Acute and chronic aneurysm of the heart: ventricle, septum, postinfarction, congenital

The pathology of the heart, which is a kind of engine of the whole organism, doctors are not in vain classified as the most dangerous for human life. Previously considered as diseases of the elderly, they have an unpleasant tendency to decrease the age of patients. Some pathologies with a rather large percentage of deaths, such as heart aneurysm, can develop in both adults and newborns. And this is already a signal to learn about this pathology as much as possible in order to prevent its development whenever possible.

[1], [2], [3], [4], [5], [6]

Epidemiology

Statistics argue that the disease is more likely to affect men after 40 years. Nevertheless, no one is immune from pathology, even small children, whose aneurysms of the heart can be congenital.

In the overwhelming majority of cases, an aneurysm is diagnosed in the anterior-lateral wall and the apex of the left ventricle of the heart. Aneurysm of the right ventricle, right atrium, posterior wall of the left ventricle, interventricular septum and aortic heart are considered a more rare diagnosis.

The most frequent and dangerous cause of the development of cardiac muscle weakness is a myocardial infarction in the past (according to various sources, from 90 to 95% of all cases of the disease). It is connected with it from 5 to 15% of cases of aneurysm of the left ventricle of the heart. If we take the total number of cases of interventricular aneurysm and left ventricular pathology, they constitute about 15-25% of the total number of patients.

[7], [8], [9], [10], [11], [12], [13]

Causes of the aneurysms of the heart

In most cases, heart aneurysm develops within three months after a myocardial infarction, but this period can last up to six months. Since the probability of a heart attack is the highest in the left ventricle and the septum separating the left ventricle from the right one, the aneurysm is formed in most cases exactly there.

Aneurysm of the heart in this situation develops as a result of deformation in the myocardial infarction of the site of the left ventricular heart muscle and subsequent necrotic tissue process. This type of aneurysm is called an aneurysm of the left ventricle of the heart. If there is a protrusion of the septum between the ventricles, then we are talking about the aneurysm of the interventricular septum of the heart.

But myocardial infarction is not the only reason for the appearance of weakened areas of muscle tissue in the heart. Such a state of affairs can be facilitated by other causes that can affect the heart's working capacity and the development of aneurysm.

Such reasons include:

• pathology, which itself develops due to hypoxia of the myocardium, and is called ischemic heart disease,
• an inflammatory disease affecting the myocardium, which most often has a viral or infectious etiology (myocarditis).
• pathology associated with persistently high blood pressure, referred to in medical circles as arterial hypertension,
• injuries of the heart muscle (consequences of accidents, falls from the height, impacts with sharp objects, etc.), as well as injuries in the heart, received during the execution of hostilities or in peacetime. Here we are talking about post-traumatic aneurysm, in which the interval between the traumatic event and the onset of the disease can be even of the order of 10-20 years.

To provoke the development of an aneurysm of the heart can also excessive physical exertion for a couple of months after a heart attack. For this reason, people who have had an infarction doctors recommend refraining from actively playing sports or doing heavy physical work at home or at work.

[14], [15]

Risk factors

Risk factors for the development of an aneurysm of various parts of the heart can be considered:

• Various infectious pathologies leading to deformation of the vascular walls and disturbance of the blood flow in them, for example:
  • venereal diseases (mainly syphilis), disrupting the work and integrity of many systems of the body,
  • inflammatory processes, encompassing the endocardium of the heart, and adversely affecting the ability of muscles to actively contract (endocarditis),
  • a serious infectious disease called tuberculosis, causing complications in various organs and systems of organisms,
  • rheumatic fever.
• Harmful habits such as tobacco smoking and alcohol abuse, which adversely affect the entire cardiovascular system.
• Heart operations and their consequences (for example, postoperative complications caused by the use of poor-quality materials, low qualification of the surgeon or features of the patient's body that were not taken into account by the doctor, the development of tachycardia or increased blood pressure in the ventricle in the postoperative period, etc. ).
• Negative effects on the myocardium of certain substances that cause its intoxication and inflammatory processes in the muscle (in this case it is a toxic myocarditis). This happens if a person is excessively addicted to alcohol, with an excess of thyroid hormones, kidney pathologies and gout, characterized by an increase in the uric acid level in the patient's blood, when substances that are badly transferred to him (drugs, vaccines, poison of insects, etc .).
• Systemic diseases in which antibodies to the "foreign" cells of the cardiac muscle begin to be produced in the patient's body. In this case, the cause of an aneurysm of the heart may be red lupus erythematosus or dermatomyositis.
• Cardiosclerosis - a disease in which there is a gradual replacement of muscle tissue connective, reducing the resistance of the heart wall. The causes of this pathology are not fully understood.
• Irradiation of the thoracic cavity organs. Most often occurs during the radiotherapy for tumors with localization in the sternum.

Among other things, an aneurysm of the heart can also be congenital in nature, with which doctors often face, diagnosing this pathology in children. There are 3 factors that determine the development of this disease:

• Hereditary factor. Disease can be inherited. The risk of this pathology increases significantly if the child's relatives had an aneurysm of the heart or blood vessels.
• Genetic factor. The presence of chromosomal abnormalities and associated qualitative or quantitative defects in connective tissue. For example, with Marfan's disease there is a systemic insufficiency of connective tissue in the child's body, progressing as it grows up.
• Congenital anomalies of the structure of the heart tissue, for example, partial replacement in the myocardium of muscle tissue connective, unable to withhold blood pressure. Such violations of the heart structure in a child are often associated with a problematic pregnancy course in the mother (smoking, alcoholism, taking forbidden drugs during pregnancy, infectious diseases in the pregnant woman, such as influenza, measles, etc., exposure to radiation, harmful working conditions, etc.). .

[16], [17], [18], [19], [20], [21]

Pathogenesis

To understand what an aneurysm of the heart is, you need to go a little deeper into the anatomy and remember what the human motor is - the heart.

So, the heart is nothing more than one of the many organs in our body. Inside, it is hollow, and its walls are made up of muscle tissue. The heart wall consists of 3 layers:

• endocardium (inner epithelial layer),
• myocardium (middle muscle layer),
• epicardium (outer layer, which is a connective tissue).

Inside the heart there is a solid septum that divides it into two parts: the left and the right. Each of the parts in turn is divided into an atrium and a ventricle. The atrium and ventricle of each part of the heart are connected by a special hole with a valve open to the side of the ventricles. The two-fold valve on the left side is called mitral, and the tricuspid on the right side is tricuspid.

Blood from the left ventricle enters the aorta, and from the right - into the pulmonary artery. The return current of the blood is prevented by the semilunar valves.

The work of the heart is a constant rhythmic contraction (systole) and relaxation (diastole) of the myocardium, i.e. There is an alternate contraction of the atria and ventricles that push blood into the coronary arteries.

All of the above is typical for a healthy body. But if, under the influence of some causes, the portion of the muscular part of the heart becomes thinner, it becomes unable to resist the blood pressure inside the organ. Having lost the ability to resist (usually due to insufficient supply of oxygen, a decrease in muscle tone or disruption of the integrity of the myocardium), this area begins to stand out against the background of the entire organ, protruding outward and in some cases sagging in the form of a pouch with a diameter of 1 to 20 cm. This condition is called an aneurysm heart.

The pressure of blood on the walls of the heart remains uniform and constant. But a healthy part of the muscular wall can restrain it, and the weakened (deformed) is no longer there. If the capacity and resistance of the septum separating the ventricles or the atrium of the two halves of the heart is disturbed, it can also protrude to the right side (since it is physiologically conditioned that the left ventricle works more than the right one), but already inside the organ.

The ischemic muscular wall loses its ability to contract normally, remaining predominantly in a relaxed state, which can not but affect the blood flow and nutrition of the whole organism, and this in turn leads to the appearance of other life-threatening symptoms.

So, we figured out what is the heart and how such a dangerous cardiac pathology as an aneurysm of certain areas of the heart arises. And even found out that the most "popular" cause of the development of this disease is another life-threatening heart pathology - myocardial infarction, as a result of which the necrotic areas and scars formed in the main cardiac muscle disrupt the supply of oxygen and nutrients to the muscle and reduce its resistance.

[22], [23], [24]

Symptoms of the aneurysms of the heart

The fact that an aneurysm of the heart can have different sizes, localization and causes of pathology, causes significant differences in the manifestation of the disease in different people. Nevertheless, in order to capture the disease at the very beginning, without expecting the growth of an aneurysm to critical dimensions (it is clinically important to reduce muscle resistance even in a small area of 1 cm), one should know and pay attention to at least those symptoms that are peculiar any of the types of aneurysms of the heart.

To the first signs on which an aneurysm of the heart of any localization is determined, it is possible to relate:

• Pain in the region of the heart or a feeling of heaviness (pressure) behind the sternum on the left. The pain is paroxysmal. When a person is resting and calm, the pain subsides.
• Malaise and weakness, which resulted from the shortage of oxygen to the neuromuscular system. This is due to a decrease in the volume of the distilled blood due to insufficient contractile function of the myocardium in the area of the aneurysm.
• Violations of the heart rate, called arrhythmia, and a feeling of a strong heartbeat, which a normal person does not feel (according to the complaints of patients, the heart is beating hard). The reason for this condition is the inadequate conductivity of nerve impulses in the aneurysm area and a large load on the diseased organ. Arrhythmias are aggravated by stress or heavy physical exertion.
• Disturbances in the rhythm of breathing, shortness of breath or simply shortness of breath, which in case of acute illness can be accompanied by attacks of cardiac asthma and pulmonary edema. High blood pressure inside the heart is gradually transferred to blood vessels that supply blood to the lungs. As a result, oxygen metabolism is disturbed and it becomes more difficult for a person to breathe. Hence the downtrodden breathing rhythm.
• Pale shade of skin. The reason again is a violation of the supply of oxygen to the tissues of the body. First of all, resources are sent to vital organs (brain, heart, kidneys), and the skin remains less saturated with blood.
• Cold extremities and their rapid freezing, associated with a violation of blood circulation.
• Reducing the sensitivity of the skin, the appearance of "goose bumps".
• A dry paroxysmal cough, not associated with a cold or infection. It is also called heart. It can be a consequence of stagnant phenomena in the pulmonary vessels, and may appear as a result of squeezing the lung with an aneurysm of large dimensions.
• Increased sweating.
• Vertigo, or, in a popular way, dizziness, which can occur with varying frequency.
• Swelling, which can be observed both on the face, and on the hands or feet.
• Fever for a long time (with acute aneurysm).
• A strong filling of the veins in the neck with blood, so that they become more noticeable.
• A hoarse voice.
• The accumulation of fluid in the abdominal or pleural cavity, enlargement of the liver, dry pericarditis, which is an inflammatory process in the cardiac bag (pericardium), accompanied by fibrotic changes, violation of the patency of various blood vessels (can be detected during diagnostic activities in chronic aneurysm).

Symptoms of heart aneurysm can be imposed different manifestations of other existing pathologies of the cardiovascular and respiratory systems, which significantly complicates the diagnosis of the disease. And the symptoms themselves, depending on the size of the aneurysm, can be expressed in varying degrees. With a small or congenital aneurysm of the heart, the disease for a long time can generally take place without any suspicious symptoms and recall yourself much later.

Where in the heart area is the aneurysm diagnosed most often?

As already mentioned, the most common form of myocardial pathology is an aneurysm of the left ventricle of the heart. It is this area that is loaded with work more than others. Experiencing the greatest burden, the left ventricle is more prone to damage due to myocardial infarction. And consequently, an aneurysm is often found on it. This can also contribute to heart injuries or infectious pathologies.

During the diagnostic activities, the doctor can observe the protrusion of the wall of the left ventricle. Most often, the aneurysm of the left ventricle of the heart is the anterior wall of the heart. But cases of illness are frequent, where the top of the heart on the left side becomes the site of aneurysm localization (protrusion).

Such pathology is not characteristic for children due to the absence of the reasons for this category of patients, which can lead to the development of this disease.

Less frequent in patients is an aneurysm of the heart vessels. It can be an aneurysm of the ascending aorta of the heart, as well as a protrusion of the aortic sinus wall.

In the first case, the disease is caused mainly by inflammatory processes that arise as a consequence of diseases of an infectious nature. Complaints of patients are reduced to aching pains in the chest, dyspnea and edema of various localization due to squeezing the wall of the aorta with a passing hollow vein.

Aneurysm of the sinuses of the aorta is associated with a decrease in the lumen of the coronary arteries, as a result of which, under the pressure of the blood, the wall weakened for some reason begins to sag, exerting pressure on the right side of the heart. Fortunately, the pathology of the vessels of the heart, associated with weakening from the walls, are infrequent.

An aneurysm of the interventricular septum does not occur very often, since it is among the congenital heart diseases. However, not in all cases it is found during pregnancy or immediately after the birth of the child. It happens that the congenital maldevelopment of the septum between the ventricles of the heart causes an aneurysm to protrude after a while.

Most often, this pathology is detected by chance, in particular, during echocardiography, because it is characterized by an asymptomatic course.

An aneurysm may choose to place its location in other areas of the heart (right ventricle or atrium, posterior wall of the left ventricle), but this happens rarely.

Aneurysm of the heart in children

No matter how strange it may sound, the heart diseases are peculiar not only to elderly and mature people. These pathologies can also affect young people, adolescents and even very young children.

Pathological protrusion of the site of the cardiac muscle in children is associated with the developmental defects of one or more valvular valves, interventricular or interatrial septum, resulting in an aneurysm at this site.

Such a rare pathology, like the aneurysm of the atrial septum, which can remind oneself even in adulthood, occurs even in the prenatal period due to the underdevelopment or alteration of the structure of the septum of the heart that separates the left and right atrium. By analogy, an aneurysm of the interventricular septum is formed.

In childhood, these types of heart disease are very rare (no more than 1% of all patients), nevertheless, they pose a great danger to the life of the child. Well, if the pathology is detected even during the ultrasound of a pregnant woman. Then the child after his birth immediately put on the record to the cardiologist, and after the baby turns a year old, he begins to prepare for an operation to remove the aneurysm.

The likelihood of an aneurysm of the heart is higher in children born with low weight, and premature babies. This is due to the fact that heart defects in these categories of children are much more common, and they are more likely associated with underdevelopment of the muscular or cardiovascular system of the heart.

While the child is small, a congenital aneurysm of the heart may not manifest itself in any way, but as the child grows up and increases in motor activity, and thus the heart, the following symptoms may appear:

• diffuse pain in the chest,
• shortness of breath and shortness of breath after physical exertion,
• the occurrence of periodic pain in the heart,
• causeless cough without excretion of phlegm,
• fast fatigue, weakness and drowsiness,
• regurgitation in feeding (in infants), nausea (in older children),
• headaches with active movement, dizziness,
• strong sweating regardless of air temperature.

During the diagnosis, doctors also determine such manifestations of the disease as

• abnormal pulsation in region 3 of the rib on the left, when listening to it resembles the sound of swinging waves,
• thrombi, adherent to the walls of large arteries of the heart, arising from the violation of blood circulation,
• arrhythmias, as a result of playing sports and stress.

A special danger for both adults and children is the rupture of the heart aneurysm due to the strong thinning of the muscular walls. That's why the doctors forbid to go in for sports with such a diagnosis, because this is associated with a significant increase in the load on the heart muscle. In the future, patients are advised to lead a healthy lifestyle, avoid stressful situations and adhere to a rational diet.

[25], [26], [27], [28], [29], [30], [31], [32], [33]

Stages

The stage of an aneurysm can be determined by the degree of damage to the heart wall. If there is a complete atrophy of the contractile ability of the heart muscle (akinesia), one speaks of a severe stage of the disease with a serious circulatory disorder.

If this is observed, the swelling of the aneurysm wall, depending on the stage of the cardiac cycle (systole or diastole), this condition is considered borderline. Although a circulatory disturbance is observed in this case, the symptomatology of the disease and its prognosis will be different.

[34], [35]

Forms

Aneurysms of the heart can be classified according to different indices:

• time of education,
• form,
• mechanisms of formation,
• dimensions,
• "Material" of the aneurysm wall.

Classification of cardiac aneurysms according to the time of formation is made only in relation to the pathologies caused by myocardial infarction. There are the following types of postinfarction aneurysms:

• Acute and most common form of the disease. The formation of an aneurysm in this case occurs within the first 2 weeks after an infarction, which caused disturbances in the walls of the myocardium. Patients experience an increase in temperature above 38 degrees for a long time, there are problems with breathing in the form of dyspnea, palpitation becomes rapid and its rhythm is lost. Analyzes of blood and urine indicate the development of the inflammatory process.

Acute aneurysm of the heart is dangerous by an increased risk of rupture of the pathological protrusion of the wall of the heart or vessels, which threatens the patient with death.

• Subacute aneurysm of the heart. It can appear in the period from 2-3 weeks and up to 2 months after the transferred myocardial infarction. The wall of this aneurysm is more dense and less prone to rupture due to fluctuations in blood pressure inside the ventricle than the acute type of aneurysm. Nevertheless, abnormal protrusions can put pressure on other organs, causing disruptions in their work. And on the circulation of blood, the reduction in the contractile function of one of the walls of the heart can not be reflected in the best way.
• Chronic aneurysm of the heart. This is already a kind of unpleasant surprise, which the patient receives after 2 or more weeks after a heart attack. Sometimes the chronic form of an aneurysm is a consequence of an incomplete acute.

Having formed, such an aneurysm is not prone to rapid growth or tearing under load. But its formation is fraught with the appearance of thrombi, chronic symptoms of heart failure, arrhythmia. This is the form with the most severe symptoms of malaise.

Classify an aneurysm of the heart in a form allows an echocardiogram. According to her data, an aneurysm can be:

• Diffuse
• Mushroom
• Saciform
• The exfoliating
• Aneurysm in Aneurysm.

Diffuse (flat) aneurysm is characterized by small dimensions, and its bottom is at the same level as the healthy myocardium. Nevertheless, bulging over time can increase and change shape. And yet a flat chronic aneurysm of the heart is considered a pathology with the most favorable prognosis.

Mushroom-like in appearance reminds a pitcher, standing on the neck. Saciform - protrusion with a wide base and a small mouth. It reminds of a diffuse aneurysm, but of a large size. Both mushroom-shaped and bag-shaped forms are considered dangerous, since the risk of blood clots inside the aneurysm or rupture of its wall is great.

The dissecting aortic aneurysm of the heart is the longitudinal stratification of the aortic walls, accompanied by an increase in the diameter of the main cardiac artery. Most often occurs as a result of often high blood pressure. Its symptoms and prognosis depend on the location of the localization of the bundles.

"Aneurysm in an aneurysm" is the rarest type of pathology when an additional bulging is formed on the wall of an already existing diffuse or sack-like aneurysm, characterized by a particularly thin stenochka and a tendency to tear at the slightest load.

The size of an aneurysm can be:

• Clinically insignificant - up to 1 cm.
• Small - 1-2 cm.
• Large 3-5 cm.

The mechanism of aneurysm formation is divided into:

• True
• False
• Functional.

The true aneurysm of the heart is formed directly from the weakened tissue of the heart itself. All of the above refers to this type of aneurysm.

False aneurysm of the heart is a pathological swelling formation, consisting mainly of adhesive tissue and a pericardial leaf (a pericardial sac). The presence of blood in such an aneurysm is due to a defect in the wall of the heart.

Functional aneurysm develops against a background of reduced contractile function of the site of the myocardium, which bends only during systole.

The aneurysm wall can consist of the following materials:

• muscle,
• connective tissue (fibrin),
• combination of two types of tissue (on the site of necrotic myocardium formed connective tissue).

In this regard, aneurysms are divided into muscle, fibrotic and fibro-muscular.

[36], [37], [38]

Complications and consequences

An aneurysm of the heart is not just a malaise, but a real threat to the life of the patient. The most dangerous complication of an aneurysm is its rupture. The account usually goes for minutes and seconds. If you do not take urgent measures to save the patient, death is inevitable, especially if the aneurysm is large.

The rupture of tissues is characteristic mainly for acute aneurysm, which develops after a myocardial infarction. The weaker infarcted tissue of the heart muscle is considered during the first or second week. It is during this period that an aneurysm of the heart can be ruptured.

Another terrible consequence of an aneurysm is the development of diseases caused by clotting of blood vessels by thrombi that formed in the cavity of the aneurysm and at some point began to move along the circulatory system. What kind of diseases can cause a broken clot, depends on its size and direction of motion.

Getting into the pulmonary artery and getting stuck in it, the thrombus provokes the development of a dangerous disease called thromboembolism, which threatens the patient with death, if no timely measures are taken to restore normal circulation of blood.

Getting into the peripheral vessels, a blood clot clogs them, leading to such complications as gangrene of the extremities (more often legs than hands).

The presence of a blood clot in the intestinal or renal artery can trigger the development of no less dangerous pathologies, such as mesenteric thrombosis (lethality about 70%) and a heart attack of the kidney (severe pathology, which, however, can be treated successfully).

A stroke of the brain may also be a consequence of a clot laceration and falling into the shoulder-head trunk. Among other things, the same thrombus sometimes becomes the culprit of recurrence of myocardial infarction.

As a complication of heart aneurysms, heart rhythm disturbances usually occur in patients. And any arrhythmia is a threat of hypoxia of various important organs in the human body, leading to a disruption in their functioning.

One of the most frequent consequences of an aneurysm is cardiac insufficiency (most often the left ventricle of the heart), which manifests itself in the form of weakness, chilliness, blanching of the skin, dizziness, dyspnea, dry cardiac cough, edematous syndrome with localization in the arms and legs. If, with the progression of the disease, there is pulmonary edema, this already threatens the patient not only with the fear of death, but also with a fatal outcome.

What is dangerous an aneurysm of the heart vessels? A small aneurysm can only slightly affect the blood circulation, but if its size eventually increases significantly under the pressure of blood flow, it can lead to atrophy of the ribs and sternum, and also promote the transmission of the atrium and ventricle located on the right side of the heart. The latter threatens to overflow the cervical veins, the development of edematous syndrome, increase in liver size.

Large aortic sinus aneurysms can pinch the pulmonary trunk. This state of affairs is life threatening for patients. In most cases, doctors simply do not have time to do anything, so death quickly comes.

The most dangerous is still the acute form of the aortic aneurysm, which in most cases is the result of a heart left heart infarction or an interatrial septum. Very often patients do not even have time to take to the operating room. Chronic and subacute form of pathology differ in a lower percentage of mortality, although they still pose a danger to the life and health of the patient, if not to seek medical help in time.

As you can see, an aneurysm of the heart is a pathology, joking with which is not worth it. And the sooner a diagnosis is made and the appropriate treatment is undertaken, the more chances a person has to avoid dangerous consequences for life and health of a dangerous pathology affecting the heart and the surrounding vessels.

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

Diagnostics of the aneurysms of the heart

The formation of an aneurysm is most often diagnosed on the walls of the left ventricle after a previous myocardial infarction in people older than 40 years. And its main danger lies in the fact that the weakened tissue can burst and blood splashes out of the heart, which, if delayed, often leads to the death of the patient.

[47], [48], [49], [50], [51], [52]

Treatment of the aneurysms of the heart

The choice of method of treatment depends on the size and type of aneurysm, as well as on the age of the patient and his condition. To correct the situation with the help of drug treatment and physiotherapy is not possible, since drugs that can restore the damaged muscles to their original shape and elasticity have not yet been found.

Prevention

Although surgical treatment of heart aneurysms is the preferred method of controlling the disease, as we have seen, it is not always possible. Medical treatment is also preferred for small relatively non-dangerous aneurysms.

But the whole point is that one conservative treatment is not limited to. In order that the aneurysm does not increase in size and do not break, the patient will have to revise the whole way of life and limit himself in something. Life with an aneurysm of the heart is a constant control of the heart and the fulfillment of the conditions necessary to prevent complications of the aneurysm.

First of all, the prevention of cardiac aneurysm complications involves the rejection of bad habits, and in particular from smoking and drinking alcohol, which increase the burden on the heart. Nicotine causes spasm of the coronary vessels, disturbances of the heart rhythm, narrowing of the vessels due to deposition of cholesterol on them. Alcohol, on the contrary, dilates the blood vessels, increasing the flow of blood through the damaged walls of the myocardium, provoking an infarction.

Particular attention will be paid not only to the full rest, which is necessary for any diseases, but also nutrition and physical exertion. Eating with an aneurysm of the heart diet (therapeutic diet number 10), involving the rejection of salty and spicy foods, fried foods, fresh bread, fatty meat or fish, products containing coarse fiber, strong tea and caffeine-containing products. The diet, based on vegetarian and light meat dishes with enough vegetables, fruits and dairy products, is designed to normalize blood circulation and facilitate the work of the diseased heart.

Physical stress in heart aneurysm should be minimized, because what is useful for a healthy person can be dangerous for a patient with cardiac pathologies. It's not just about the big physical exertion associated with sports or working, but also about active movement (running, climbing stairs and even fast walking). Such activity causes increased respiration and an increase in heart rate, which is dangerous for a weakened tissue of an aneurysm prone to rupture.

Nevertheless, to give preference to the hypodynamic way of life is also not worth it, so as not to earn additional health problems. Daily quiet walks on foot in the fresh air and the simplest physical exercises will not harm the weak heart, but will satisfy his need for oxygen.

Control of the heart requires regular measurement of blood pressure, as well as taking measures to normalize it.

The need to facilitate the work of the patient's heart involves both weight loss (if it is higher than normal) and timely access to a doctor if there are alarming symptoms (even if they are not related to cardiac activity).

[53], [54], [55], [56], [57]

Forecast

The prognosis of an aneurysm of the heart, especially after myocardial infarction, is difficult to call favorable. Without appropriate treatment, such patients die within the next 2-3 years after the formation of the aneurysm.

The best prognosis, of course, is for flat aneurysms, but saccate and mushroom aneurysms, which in most cases have a complication in the form of blood clots and heart failure, are a very common cause of death of patients. The comorbidities, such as diabetes mellitus or renal failure, worsen the prognosis, as well as the patient's respectful age.

It is not possible to unequivocally answer the question of how many patients live with an aneurysm of the heart. Everything depends on the type and size of the aneurysm, the methods of its treatment, and the age of the patient, when the heart aneurysm was formed. For example, if an aneurysm was formed in the interatrial septum as early as childhood and it was not removed, the patient is likely to live on the order of 40-45 years. Those who cross this threshold become disabled due to progressive heart failure.

If the patient is on medication, everything depends on the accuracy of the doctor's instructions not only about taking the medicine, but also about the way of life in general. After heart surgery, most patients live more than 5 (about 75%) and even more than 10 (30 to 60%) years. But again, throughout life they will have to restrain themselves in both physical activity and in some far from useful pleasures.

As for disability, such a scenario is considered to be quite possible, both with surgical aneurysm of the heart, and with certain complications after the operation. The group of disability is given mainly in chronic aneurysms, especially if they are complicated by severe heart failure or there are accompanying pathologies that worsen the patient's condition.

Various factors can influence the decision of the MCEC on the group. It is very likely that patients of pre-retirement age will receive disability and those with whom surgical operation is impossible for good reasons. If a patient with a limited capacity for work simply refuses the operation, the MCEC will insist on carrying out the operation before he can make the final verdict.

Patients with an aneurysm can receive both working 3 group, and non-working. Everything depends on their condition and working capacity. In some cases, patients are simply sent for re-qualification or are provided with another workplace where heart aneurysm will not interfere with the performance of labor obligations.

[58], [59], [60]