Metabolic cardiomyopathy: causes and treatment
Author Ольга Кияница
Metabolic cardiomyopathies (MMP), previously referred to as myocardial dystrophy or myocardial dystrophy, include amino acid, lipid, and mitochondrial disorders. Metabolic disorders are associated with both myopathy and cardiomyopathy. The basis of the disease most often are non-inflammatory changes in the myocardium and other types of muscles.
Cardiomyopathy is a disease of the myocardium in which the heart muscle is structurally and functionally changed in the absence of coronary artery disease, arterial hypertension, and valvular lesions.
According to wikipedia.org
The disease belongs to a large group of secondary cardiomyopathies, since it most often occurs against the background of other pathological conditions. MLCD affects more men than women, while under the influence of various factors, the first symptoms do not appear immediately.
Video: Cardiomyopathy - general characteristics
Description of metabolic cardiomyopathy
The development of the ICMP most often occurs unnoticed. Adults get sick more often, but pathology can also be determined in children, especially in infancy, middle school age and during puberty.
Morphological changes of the heart muscle during the formation of the MCP:
- Dystrophy of the parenchyma . The coagulation of protein elements with their further sticking is determined. At the same time, fluid accumulates between cardiomyocytes and the heart stops functioning normally. Parenchymal dystrophy can be granular, horny, hydropic, and hyaline-droplet.
- Mesenchymal dystrophy . In this type of MMP, the structure of cardiomyocytes is disturbed. Electrical impulses no longer spread normally, there are interruptions in the work of the heart. There are also metabolic disorders, both fluid and nutrients, necessary for cardiac cells.
- Mixed dystrophy . There may be signs of disorder in the two previous varieties of the ICMP. The heart muscle is stretched, it stops contracting normally. In the first place this contributes to the thinning of the intercellular membranes.
Metabolic cardiomyopathy is associated with a disorder of various metabolism, therefore protein dystrophy, fat, carbohydrate, mineral and mixed can be determined.
Metabolic cardiomyopathy can occur :
- According to the type of myodystrophic cardiosclerosis.
Stages of development of metabolic cardiomyopathy:
- The appearance of symptoms of neurocirculatory dystonia . In particular, dizziness, coldness of the extremities, white or red dermographism, etc. can be determined.
- Structural exchange disorders . In the course of its development is divided into two sub-steps:
- The compensatory period - the patient feels well in a calm state, therefore at this stage it is still possible to improve the quality of a person’s life.
- Decompensated period - the changes are so pronounced that the clinical signs in the patient are determined both during exercise and in a calm state.
- Circulatory disorders often take on irreversible development , therefore metabolic disorders in the myocardium become extremely pronounced and require immediate medical intervention.
Pathophysiological changes in the myocardium can be expressed in two forms: focal and diffuse. In the first case, structural violations have clear boundaries. The second variant of the ICMP is characterized by the absence of well-defined limits for dystrophy.
Causes of metabolic cardiomyopathy
It was stated above that the disease can be diagnosed at any age. Depending on this, certain reasons are determined.
1. In newborns, MKMP is most often diagnosed as a result of intrauterine development disorders. infant encephalopathy, infectious pathologies that were diagnosed during pregnancy.
2. In children of secondary school and adolescence, an ICMP may occur against the background of an unhealthy diet depleted in vitamins. Also, the reason may be a lack of physical activity or, on the contrary, overstrain, iron deficiency anemia, frequent acute respiratory viral infections and other infectious diseases.
3 . Adults can get MKMP for a variety of reasons, so it is not always when the symptoms of the disease occur the idea of cardiomyopathy comes. In particular, there are the following reasons, which partly concern not only adults, but also children:
3.1 Chronic diseases (tonsillitis, pyelonephritis, pancreatitis, stress, alcohol intoxication).
3.2 Poisoning that can occur if you take the wrong medicine or live in an unfavorable region.
3.3 Malignant neoplasms, especially those that are accompanied by a disorder of connective tissue synthesis.
3.4 Endocrine disorders by type of diabetes mellitus and thyrotoxicosis.
3.5 Atrophic myopathy of congenital origin.
3.6 Lack of vitamins (hypovitaminosis).
3.7 Anemia by type of iron deficiency.
3.8 Increased body weight.
The definition of the above symptoms separately relates a person to a risk group for cardiomyopathy and cardiovascular diseases in general. Looking at the statistics, most often MKMP. Arises due to improper diet and work patterns.
Signs of metabolic cardiomyopathy
The disease has no characteristic symptoms, therefore, the diagnosis of an ICMP is not easy and sometimes incorrect diagnoses can be made. The most common clinical manifestations are those that occur in other cardiovascular disorders. In particular, it may be:
- Decreased performance.
- Increased fatigue and weakness.
- Chest pain or pain in the heart area.
- Irregular heartbeat (arrhythmia).
During the examination by a cardiologist, the following pathological changes can be identified:
- Increased heart size.
- Listening to deaf heart tones.
- The presence of systolic noise.
- Determination of signs of heart failure (edema, shortness of breath).
In severe cases, signs of blood stasis become extremely pronounced and can be a choking cough, angina attacks, swelling in the lower extremities and face, liver enlargement, ascites.
Diagnosis of metabolic cardiomyopathy
Reception at the doctor begins with the collection of complaints, anamnesis of the disease and life, after which an objective examination is carried out. Be sure to specify the lifestyle, diet and the presence of bad habits. Additionally, laboratory and instrumental methods of research are assigned, without which it is impossible to establish an accurate diagnosis.
- Electrocardiography - allows you to evaluate the functioning of the cardiac conduction system.
- Ultrasound examination of the heart - based on a survey of various structural elements of the body, determines its size, the pumping capabilities of the heart.
- Magnetic resonance imaging - creates a spatial model of the heart due to layer-by-layer images, in which structural changes in the myocardium are clearly visible.
- Cardiac tissue biopsy - is performed as a last resort, when the disease is difficult to diagnose. With the help of special tools, a piece of myocardium is taken, which is examined under a microscope and, as a result, an accurate conclusion is guaranteed.
- A blood test is a mandatory test that is carried out in the first place, especially if there are signs of anemia.
- Urinalysis - if there are complaints indicating kidney disease or diabetes mellitus, a urine test is performed.
After a full examination and diagnosis, treatment is prescribed that can improve the condition of the patient.
Treatment of metabolic cardiomyopathy
Therapy for cardiomyopathy associated with metabolic disorders primarily depends on the specific cause. If the patient is diagnosed with diabetes, thyrotoxicosis, lack of vitamins or minerals, medications are prescribed that correct the underlying disease. This may be hormonal drugs or iron-containing agents. It is important to adhere to medical recommendations, so as not to further harm the health.
Additionally, the treatment is carried out in order to:
- Maximize cardiac output.
- Maintain ejection fraction.
- Prevent further damage to the heart muscle.
- Prevention of loss of myocardial function.
If metabolic cardiomyopathy is accompanied by disturbances in the electrical conduction system of the heart, cardiac pacemakers can be implanted to ensure stable, coordinated work of the heart muscle.
If there are risks of sudden cardiac death during an MCMP, a variant of implantation of a defibrillator may be considered.A medical device can recognize ventricular fibrillation (a life-threatening condition) and have an electrical effect that allows you to restore a coordinated, stable heart rhythm. Some implantation devices simultaneously function as pacemakers and defibrillators, so their scope of use is quite broad.
In severe cases, cardiomyopathy may not be controlled by medical treatment and standard surgical procedures. In this situation, heart transplantation is considered as the final version of improving the patient's condition.
Medications used in cardiomyopathy
Medicines prescribed to the patient will depend on the underlying cause that caused cardiomyopathy.
If necessary, angiotensin-converting enzyme inhibitors (ACE inhibitors) and beta-blockers can be used so that the heart can beat more effectively. As a result, cardiac output is potentially increased.
In the presence of congestive heart failure symptoms, diuretics can be used in combination with dietary changes and salt restriction. Such treatment is necessary to prevent water retention and reduce the burden on the heart.
Metabolic cardiomyopathy is a long-term disease in which periodic and consistent monitoring is essential.
After treatment, patients with cardiomyopathy often require lifelong monitoring of their cardiac activity. Symptom control can be the key to optimal outcome.
Repeated blood tests are often required to monitor exposure to drugs and other markers in the body.
An echocardiogram and ultrasound can be used to evaluate heart function, including the anatomy of the valves, the ejection fraction, and the contraction function of the atrial and ventricular walls.
Prevention of metabolic cardiomyopathy
Cardiomyopathy is a term that describes the end result of many diseases and illnesses. The type of damage to the heart muscle and the subsequent decrease in the pumping function of the heart depends on the course of the underlying disease, the size of the damage to the heart and the possibility of recovery.
Metabolic cardiomyopathy is most often reversible in children who have undergone timely treatment. In adults, it is possible to slow the course of the disease with the help of drugs, but its complete reversal is impossible.
A healthy lifestyle will help minimize the risk of progression of the underlying disease, complicated by metabolic cardiomyopathy. In particular, it is necessary to maintain a healthy balanced diet and regularly exercise permissible exercise. In some diseases, life-long monitoring of blood pressure, cholesterol levels and blood glucose levels may be required.
Prognosis for metabolic cardiomyopathy
Cardiomyopathy tends to progress rapidly, so mortality primarily depends on the magnitude of the lost function of the heart muscle. If the treatment has a positive effect on the disease, then the pumping capacity of the myocardium will be preserved, and with this the prognostic conclusion on the ICMP will improve.
Finally, it should be pointed out that research into new medical and surgical treatments is ongoing. New drugs are being developed, stem cells and innovative types of implantable auxiliary devices for the heart are being studied. Therefore, in the near future, cardiomyopathy, including metabolic, is likely to be cured more effectively.
- Metabolic cardiomyopathy is not associated with the inflammatory process in the myocardium, but with structural changes that occur against the background of metabolic disorders.
- The disease develops at any age, but most often in adults, namely in men.
- For metabolic cardiomyopathy is not characterized by specific symptoms, therefore, in the diagnosis of great importance instrumental methods of research.
- MKMP treatment is mainly aimed at stopping the progression of the underlying disease, in extreme cases surgical intervention and heart transplantation are used.
- To prevent the development of the ICMP, you need to follow basic guidelines for the prevention of cardiovascular diseases.
Video: Cardiomyopathy - symptoms, causes and risk group