Postinfarction cardiosclerosis (PIX) is a cardiovascular disease in which myocardiocytes are replaced by connective tissue. Most often this contributes to necrosis of cells that occurs during long-term ischemia of the heart muscle. As a result, the heart activity is disturbed, various forms of arrhythmia can develop.
The disease is included in the International Classification of Diseases (ICD-10), where it is placed under the code
For examination of patients with suspected postinfarction cardiosclerosis, various methods of examination (electrocardiography, ultrasound of the heart, X-ray of OGK) are used. After the installation of an accurate diagnosis, treatment is necessarily prescribed, since without this the development of heart failure threatens.
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Postinfarction cardiosclerosis is formed for one main reason – the death of heart cells, most often caused by coronary disease. After that, the necrotic myocardial areas are replaced by connective tissue elements, as a result of which the heart begins to contract worse.
Cicatrization of the myocardium after a heart attack begins immediately after the attack and ends in about two to four months.
In rare cases, PICS develops due to two other reasons:
- Myocardial Dystrophy – due to metabolic disorders in the heart muscle, irreversible processes develop, leading to the same necrosis of cardiomyocytes. In their place, PICS is formed.
- Organ injury – during physical impact on the myocardium, which most often happens during various operations and procedures, a PISK develops at the site of the affected area with all the ensuing consequences.
The last two reasons for PICS are much less common than the main one.
Predisposing factors for the development of PICS are:
- Frequent stress
- Physical stress
- Long flowing hypertension
- Hereditary predisposition
Against the background of exposure to such risk factors, the disease develops more slowly, but constantly, which as a result can also lead to heart failure.
The severity of manifestations of post-infarction cardiosclerosis mainly depends on the severity of myocardial damage. The deeper and more scars formed after myocardial infarction and underlying post-infarction cardiosclerosis, the more severe the clinical picture. Also of great importance is the localization of PISK.
Symptoms of PICS often coincide with signs of complications developing on the background of the disease. In particular, the following diseases can be determined with their characteristic manifestations:
- Heart failure – there will be swelling, heavy breathing, decreased physical activity.
- Cardiac asthma – manifested by dyspnea at night. Often, such patients occupy the position of orthopnea (half-sitting), since it becomes worse while lying down.
- Spontaneous angina may also be a consequence of PISK, and in this combination the pain in the heart is determined in the patient, especially during emotional or physical stress.
- Hydrothorax – manifested by a feeling of heaviness on the affected side. Dyspnea is further enhanced.
- Acrocyanosis is characterized by blueing of distant parts of the body (nose, lips, fingers) due to circulatory disorders.
The development of large-scale post-infarction cardiosclerosis is often associated with a difficult clinic. This is due to the replacement of a large portion of the myocardium with connective tissue that is not able to conduct electrical impulses and contract. Therefore, in this case, the following signs are more often defined:
- Pain in the heart
- Complicated breathing
- Heart rhythm disorder
- Great weakness and fatigue
- Heaviness in the lower limbs due to tissue swelling
As a result of the development of post-infarction cardiosclerosis, other diseases may appear on its background:
- Atrial fibrillation
- Aneurysm of the left ventricle
- A variety of blockade: atrioventricular, bundle His, legs Purkinje
- Various thrombosis, thromboembolic manifestations
- Paroxysmal ventricular tachycardia
- Extrasystole of the ventricles
- Pericardial tamponade
- Sick sinus syndrome.
In especially severe cases, the aneurysm can rupture and, as a result, the patient dies. Additionally, complications reduce the patient’s quality of life due to the progression of certain conditions:
- Shortness of breath increases
- Decreased ability to work and physical endurance
- Often disturbed by heart rhythm disorders
- Fibrillation of ventricles and auricles can be observed
When atherosclerosis is formed, adverse symptoms may affect extracardiac parts of the body. In particular, it is often determined:
- Disorder of sensations in the limbs, mainly affects the legs and phalanges
- Cold extremity syndrome
- Progressive muscle atrophy
Such pathological disorders can affect the vascular system of the brain, eyes and other organs / systems of the body.
Video Hypertension, ischemic heart disease, cardiosclerosis
If a post-infarction cardiosclerosis is suspected, a cardiologist is prescribed a number of studies:
- Patient history analysis
- Physical examination of the patient by the doctor
- Heart ultrasound
- Ritmocardiography, which is an additional non-invasive electrophysiological study of the heart, due to which the doctor receives information about the variability of rhythm and blood flow
- Positron emission tomography (PET) of the heart is a radionuclide tomographic study that allows you to find hypoperfusion (sclerosed) areas of the myocardium
- Coronary angiography is a radiopaque method for studying coronary arteries of the heart to diagnose coronary artery disease using x-rays and a contrast agent
- Echocardiography – is one of the methods of ultrasound, aimed at studying the morphological and functional changes in the heart and its valvular apparatus
- Radiography can help determine the change in the size of the heart.
- Stress tests – allow you to diagnose or exclude transient ischemia
- Holter monitoring – gives the opportunity to monitor the patient’s heart daily
- Ventriculography is a more focused study, which is an x-ray method for evaluating heart chambers into which a contrast agent is injected. In this case, the image of the contrasted parts of the heart is fixed on a special film or other recording device.
This method of examination of patients with PICS is aimed at analyzing the bioelectric activity of myocardial fibers. The impulse arising in a sinus node passes through special fibers. In parallel with the passage of the pulse signal, the cardiomyocytes are reduced.
During electrocardiography, the direction of the moving pulse is recorded using special sensitive electrodes and a recording device. As a result, the doctor can get a clinical picture of the work of individual structures of the heart.
The procedure itself is painless and takes a little time. Taking into account all the preparations for this study, it generally takes 10 to 15 minutes.
When PIX on ECG shows the following violations:
- The height of the QRS teeth tension changes, indicating a disorder of ventricular contractility.
- The S -T segment may be located below the contour.
- T teeth sometimes drop below normal, including a transition to negative values.
- In severe cases, atrial flutter or fibrillation is determined.
- The presence of blockades indicates poor conductivity of the heart.
Formed post-infarction cardiosclerosis can be cured only operatively. Drug treatment is used only at the stage of vascular lesion by atherosclerosis. In such cases, it is still possible with the help of special preparations to strengthen the metabolism and blood supply of the heart, which will improve the patient’s condition.
Drug effects based on the use of the following groups of drugs:
- Metabolic substances (riboxin, cardiomagnyl, mildronate, glycine, biotredin, etc.)
- Fibrates (gevilon, normolip, fenofibrate, gemfibrozil, regulaple, etc.)
- Statins (apexstatin, lovacor, pitavastatin, atorvastatin, cardiostatin, simvastatin, choletar, etc.)
- ACE inhibitors (miopril, minipril, captopril, enalakor, olivine, etc.)
- Cardiotonics (strophanthin, lanoxin, dilanacin, etc.)
- Diuretics (lasix, furosemide, indap, etc.)
Treatment with medicines, as a rule, is carried out comprehensively, taking into account the individual characteristics of each patient.
Used in case of ineffectiveness of drug exposure. From modern methods of surgery to improve the condition of patients with postinfarction cardiosclerosis, the following are most often used:
- Dilation of blood vessels in particular, coronary. For this, either balloon angioplasty or stenting is used, which in some cases are combined in one procedure.
- Shunting – to bypass the narrowed portion of the artery, a shunt is created, for which the femoral vein is most often used.
In addition to the above methods of treatment, physiotherapeutic therapy such as electrophoresis is used. It is used locally, in the region of the heart, and it is necessary to use any drugs, most often statins, which, thanks to this method of treatment, go directly to the lesion sites.
To strengthen the body, it is recommended to undergo treatment at a resort that is located in a mountainous region. In the normal state of the patient, therapeutic exercises can be prescribed to help improve muscle tone and normalize blood pressure.
In postinfarction cardiosclerosis, prognostic conclusion is based on the severity of the course and the location of the pathological focus.
A significant deterioration in the quality of life of patients is observed with lesions of the left ventricle, especially if cardiac output is reduced by 20%. Medications can maintain the condition, but a radical improvement can occur only after an organ transplant. Otherwise, five-year survival is predicted.
A clinically unfavorable prognosis is given for a large number of connective tissue foci. As you know, they are not able to contract or carry out impulses, so the rest of the myocardium try to withstand intensive work, but as a rule, heart failure develops after such a compensation.
The development of postinfarction cardiosclerosis is an irreversible process, therefore, after its detection, adequate treatment should be performed under the supervision of a qualified specialist. Only in this case it is possible not only to improve the condition, but also to save the life of the patient.
Practicing the principles of a healthy lifestyle is the prevention of many pathologies, including post-infarction cardiosclerosis. This disease, like any other cardiovascular disorder, is closely related to the diet and lifestyle of a person, therefore, in order to prevent the development of PICS, some simple rules should be followed:
- It is important to adhere to a healthy and balanced diet. In particular, you need to eat fractional, but often, about 5-6 times a day. Foods must be rich in potassium and magnesium.
- Physical activity should be regular, but without overload.
- Of great importance is a good rest and adequate sleep.
- It is necessary to maintain emotional stability, which should avoid stress.
- Useful moderate spa treatments.
- A good effect on the body has a healing massage.
- It is necessary to adhere to a positive attitude no matter what.
Separately paying attention to nutrition, it should be noted:
- It is useful to refuse coffee and alcohol.
- It is necessary to minimize the use of tonic drinks (cocoa, black tea)
- Salt should be consumed in limited quantities.
- It should not be hard to use garlic and onions
- Varieties of fish should be lean.
The accumulation of gas in the intestines can also badly affect the human condition, so it is important to limit the use of beans, milk, fresh cabbage of any kind. Also as a preventive measure for the development of atherosclerosis, leading to PICS, it is necessary to exclude from the diet the lungs, the liver, the brain of animals. It is better to eat more greens and fruits instead.