Internal illnesses. Dilated (congestive) cardiomyopathy (most important)

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Internal illnesses. Dilated (congestive) cardiomyopathy (most important)

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18. DILATED (CONSTANT) CARDIOMYOPATHY

Myocardial diseases of unknown etiology, manifested by cardiomegaly and heart failure, with the exclusion of damage to the heart valves, coronary and pulmonary vessels, arterial hypertension.

Pathogenesis. A hypocirculatory hemodynamic state develops with a decrease in the stroke volume of the heart with increased filling of the heart with blood.

Clinic. Extrasystole, ventricular tachycardia appear; atrial fibrillation, initially of a paroxysmal type, which quickly becomes permanent. Signs of circulatory decompensation. Systolic blood pressure decreases while maintaining diastolic blood pressure.

The apex beat is weak, diffuse, the first sound is dull. At the apex of the heart, in the 4th intercostal space on the left near the sternum, a prolonged systolic murmur appears. Auscultatory signs increase with the progression of heart failure and cardiac dilatation and weaken as the condition improves.

In the first asymptomatic period there are no complaints. The ejection fraction was reduced to 35%, the end-diastolic size of the left ventricle was 6,5 cm.

In the II period of progressive myocardial damage, symptoms of chronic heart failure appear - NC stages I-II. Ejection fraction 35-25%, end diastolic size of the left ventricle 7-7,5 cm.

In the III period of developed clinical manifestations, a clinic of total heart failure appears - NK IB-III, severe cardomegaly.

Mortality is high from congestive heart failure, thromboembolic complications.

In the IV period of stabilization, complete or significant regression of edema, venous congestion occurs with the progression of the actual signs of circulatory failure.

In the fifth terminal period, severe degeneration of all internal organs occurs, ischemic damage to the liver, kidneys, discirculatory encephalopathy, loss of body weight, and recurrent thromboembolism is possible.

Diagnostic study. Conducting a biochemical blood test (dysproteinemia, hypoalbuminemia in congestive heart failure).

An ECG study reveals conduction rhythm disturbances. 24-hour Holter ECG monitoring and EchoCG are performed (dilatation of all cavities of the heart, mainly the left ventricle, decreased ejection fraction, and signs of heart failure are noted).

Treatment. In the presence of tachysystolic atrial fibrillation and symptoms of left ventricular failure, cardiac glycosides (digoxin) are used; β-blockers are prescribed after stabilization of the condition with cardiac glycosides and diuretics. Potassium-sparing diuretics are used.

ACE inhibitors have a beneficial effect on pre- and afterload with subsequent improvement in hemodynamics; nitrosorbide, cordarone, anticoagulant therapy, and blood ultrafiltration are used to reduce stagnation.

Flow. Rapid progression (1-1,5 years), slow progression or recurrent.

Forecast. Adverse.

Author: Myshkina A.K.

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