoked products, sausages;
  • canned in oil;
  • nuts and seeds;
  • honey, sugar, jam, jam, confiture;
  • ice cream, confectionery and baked pastries.

Prevention

To prevent obesity of the heart is not difficult, it is only to control your weight and keep it in the norm. Even people who are prone to fatness, but who do not overeat, do not bring their weight to the stage of obesity.

Combines all methods of combating excess kilograms and preventing obesity of the heart-limiting the number of foods consumed, accelerating metabolic processes, and physical activity adequate for consumed energy. Principles of dietary nutrition are based on reducing the energy value of consumed foods by eliminating digestible fats and carbohydrates while maintaining the required amount of protein food.

Forecast

The prospects for slowing the growth of fat in the heart of a particular patient depends on the timeliness of the initiation of treatment, the seriousness of the attitude towards medical recommendations, energy, age and concomitant pathologies.

Last update: 25.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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