Cardiac obesity

This formulation suggests excessive accumulation of lipids in the heart muscle or abnormal growth of fatty tissue under the epicardium, leading to dystrophic changes in muscle tissue. The disease develops in people suffering from obesity. It is this, forcing the heart muscle to constantly work in overload mode, and not cardiac pathology, that over time leads to cardiac and respiratory failure.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Epidemiology

In the modern world, the problem of excess weight, which has a negative impact on health and, among other things, causes this type of fatty myocardial dystrophy, is quite acute. The top twenty countries in which from a quarter to a third of the population suffers from obesity are headed by Mexico, the United States of America and Syria. Among Mexicans, approximately 70% are overweight, almost 33% are obese. They are being caught up by Americans and Syrians (about 32%). The top twenty mainly includes Latin American and Asian countries, as well as Australia and New Zealand. Hungary is in twentieth place, and the line above it is occupied by Great Britain and Russia. In these countries, approximately a quarter of their residents suffer from excess weight in the obesity stage.

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

[ 11 ], [ 12 ], [ 13 ], [ 14 ]

Causes cardiac obesity

The main etiological factor is considered to be genetic; a tendency to excessive obesity is often observed in members of the same family. Family traditions regarding diet – preference for fatty foods, encouragement of overeating, insufficient consumption of vitamins, minerals, fiber leads to a slowdown in metabolism and accumulation of excess fat deposits in the body tissues. And this type of fatty myocardial dystrophy, called cardiac obesity, develops against the background of significant excess weight of any genesis.

There are numerous risk factors for gaining weight and, consequently, “earning” heart obesity. These include age (as the years go by, more and more muscle cells are replaced by fat cells), stressful situations that cause many to want to “eat away” the troubles that have arisen; nervous diseases, in particular, bulimia; some mental pathologies; hormonal surges (puberty) and the fading of their activity (menopause).

The risk of developing obesity of the heart is much higher in people leading a sedentary lifestyle; in athletes who have finished their careers and sharply reduced physical activity; in beer lovers; in cases of endocrine and genetic disorders; diseases of the digestive organs, circulatory system, liver and kidneys. Among the risk factors are long-term use of psychotropic drugs. There is a high probability of gaining excess weight in people who have been exhausting themselves with a strict diet for a long time - the body intensively replenishes fat reserves after stress caused by prolonged malnutrition.

Fatty myocardial dystrophy caused by primary (alimentary) obesity is always associated with overeating and a sedentary lifestyle, in which energy consumption does not correspond to its expenditure. In secondary obesity, which develops as a result of diseases, the connection between obesity and high-calorie nutrition and physical inactivity may not be observed.

[ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ]

Pathogenesis

In the mechanism of development of cardiac obesity, the leading pathogenetic links are considered to be oxygen starvation of cardiomyocytes, as a result of diseases leading to disruption of metabolic processes, or disruption of the diet (preference for carbohydrate-containing foods against the background of a deficiency of vitamins and proteins).

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

Microscopic droplets of fat appear in the myocardial cells, gradually completely replacing the cytoplasm of muscle cells. Fatty dystrophy of the cardiac muscle is detected by foci of fat cells that have replaced cardiomyocytes. Cell replacement occurs in different functional systems of the cardiac muscle, which causes disturbances in the rhythm and frequency of heart contractions, cardiac conduction. The automatism of the myocardium is upset.

When fatty tissue grows under the outer serous cardiac membrane (epicardium), it penetrates deep into the layers of the heart muscle, which becomes heterogeneous, penetrated by bundles of fatty tissue of varying thickness. Due to the pressure of the fatty strands, atrophy of muscle fibers develops and progresses. Over time, the epicardium turns into a layer of fatty tissue penetrated by blood vessels.

[ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ]

Symptoms cardiac obesity

Fatty myocardial dystrophy itself does not have clear symptoms. It is typical for many disorders of cardiac activity. The first signs that you should pay attention to are shortness of breath, which appears after unusual and more intense physical activity. A person feels that he does not have enough air, difficulties arise when inhaling. Breathing becomes more frequent, noisy and less deep. Shortness of breath is usually noticed by others. Cardiac shortness of breath is caused by hypoxia, which occurs when the heart rate is insufficient for normal blood supply to the brain and lungs. To compensate for the lack of oxygen, breathing becomes more frequent. At the beginning of the disease, shortness of breath occurs against the background of physical activity. The lack of proper treatment leads to the fact that in later stages shortness of breath appears even in a patient at rest. The higher the body mass index of a person, the more noticeable it is that he suffers from shortness of breath.

The further process of muscle tissue degeneration into fat provokes myocardial dysfunction (decrease in rhythm, frequency and disruption of the sequence of its contractions, electrical conductivity). Symptoms of heart failure arise. Dyspnea is accompanied by pain in the heart area, arrhythmia, tachycardia and hypertension. The clinical picture is supplemented by tinnitus and dizziness, headaches and fainting are possible, as well as an enlarged liver, swelling of the legs.

Cardiac obesity in children is also associated with excess weight and can cause symptoms of heart problems: shortness of breath, irregular heart rhythms and palpitations, and fluctuations in blood pressure.

Types of cardiac obesity are the proliferation of fatty tissue located under the epicardium or focal fat deposits in the heart muscle. Both of these types lead to serious degenerative changes in the myocardium.

According to the localization of fat deposits, obesity can be symmetrical, and also divided into upper, middle and lower.

In the initial stage, fatty heart disease does not cause noticeable symptoms and the presence of lipids in cardiomyocytes can only be seen under a microscope. In a more advanced stage, the heart increases in size, its chambers stretch. The myocardial tissue becomes flabby and acquires a striped yellow-white color, called "tiger skin". In the outer serous membrane of the heart, especially on the right, there is an overgrowth of fatty tissue, which covers the heart like a case. Simple fatty heart disease, when there are no gross destructive changes in the cells, is reversible with adequate treatment. Without treatment, heart failure develops, primarily right ventricular. More advanced stages of fatty degeneration can lead to death due to thinning of the myocardium and its rupture.

Complications and consequences

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

The patient's life is endangered by possible complications of fatty heart disease - right ventricular paroxysmal tachycardia and third-degree atrioventricular block.

[ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ]

Diagnostics cardiac obesity

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

The earliest stages, when instrumental diagnostics are not yet able to detect it, almost never fall into the field of view of doctors. If the patient has complaints about cardiac dysfunction, then usually instrumental studies can already register some changes.

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

An ultrasound examination of the heart will allow you to assess the size of the heart, the thickness of the walls of the heart chambers, and the contractility of the myocardium. One ultrasound may not be enough; the doctor may prescribe phonocardiography, X-ray, coronary vessel examination, cardiac electrophysiology, and other diagnostic procedures to obtain additional information. Magnetic resonance imaging 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 that led to obesity of the heart. The patient is prescribed blood tests - clinical, glucose level, thyroid hormones, adrenal glands, female sex hormones. Instrumental diagnostics are prescribed depending on the suspected diagnosis of the underlying disease.

Based on the anamnesis and a thorough examination, differential diagnostics are carried out, which allows identifying the primary disease and differentiating obesity of the heart from other diseases of the cardiovascular system that can develop in a patient suffering from excess weight.

[ 35 ], [ 36 ], [ 37 ], [ 38 ]

Treatment cardiac obesity

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

Combating excess weight and oxygen starvation is impossible without changing the patient’s habits and lifestyle, which includes, primarily, giving up bad habits, increasing physical activity in combination with following a dietary regimen and eating habits.

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. Over the entire course of treatment, a weight loss of 10% is considered sufficient to prevent the development of heart pathologies.

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 reduce the load on the heart, freeing it from the need to pump excess fluid around the body. In case of congestion, hypertension caused by cardiac dysfunction, Furosemide is prescribed, which is characterized by fast action, works well both in conditions of blood acidification and alkalization. It can be prescribed to patients with impaired renal function, since it does not affect glomerular filtration. Contraindicated in the terminal phase of renal dysfunction and in the presence of mechanical obstruction to urination. Not prescribed in the first three months of pregnancy. May cause skin and gastrointestinal side effects, promotes the excretion of potassium and an increase in blood sugar levels. Orally, a daily single morning dose of 40 mg of the drug is prescribed, if necessary, a dose of 80 mg.

Potassium loss, which is necessary for normal functioning of the heart muscle, can be prevented by using the complex diuretic Furesis compositum, the active components of which are furosemide and triamterene, which preserves potassium in the body. Therefore, patients without hyperkalemia can be prescribed this diuretic. The standard dosage involves taking one or two tablets once in the morning, if necessary, you can take two pieces (in the morning and during the day). After the swelling has reduced, switch to maintenance treatment (one or two pieces at intervals of two to three days).

Using diuretics alone can help lower blood pressure and reduce weight.

In case of persistent hypertension, drugs from the group that inhibit the enzymatic activity of the catalyst for the synthesis of angiotensin II (a hormone produced by the kidneys) are prescribed. They promote relaxation of blood vessels, reduce blood pressure in them and the load on the heart. Enalapril belongs to this group. When it enters the body, it is hydrolyzed into enalaprilat, which inhibits the 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 blood circulation in the pulmonary circulation and in the renal vessels. The duration of the hypotensive effect after a single oral dose of the drug is about a day. The drug can cause side effects on the skin and vegetative-vascular system, often causing a dry cough, very rarely - angioedema. Contraindicated in people 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 blood vessels in the brain, thromboembolism.

In case of intolerance to the previous group of drugs, drugs are prescribed that directly block the receptors of the renal hormone. The effect is similar to the effect of angiotensin-converting enzyme inhibitors. These drugs have very rare side effects and do not cause dry cough.

This group of drugs includes Valsacor, a hypotensive agent that acts on the renin-angiotensin-aldosterone system. Its action does not affect the heart rate, is effective in edema, and helps normalize respiratory function.

Valsacor H and HD variants are complex, containing a second active ingredient – the diuretic hydrochlorothiazide, which has hypotensive activity and removes Na, Cl, K and water from the body. The active substances, hypotensive and diuretic, synergistically complement each other's effects and reduce the likelihood of negative results of taking.

A significant decrease in blood pressure is observed after half a month from the start of treatment. The maximum effect of the drug is observed approximately a month later. A single oral dose of the drug provides a 24-hour effect.

It is not recommended for women planning pregnancy, pregnant women and nursing mothers, as well as for minors, sensitized people and those in the terminal stage of renal failure.

At 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.

The maximum dose that can be prescribed is 160 mg/day, taken at one time or divided into 80 mg for morning and evening intake. If the therapeutic effect is unsatisfactory, the monodrug is replaced by a complex version of h or hd.

To correct the heart rate, Coraxan may be prescribed, which contains ivabradine, which has opened a new group of drugs that inhibit the If channels of the sinus node, which leads to a selective and dose-dependent decrease in its rhythm frequency. Ivabradine-based drugs are prescribed to patients whose heart rate is higher than 70 beats/min, regardless of their intake of ß-blockers. This substance practically does not cause side effects, except for photopsia.

The use of standard therapeutic doses - from 5 to 7.5 mg twice a day during meals leads to a decrease in heart rate by about 10 beats/min, 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 conduction, does not cause an inotropic effect and ventricular repolarization syndrome.

Vasodilators or vasodilators, the most well-known of which is Nitroglycerin, which has a short action and is used when needed, relieve pain and eliminate vascular spasms. They can be used locally, as they are available in the form of ointments or patches.

In case of arrhythmia, β-blockers of classes II-V are prescribed according to symptoms. Antiarrhythmic drugs are prescribed to correct the heart rhythm. For example, Cordanum, which belongs to class II of this group. The drug normalizes the heart rhythm, slows down intracardiac conduction, relaxes the heart muscles, reducing its contractions, and reduces oxygen consumption. Treatment begins with taking one tablet once a day half an hour or an hour before meals, if necessary, the dosage is adjusted towards increasing the portion or frequency of administration. May cause side effects and withdrawal syndrome.

Side effects of antiarrhythmic drugs depend on their class. This should be taken into account by the doctor when prescribing.

Vitamins are prescribed to normalize the patient's weight and body condition. For example, vitamin B6 is necessary to normalize the functioning of the heart muscle tissue and nervous system, promotes the absorption of polyunsaturated fatty acids, accelerates the process of protein and amino acid synthesis. People taking diuretics need vitamin B9 (folic acid), without it, high-quality hematopoiesis is impossible. Excess weight is often accompanied by a deficiency of vitamins D, A, E. With obesity, iron deficiency anemia often develops, diuretics remove many trace elements from the body. Therefore, the doctor may prescribe vitamin and mineral complexes.

Physiotherapy treatment is also carried out as prescribed by a doctor:

• laser therapy that stimulates blood circulation and cellular immunity;
• the effect of electric current pulses on adipose tissue, accelerating metabolic processes;
• cardiac stimulation;
• balneotherapy, which activates metabolic processes;
• mud therapy, which activates the respiratory function of tissues;
• ozone therapy, which strengthens the immune system and enriches tissues with oxygen.

Folk remedies

Since obesity of the heart is accompanied by significant excess weight, which is often caused by food excesses, traditional medicine can bring an undoubted effect. When treating with herbs, especially at the beginning of their use, weight is reduced quite actively. It should be taken into account that most folk remedies 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 useful vitamins and microelements with toxins and slags.

Cleansing teas are brewed from a mixture of herbs:

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

In spring, it is recommended to drink birch sap, and green tea all year round in the first half of the day. Fresh cranberry juice mixed in equal parts with beetroot juice improves digestion. This mix also reduces blood pressure and relieves vascular spasms. It is recommended to drink a quarter of a glass three times a day.

Grind rose hips and lingonberries (equal amounts by weight). Take a tablespoon of the mixture, brew with boiling water and leave to infuse until the color is rich. Take half a glass before breakfast and dinner. In the same way, you can prepare an infusion from equal parts by weight of red rowan berries and nettle leaves.

You can make herbal baths, adding sea salt to them. For baths use: juniper, wormwood, horsetail, chamomile, burdock, savory, string. You can choose any combination of these herbs. Take a bath at night. After the bath, do not wipe dry, lightly pat the body with a towel, put on a shirt made of natural fabric and wrap yourself in a blanket.

[ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ], [ 46 ], [ 47 ]

Homeopathy

Homeopathic treatment can be beneficial for patients with obesity of the heart. Remedies that can be prescribed for discomfort in the heart area are:

• Arnica Montana – is prescribed for high blood pressure, sclerotic changes in the arteries, fatty degeneration, edema, angina pectoris, 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 for rapid heartbeat during movement and at rest, heart pain, atrial fibrillation;
• Natrium muriaticum – tachycardia, rhythm and conduction disturbances, atrial fibrillation in patients with eating disorders who eat everything they see all the time, even when they are not hungry (this drug may be indicated for patients with endocrine genesis of obesity);
• Lycopus – shortness of breath, paroxysmal atrial fibrillation, high blood pressure, heart failure; cardiac symptoms in thyroid disease.

In case of dysfunction of the right ventricle, Kalium Carbonicum, Phosphorus, Digitalis, Convallaria majalis are prescribed.

Homeopathic treatment is prescribed by a suitably qualified physician, taking into account many factors, so he can choose any homeopathic remedy that is constitutionally or symptomatically suitable for his patient.

Surgical treatment

Obesity of the heart is mainly caused by significant excess weight, therefore the main treatment is weight normalization.

The issue of surgical intervention for obesity is decided in cases of decompensated hypertension, which does not respond to drug treatment and other serious complications individually. Laparoscopic operations (most often - this is gastric banding), are performed on patients with a body mass index above 35. Liposuction is not used, since it is a cosmetic operation, for health, from the point of view of modern medicine, absolutely useless.

Cardiac obesity itself cannot be treated surgically; if muscle fibers are completely replaced by fatty tissue and the function of the heart muscle is lost, organ transplantation is recommended.

Diet for obesity of the heart

Modern medical research suggests that dieting, especially with a sharp reduction in calories, although it gives a quick result in weight loss, but after it is stopped, obesity often increases. Each subsequent attempt to lose weight with the help of a strict diet leads to the fact that it becomes more and more difficult to lose weight each time, and it becomes easier to gain extra pounds, and the weight gain increases with each subsequent attempt. Therefore, focusing on quick results is a vicious practice.

However, 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 that for successful weight normalization, the caloric content of the usual daily diet should be calculated and reduced by 500 kcal each month. You should stop when the caloric content is lower than the specific patient's need for energy resources by 300-500 kcal (people who are not engaged in intense physical activity are considered to need to consume an average of 1,500 to 2,000 kcal per day).

In case of obesity of the heart, the basic principles of a diet for reducing significant excess weight are used, and table No. 8 can be used as a basis.

The following products and dishes made from them are allowed to be eaten: all types of cabbage, cucumbers, tomatoes, peppers, zucchini, eggplants, carrots, beets, radishes, turnips and horseradish, fresh green peas, lettuce of all types, spinach, sorrel. Low-fat meat (fish) dishes will provide the body with proteins. Mushroom dishes are allowed. Drinks - mineral water, unsweetened tea and coffee without cream. These products will not cause excess fat deposits, but they should be consumed taking into account individual tolerance and concomitant diseases. It is recommended to steam, stew, boil and bake dishes for daily use.

Products that need to be reduced in consumption to half of the usual portion:

• skim milk and fermented milk products, low-fat cheeses (less than 30%) and cottage cheese (less than 5%);
• potatoes, peas, beans, lentils, cereal porridge, pasta - portions of no more than six tablespoons are allowed;
• bakery products made from whole grain flour, with bran (maximum 150g per day);
• fruits;
• eggs.

The following are subject to exclusion (strict restriction):

• alcoholic 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 meats, sausages;
• canned food in oil;
• nuts and seeds;
• honey, sugar, jam, preserves, confiture;
• ice cream, confectionery and baked goods.

[ 48 ], [ 49 ], [ 50 ], [ 51 ]

Prevention

Preventing obesity of the heart is not difficult, you just need to control your weight and keep it within the norm. Even people who are prone to being overweight, but do not sin by overeating, 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 amount of food consumed, accelerating metabolic processes and physical activity adequate to the energy consumed. The principles of dietary nutrition are based on reducing the energy value of food consumed by eliminating easily digestible fats and carbohydrates while maintaining the required amount of protein food.

[ 52 ], [ 53 ], [ 54 ], [ 55 ], [ 56 ], [ 57 ], [ 58 ], [ 59 ]

Forecast

The prospects for slowing down the process of fatty tissue growth in the heart in a particular patient depend on the timeliness of treatment initiation, seriousness of the attitude to medical recommendations, energy, age and concomitant pathologies.

[ 60 ], [ 61 ], [ 62 ], [ 63 ]