Aneurysm of the heart is a limited protrusion of the thinned wall of the myocardium, which is accompanied by a sharp decrease or absence of contractility of the pathologically altered region of the heart muscle.
Aneurysm of the heart is revealed in 10-35% of patients who have suffered myocardial infarction. Most heart aneurysms are diagnosed in men aged 40 to 70 years. The most common aneurysm is formed in the wall of the left ventricle, somewhat less often in the right ventricle or interventricular septum. Dimensions of an aneurysm of the heart in diameter range from 1 to 20 cm.
The vast majority of cases cause this disease is an extensive transmural myocardial infarction. Usually an aneurysm is localized in the anterior-lateral wall or top of the left ventricle. With massive myocardial infarction, destruction of myocardial structures occurs. Under the influence of intracardiac pressure, the dead wall of the heart becomes thinner and stretches glycia meldonium.
An important role in the formation of an aneurysm of the heart belongs to factors contributing to increased intraventricular pressure and heart load - arterial hypertension, tachycardia, repeated infarction, progressive heart failure.
Less common are congenital, infectious and traumatic aneurysms of the heart. Traumatic aneurysms occur as a result of open or closed traumas of the heart. This group can also include postoperative aneurysms arising after surgery for congenital heart defects (pulmonary stenosis, tetralogy of Fallot, etc.)
Aneurysms of the heart caused by the infectious process (bacterial endocarditis, syphilis, tuberculosis) are very rare.
Acute aneurysm of the heart is characterized by shortness of breath, pulmonary edema, weakness, prolonged fever, tachycardia, increased sweating, heart rhythm disturbances (tachycardia, bradycardia, extrasystole, fibrillation, atrial and ventricular blockades).
A subacute aneurysm of the heart is characterized by a rapid progression of symptoms of circulatory insufficiency.
In chronic heart aneurysm, severe signs of heart failure are revealed: syncopal conditions, dyspnea, a sense of irregularity in the work of the heart, restless stenocardia and tension. The late stage is characterized by swelling of the veins of the neck, hydrothorax, edema, ascites, hepatomegaly.
In chronic form, fibrous pericarditis can develop, which causes the development of an adhesive process in the thoracic cavity. Also, with chronic aneurysm of the heart, there is a thromboembolic syndrome, which is represented by acute occlusion of the vessels of the extremities, brachiocephalic trunk, kidneys, cerebral arteries, intestines, lungs.
A typical sign of an aneurysm of the heart is pathological precordial pulsation. An electrocardiogram (ECG) records signs of transmural myocardial infarction that do not change in stages, but retain a "frozen" character for a long time. Echocardiography (echocardiography) allows you to examine the cavity of the aneurysm, its size, configuration, to reveal thrombosis of the ventricle.
With the help of PET (positron emission tomography) and stress EchoCG of the heart, it is possible to reveal the viability of the myocardium in the aneurysm zone. Radiography of chest organs allows to detect the phenomena of stagnation in a small circle of blood circulation, cardiomegaly.
Radiocontrast ventriculography, MRI (magnetic resonance imaging), MSCT (multispiral computed tomography of the heart - highly specific methods of topical aneurysm diagnosis of the heart, revealing thrombosis of its cavity. According to the testimony, heart cavities are probed, electrophysiological studies are performed, coronarography.
Surgical treatment of acute or subacute heart aneurysm is carried out in connection with the rapid progression of heart failure, the threat of rupture of an aneurysmal sac. In chronic heart aneurysm, surgical intervention is performed to prevent the risk of thromboembolic complications, myocardial revascularization.
In the pre-operative period appoint cardiac glycosides, antihypertensives, anticoagulants (heparin), oxigenobaroterapy, oxygen therapy. As a palliative intervention, the aneurysm walls are strengthened with the help of polymeric materials.
Radical operations include resection of the aneurysm of the atrium or ventricle, septoplasty according to Cooley. When a posttraumatic or false heart aneurysm is performed, the heart wall is sutured.
Complications. The most serious complications are the rupture of the heart aneurysm, the migration of the thrombus. Potential complications of chronic heart aneurysm include gangrene of limb, kidney infarction, stroke, PE, repeated myocardial infarction, occlusion of mesenteric vessels.
Prevention of heart aneurysm. Prevention of heart aneurysm, its complications is the timely detection of myocardial infarction, adequate therapy and rehabilitation of patients, control of rhythm disturbance, thrombosis.