Cardiomegaly: what it is, signs how to treat

To date, diseases of the cardiovascular system occupy one of the leading positions among all pathological processes. Cardiomegaly or "bovine heart" is characterized by pronounced changes in the shape, volume and size of the heart muscle, resulting in a violation of the pumping process. This pathology is not an independent disease, but develops against the background of other cardiac diseases. Cardiomegaly can be both congenital and acquired, so it occurs equally often at any age.

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

Epidemiology

According to statistics from the World Health Organization, cardiomegaly accounted for 9% of all cases of cardiovascular disease, the incidence of the disease from 3 to 10 recorded cases per 100 000 people.

[5], [6], [7], [8], [9], [10], [11], [12]

Causes of the cardiomegaly

The increase in the size of the heart can be a consequence of both pathological and physiological changes. Natural processes include an enlarged heart in athletes, because of the high cardiac muscle loads it is necessary to pump large amounts of blood, and as a result, muscle fibers also increase. As for the pathological changes, the following causes are attributed to them, the impact of which may lead to the development of cardiomegaly:

• persistent increase in blood pressure;
• insufficient oxygenation of the heart muscle;
• congenital and acquired defects in the development of the structure of the heart muscle;
• myocarditis;
• pneumosclerosis;
• emphysema of the lungs;
• myocardial infarction.

[13], [14], [15]

Risk factors

Factors contributing to the development of cardiomegaly include:

• viral and infectious diseases;
• the use of necrotic drugs;
• alcohol abuse;
• tobacco smoking;
• genetic predisposition;
• labor activity, period of gestation;
• chronic anemia;
• weighed allergic anamnesis;
• diseases of the endocrine system;
• chronic stress;
• defeat of the renal apparatus;
• work with toxic substances.

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

Symptoms of the cardiomegaly

An accurate diagnosis is formulated not only on the basis of the examinations conducted, but also on the patient's complaints. Cardiomegaly often develops against the background of other pathologies of the cardiovascular system, so most often there are no specific symptoms on the basis of which it is possible to establish a precise diagnosis.

[21], [22], [23]

First signs

The first thing you need to pay attention to when you suspect a heart pathology is the presence of shortness of breath, swelling, pain in the heart and the development of a direct arrhythmia.

[24], [25], [26], [27], [28]

Cardiomegaly in the fetus and newborns

Cardiomegaly can be a congenital pathology of the heart muscle, which can be detected at the first planned ultrasound screening. This condition is quite dangerous in the first place for the child and for the mother as well. In almost every third case, the pregnancy ends with an interruption. Cardiomegaly of the fetus develops under the influence of negative factors on the pregnant woman in the first trimester, the period of the laying of all organs and systems.

Congenital heart defects can manifest themselves in the first few days after birth, but can retain a latent flow until the first signs manifest themselves at an older age. Cardiomegaly is manifested in newborns in the form of pronounced lethargy, rapid fatigue, anxiety, rejection of the breast, oral cyanosis.

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

Cardiomegaly in children

In children of all return groups, cardiomegaly is formed in the case of previously not diagnosed congenital or acquired heart defects. At this age, the pathological process manifests itself in the form: rapid fatigue, decreased attention, endurance, sleep disturbances, lack of appetite, neurological disorders and psychoemotional lability.

[34], [35], [36], [37], [38], [39], [40], [41]

Stages

Moderate degree of cardiomegaly

Most often, the myocardium of the left ventricle of the heart undergoes pathological changes, normally the thickness of the wall is 1-1.2 mm. Minor deviations from the norm are considered moderate.

1. degree of cardiomegaly

The first degree of development of cardiomegaly starts from an increase in the wall of the myocardium in the range from 1, 2 mm to 1.5 mm.

2. degree of cardiomegaly

The second degree corresponds to an increase in the wall thickness from 1.5 mm to 2 mm.

3. degree of cardiomegaly

The third degree of development of the pathological condition corresponds to an increase in the wall up to 2 mm and higher.

[42], [43], [44], [45], [46]

Forms

Types of cardiomegaly depend on the original cause, against which the pathological process developed.

[47]

Complications and consequences

The increase in the heart muscle can lead to the development of a number of other complications and pathologies, in addition to the one that is the primary cause of the development of cardiomegaly. With excessive heart enlargement, some parts of the myocardium are exposed to greater pressure, which can subsequently lead to the development of complications such as ischemia, heart attack or stroke.

[48], [49], [50], [51], [52], [53]

Diagnostics of the cardiomegaly

Diagnosis of this pathology, as well as any other disease of the cardiovascular system, is based on a number of laboratory and instrumental studies.

[54], [55], [56], [57], [58],

Auscultation in cardiomegaly

When examining a patient with a phonendoscope, the doctor can note the enlargement of the heart's borders, the muffledness of the tones, the weakening of the first tone at the top, the noise of regurgitation, and the appearance of a specific symptom of "gallop rhythm". More specific data depend on the initial cause of cardiomegaly.

[59], [60], [61], [62]

Analyzes

With the newly discovered cardiomegaly, a comprehensive blood test is needed, including serological, immunological and biochemical analysis.

Elevated parameters of CK and KFK-MB indicate the development of an acute process in the myocardium of myocardial infarction.

Elevated levels of iron and transferrin is a direct confirmation of the development of dilated cardiomyopathy.

The necrosis factor, natural killers, specific circulating antibodies are markers of dilated cardiomyopathy

[63], [64]

Instrumental diagnostics

ECG: ST-T change, in some cases LV hypertrophy, pronounced Q-wave in leads I, aVL, V5-6.

Echocardiography: LV and RV enlargement, violation of contractility, asymmetric hypertrophy of the septum, an increase in the thickness of the SVL.

Cardiomegaly on the roentgenogram

Conclusion on the development of cardiomegaly can be obtained by making an x-ray in two projections, most often using a straight and a side. The increase in LP is indicated by the doubled density of the radiographic shadow located along the right border of the heart and the elevated level of bronchus standing on the left side. The increase in the LV cavity is determined by decreasing the intensity of the shadow of the whole heart directly on the anterior rectal projection and increasing the LV contour. Increased PP is difficult to recognize on the roentgenogram, in some cases, a decrease in the curvature of the silhouette is noted.

Transesophageal echocardiography : is an additional method of diagnosis in those cases when the standard ECG cardiography was not very informative.

Stress ECHO-CT : a method of diagnosis that allows you to determine the etiology of the development of the pathological process (ischemic or non-ischemic heart failure) and evaluate the effectiveness of the treatment.

MRI (magnetic resonance tomography) : allows you to accurately determine the weight of the heart, the thickness of the walls, the volume of the left ventricle, in addition, using this method of diagnosis can determine the thickening of the pericardial sac and the length of necrosis.

[65], [66], [67], [68], [69]

Differential diagnosis

Comparative diagnosis of cardiomegaly is carried out with constrictive pericarditis, myxoma atrium and Ebstein abnormality.

Treatment of the cardiomegaly

If there are signs of cardiomegaly, a person should be warned immediately that the body develops irreversible processes that damage the walls of the myocardium and the heart cavity. Therefore, the most effective method of treatment in this situation is surgical intervention. But despite this, people suffering from this pathology, it is necessary to regularly maintain their condition with the help of drug therapy and comply with all the recommendations of the attending physician, in particular, concerning a healthy lifestyle.

Medication Therapy

Depending on the degree of development of the disease and on the presence of concomitant pathology, a course of medications is prescribed, which often includes:

• diuretic preparations:

Furosemide : from 40 mg per day.

Side effects: vomiting, nausea, dizziness, diarrhea, hypotension, redness, itching and swelling.

Contraindications: first trimester of pregnancy, breast-feeding, hypokalemia, renal coma, renal failure in the terminal stage.

• anticoagulants:

Warfarin : 2.5-3 mg once daily

Side effects: bleeding, anemia, allergic reaction, diarrhea, vomiting, dizziness.

Contraindications: allergic reaction to the substances included in the preparation, predisposition to bleeding, cirrhosis, hepatic and renal failure, malignant neoplasms, varicose veins esophagus, arterial hypertension.

• beta-blockers:

Anaprilin : 10-15 mg to 100 (maximum dosage) per day (the greater the dosage, the greater the number of receptions of 10-20 mg per dose)

Side effects: vomiting, nausea, dizziness, bradycardia, insomnia, severe pain in the neck and forehead, shortness of breath, cough, rashes in the form of urticaria, itching.

Contraindications: allergic reaction, stenocardia, atrioventricular blockade, bronchial asthma, diabetes, colitis.

• angiotensin receptor blockers:

Losartan : up to 5 mg once daily

Side effects: nausea, possibly vomiting, pressure decrease, hypercalcemia.

Contraindications: hypersensitivity to the components included in the drug, the period of gestation and lactation.

Cardiomegaly can develop against a background of vitamin deficiency, so one of the important components of drug therapy is the appointment of a complex of vitamins, which must necessarily include vitamin B1.

Physiotherapy

Another important component of the treatment of cardiomegaly is physiotherapy, which is recommended to be performed both during the period of exacerbation and during the period of remission. The following methods are most effective in the treatment of cardiomegaly:

• electrophoresis with anti-inflammatory drugs;
• UHF-therapy;
• magnetotherapy;
• inhalation with steroid hormones;
• DMV-therapy;
• radon or carbon dioxide baths;
• hypoxic therapy.

Contraindications to the physiotherapy procedures:

• average and severe degree of cardiac pathology;
• heart failure;
• circulatory insufficiency;
• arrhythmias.

Alternative medicine

In addition to drug therapy, many patients resort to old, proven recipes for alternative medicine, herbal collections help strengthen the heart muscle and purify the vascular system.

Herbal decoction : to prepare the broth you need 20g of horsetail, 50-60g of hawthorn and 40g of mountain herrings, the resulting mixture must be filled with a glass of boiling water and let it brew for one hour. Infusion take 20ml 6 times a day.

Tincture of rosemary on a red wine: 100g leaves of rosemary should be poured 2l of red table wine, let it brew in a dark and dry place for 30 days. Take 20 ml 2-3 times a day, lasting up to 6-9 months.

Adonis : a tablespoon of dry, chopped herbs pour a glass of hot water, let it brew in a warm place, then strain and take 1-2 tablespoons 3-4 times a day.

[70], [71], [72], [73], [74]

Recipes for the treatment of cardiomegaly with alternative agents

Cranberries : a berry rich in lots of vitamins, useful both in fresh and dried form. When heart diseases are recommended to consume 1 tablespoon of berries rubbed with sugar 3-4 times a day.

Red beet: with congenital cardiovascular system it is recommended to drink freshly squeezed red beet juice with one teaspoon of honey.

Garlic juice: to strengthen the wall of the heart muscle and blood vessels it is recommended in the morning, on an empty stomach, to drink 6-7 drops of garlic juice and a teaspoon of olive oil.

Homeopathy

Homeopathic remedies in the treatment of cardiomegaly also occupy a niche, most often recommend:

Arsenicum album : the drug is used in a dosage of 3 to 30 bars

Indications: cardiovascular diseases, gastrointestinal pathology, neuralgia, nephritis, bronchial asthma, pleurisy, pneumonia, eczema.

Side effects: diarrhea, nausea, vomiting.

Contraindications: renal failure, dyspepsia, neuritis.

Arnica : used in a dosage of 3 to 30 bars.

Indications: treatment of diseases of the cardiovascular system, the nervous system.

Side effects: dizziness, nausea, vomiting.

Contraindications: individual sensitivity to the components included in the drug, pregnancy, the period of breastfeeding, increased blood coagulability.

Claronin : dosage of 15 drops once a day.

Indication: IHD, angina, cardiosclerosis, cardiomegaly, myocarditis, pericarditis, vegetovascular dystonia, physical and mental overstrain.

Side effects: dizziness, nausea, vomiting.

Contraindications: not identified.

Surgery

Surgical treatment of cardiomegaly is the most effective among all methods of treatment, to date, experienced doctors surgeons resort to such operations as:

• operation to replace heart valves;
• coronary bypass surgery, is performed in the case of progressive ischemic heart disease;
• the installation of pacemakers, whose action is directed to the regulation of heartbeat;
• installation of devices of an auxiliary circulation of a left ventricle is spent.

Prevention

Preventive measures are based on the exclusion of all possible risk factors, the effect of which can provoke the development of the pathological process: smoking, the use of narcotic drugs and alcoholic beverages, constant stress, unfavorable living conditions.

In addition to the prevention of acquired cardiomegaly, it is necessary to prevent congenital pathology, which includes:

• registration before the 12th week of pregnancy in the women's consultation;
• early screening;
• rejection of bad habits;
• vitamin therapy;
• observance of the doctor's recommendations.

[75], [76], [77], [78], [79]

Forecast

It is impossible to speak full recovery with this pathological condition, since cardiomegaly implies structural changes in the walls of the heart. However, properly selected treatment can significantly improve the patient's quality of life.

[80], [81], [82], [83]