Atherosclerotic cardiosclerosis

Cardiosclerosis is a myocardial disease caused by the formation of fibrous elements in the heart muscle.Atherosclerosis and myocardial cardiosclerosis today are the most well-known diseases. In some cases, occur on the background of any other myocarditis.

Atherosclerotic cardiosclerosis is the result of atherosclerosis of the coronary arteries (vessels supplying the heart muscle) with atherosclerosis.

When patients undergo appropriate and timely treatment, atherosclerotic cardiosclerosis can proceed favorably. In severe cases, against the background of focal cardiosclerosis, myocardial infarction is often developed. Therefore, in order to avoid death, you should not hesitate to contact your doctor, who, if necessary, refer to another specialist.

Video: Atherosclerosis – Pathophysiology

Atherosclerotic cardiosclerosis: description

Atherosclerotic cardiosclerosis (AK) is a condition in which scar tissue forms inside the heart muscle. Clinically characterized by the degeneration of muscle fibers, which are subsequently replaced by connective tissue. As a result, the number of cardiac muscle cells decreases, and the heart valves gradually deform. Such processes can lead to valve stenosis or failure.

AK is often a consequence of atherosclerosis of the coronary arteries, therefore it is also called coronary atherosclerotic cardiosclerosis.

This disease usually occurs in combination with other cardiovascular disorders, such as coronary heart disease, myocarditis, atherosclerotic lesions of the coronary vessels, etc. Atherosclerotic cardiosclerosis is classified as ischemic cardiomyopathy, which is not accompanied by pain.

What happens to the heart of a patient during the development of atherosclerotic cardiosclerosis?

The heart becomes larger due to dilatation (increase in the cavity of the heart chambers) and hypertrophy (increase in muscle mass of the heart). Such violations are particularly often related to the left ventricle. If there is a concomitant disease of the type of hypertension, myocardial hypertrophy prevails.

There are two forms of AK, determined by morphological analysis:

1. Diffuse form resulting from slow stenosis of the coronary arteries (less common).
2. Focal form , when fibrous tissue is unevenly distributed. In some areas, fibrous filaments may occur, which usually develop due to thrombosis or stenosis of the coronary arteries. Damaged muscle fibers are replaced by connective tissue, while other fibers become hypertrophied.

Mechanisms of development of atherosclerotic cardiosclerosis

With age, vascular walls undergo biochemical changes. In particular, the following processes are distinguished:

• Macromolecules, such as beta-lipoproteins, are cleaved to release cholesterol during their passage through the arterial wall.
• Cholesterol is insoluble, so it precipitates and forms atherosclerotic plaques.
• Over time, a mesenchymal reaction occurs that leads to sclerosis of the coronary arteries. As a result of sclerosis of cardiac vessels, chronic myocardial hypoxia occurs.
• Muscle fibers undergo dystrophy, degeneration and, finally, are replaced by another non-contractile connective tissue.

When the atherosclerotic process affects the important arteries that feed the heart muscle, atherosclerotic cardiosclerosis is complicated by rhythm disturbances or myocardial ischemia. If atherosclerotic processes affect papillary muscles, they lead to their contraction and shortening. As a result, the mitral valve (or in rare cases, the tricuspid valve) cannot properly open and close, which causes its insufficiency.

Compensation mechanism

Compensation is the ability of the heart to make up for any kind of deficiency. At the same time, either an overstrain of a certain part of the heart is observed, or changes occur at the cellular level, which partially compensates for the damage that has occurred.

With uncomplicated atherosclerotic cardiosclerosis, early signs of heart failure may be absent for a very long time. This is explained by the fact that AK is usually caused by atherosclerosis of the left coronary artery (LCA). With her participation, the myocardium of the left ventricle, the thickest, most powerful cardiac muscle, is supplied with blood. As a result, if the LCA is damaged, the heart compensates for a decrease in the efficiency of any part of it, for which some muscle fibers are hypertrophied.

Compensatory and adaptive response of the body with AK in the form of hypertrophy, which is an increase in the size of the tissue or the entire body due to the growth of cell size.

Causes of Atherosclerotic Cardiosclerosis

The main cause of this disease is atherosclerosis. Age plays an important role in the occurrence of pathology - it usually appears in the fifth decade of life, and the probability of its occurrence increases with age. Also, atherosclerotic cardiosclerosis can occur by itself or as a complication, against the background of the development of the same angina pectoris or hypertension. All these disorders are most common among people over 60 years old.

Unlike acute forms of ischemic cardiomyopathy, atherosclerotic cardiosclerosis is equally common among two sexes, while in older people it is more common among women. There are also factors contributing to the occurrence of the disease:

• Passive lifestyle.
• A diet that contains high levels of fat and cholesterol.
• Disruption of fat metabolism, which is more common in patients with obesity, diabetes, myxedema, or familial hypercholesterolemia, etc.
• Psychological stress at home or at work.
• Extreme emotional turmoil.
• Smoking.
• Menopause.
• Ovariectomy, etc.

Atherosclerotic cardiosclerosis may occur more frequently due to nodal panarteritis or coronary artery embolism.

Atherosclerotic cardiosclerosis: symptoms

In most cases, patients do not make any complaints for many years. With a long course of the disease, the following symptoms may occur:

• Shortness of breath (respiratory failure, difficulty breathing). This is the main symptom of heart failure as it develops.In the beginning it manifests itself only during physical exertion, such as brisk walking, climbing stairs, lifting weights, etc. Later, as the disease progresses, difficulties during breathing become apparent, even when the patient is at rest or performed simple exercises . Thus, patients show less ability for mental or physical work. Sometimes shortness of breath manifests itself as a paroxysmal phenomenon, which most often occurs at night, due to the horizontal position of the body in addition to the influence of the vagus nerve. In these cases, talking about cardiac asthma.
• Cardiac asthma . This condition is associated with acute failure of the left ventricle, while the right ventricle functions perfectly. The patient may suddenly wake up, choking due to lack of air. Relief comes in an elevated position with legs dangling from the bed. In this case, the patient may be pale or even bluish, covered with sweat. Sometimes mixed dyspnea is defined - during inhalation and exhalation. Tachypnea often occurs (an increase in the number of breaths per minute at a rate of 15–20 times per minute). During heart asthma, you can hear wheezing. The attack itself can last from a few minutes to 2-3 hours or more. Cardiac asthma and pulmonary edema are manifestations of acute left ventricular failure.
• Tachycardia . Heart rate with dyspnea and cardiac asthma is increased, muffled heart sounds. During auscultation with the help of a stethoscope, the systolic murmur on the apex and the spasmodic rhythm due to the hypotonic myocardium are often determined. Additionally, extrasystoles or other rhythm disturbances can be determined.
• Blood pressure may remain normal, but it often rises.

When determining the symptoms of cardiac asthma, immediate action must be taken, because the patient may develop acute pulmonary edema, a condition that is life threatening. Therefore, it is recommended that you seek medical attention as soon as possible.

When the right ventricle is also damaged, the heart can no longer compensate for the abnormalities that have occurred, and, consequently, there is general heart failure (heart failure). In this condition, the heart rate is fast, almost arrhythmic, but not as strong as in heart diseases with other characteristics. It should be noted that the symptoms of heart failure appear earlier in patients with atherosclerotic cardiosclerosis, accompanied by arterial hypertension. At the same time, those suffering from AK without concomitant hypertension are less susceptible to such complications as heart failure.

Orthopnea - the position of the patient with cardiac asthma.

Diagnosis of atherosclerotic cardiosclerosis

During auscultation, the apex of the heart is shifted down and to the left. There are no cardiac tones in this direction due to left ventricular hypertrophy, whereas later, when the ventricle expands, general cardiovascular insufficiency occurs.The lack of heart tones applies to almost all directions.

Heart sounds are muffled, heard as if from a distance or almost inaudible, especially the first sound. The second sound over the aorta is enhanced because sclerotic aortic affection occurs. Often at the apex of the heart, systolic murmur can be heard due to functional insufficiency of the mitral valve caused by the expansion of the left ventricle.

The diagnosis of AK is based on the age of the patient, the clinical symptoms of the disease, concomitant manifestations of the type of hypertension, diabetes or atherosclerosis of other organs, etc.

Additionally, depending on the indications, the following diagnostic methods are used:

• X-ray examination , which allows you to see the enlarged shadow of the heart, especially the expansion of the left borders, where they pass over the diaphragm due to reduced muscle tone.
• Electrocardiography may indicate signs of chronic coronary insufficiency, showing lower ST intervals, below the isoelectric line, as well as flattening or negative T-wave in some leads. In other cases, a decrease in the ST segment may become apparent only after a stress test (when the patient performs a physical exercise to observe how the heart copes with stress).
• Blood tests that indicate a violation of lipid metabolism and other indicators related to heart failure.

AK can not always be correctly determined and then diagnosed with cardiomyopathy, mitral valve insufficiency or chronic pulmonary heart.

Video: Atherosclerosis (2009)

Atherosclerotic cardiosclerosis: treatment

AK therapy (when there are no complications, such as heart failure or rhythm disturbance) is generally the same as atherosclerosis treatment.

General recommendations related to the treatment of atherosclerotic cardiosclerosis:

• You need to adapt your diet to limit foods that are cholesterol-rich, such as lard, butter, beef / pork, internal organs (brain, kidneys, or liver), egg yolks, etc. It is acceptable to use vegetable oils such as corn, sunflower, olive etc.
• The diet should be hypocaloric, especially if the patient is overweight, obese or diabetic. In such cases, it is important to limit carbohydrate intake. It is recommended to use more vegetables and herbs that contain vitamins and minerals necessary for good health.
• Smoking should be categorically excluded.
• Alcohol consumption is limited.

Drug exposure

• First of all, anti-lipidemic drugs from the class of statins (atorvastatin, pravastatin, fluvastatin, rosuvastatin, etc.) are prescribed.
• If necessary, add drugs from the class of fibrates (ciprofibrate, fenofibrate, etc.).
• Vitamin C and vitamin B complex have a beneficial effect.

If a patient has such complications as cardiac asthma, heart failure, rhythm disturbance, etc., appropriate measures are taken.

When atherosclerotic cardiosclerosis proceeds without complications, then teeth removal is not contraindicated. These procedures can be performed without the need for hospitalization of the patient.

Complications of Atherosclerotic Coronary Cardiosclerosis

Complications that can occur during atherosclerotic cardiosclerosis include:

• Problems with rhythm and blood circulation.
• Acute failure of the left ventricle, manifested as cardiac asthma or acute pulmonary edema.
• Cardiovascular insufficiency of varying severity.

Atherosclerotic cardiosclerosis is one of the most common causes of rhythm disturbances . In particular, extrasystoles may occur that usually originate from the left ventricle, whereas extrasystoles of the right ventricle or atrial extrasystoles are less common.

Other common arrhythmias are atrial fibrillation and atrial flutter , which gradually develop in the presence of right atrial dystrophy. Initially, they may have paroxysmal character, but over time become permanent. They are almost always defined in the late stages of AK, especially when the disease is complicated by chronic cardiovascular failure. In other cases, atrioventricular blocks of varying severity can develop, which can lead to Morgagni-Adams-Stokes syndrome or blockage of the left branch.

Prognosis and prevention

The prognosis of this disease is satisfactory, since the sclerotic process is irreversible. The prognosis is more severe in patients with symptoms of acute coronary insufficiency, serious rhythm disturbances and hypertension. These complications further accelerate the progression of heart failure, diabetes, etc. It should be noted that many patients may be at the stage of compensation for many years and, thus, they manage to maintain their efficiency.

Preventive actions

When the disease has progressed significantly, it becomes irreversible, so doctors focus on keeping the patient in a more or less efficient state. This allows them to maintain their ability to daily activities for as long as possible. In this case, attention is paid to the regulation of the living conditions and work of the patient.

Additionally, the patient or his relatives should take care of maintaining a healthy sleep pattern, proper nutrition, and also consider avoiding any neuropsychological stress, severe physical fatigue, a sedentary lifestyle, etc. It is important to be examined regularly by a cardiologist.

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