Hospital therapy. Clinical picture and diagnosis of restrictive cardiomyopathy (RCMP) (most important)

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Hospital therapy. Clinical picture and diagnosis of restrictive cardiomyopathy (RCMP) (most important)

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15. Clinical picture and diagnosis of restrictive cardiomyopathy (RCMP)

clinical picture. The manifestations of the disease are extremely polymorphic and are determined by the symptoms of circulatory disorders in the small or large circle (depending on the primary lesion of the right or left ventricles).

Complaints may be absent or may be due to congestion in the pulmonary or systemic circulation. Patients usually complain of shortness of breath, which first appears during exercise, and as the disease progresses, shortness of breath is observed at rest. Due to a decrease in the pumping function of the heart, the patient complains of fatigue and poor tolerance to any load. Over time, swelling of the legs, an enlarged liver and dropsy of the abdomen join. Periodically, an irregular heartbeat appears, and with the development of persistent blockades, there may be fainting.

The first stage of the development of the disease (necrotic) is characterized by the appearance of fever, weight loss, cough, skin rash and tachycardia.

Diagnostics. Recognition of RCM is extremely difficult. It is possible to speak with confidence about this pathology only after the exclusion of a number of similarly occurring diseases (such as idiopathic myocarditis of the Abramov-Fiedler type, exudative pericarditis, valvular heart disease).

When examining patients with RCMP, symptoms characteristic of congestive heart failure (edema, hepatomegaly and ascites), as well as pronounced pulsation of the neck veins, are found.

During auscultation, the detection of an enlarged heart, a soft late systolic murmur and a loud early III tone is of great importance.

An ECG study reveals moderate hypertrophy of the ventricular myocardium, as well as various disturbances in the rhythm and conduction of the heart impulse, and nonspecific changes in the T wave on the ECG.

Echocardiography is one of the most informative methods for diagnosing the disease, with its help, thickening of the endocardium, a change in the nature of the filling of the ventricles of the heart, a decrease in the pumping function of the heart, a rapid movement of the anterior leaflet of the mitral valve during diastole and a rapid early movement of the posterior wall of the left ventricle outward are detected.

Magnetic resonance imaging allows you to obtain information about the anatomy of the heart, determine pathological inclusions in the myocardium and measure the thickness of the endocardium.

When examining the parameters of central hemodynamics, an increased filling pressure in both ventricles is determined, and the final pressure in the left exceeds that in the right ventricle.

Ventriculography reveals increased contraction of the left ventricle, smooth contours of its walls, sometimes with a filling defect in the apex (evidence of obliteration). There are signs of valvular insufficiency, in particular the mitral or tricuspid valve.

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