Cardiomegaly. Causes and prevention

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Cardiomegaly is a disease accompanied by an increase in the size and weight of the human heart. The disease is otherwise called “bull heart” syndrome (due to the large key parameters of the myocardium).

It may have a congenital form or be an independent disorder that manifests itself as a result of pathologies of the heart and blood vessels.

Causes of cardiomegaly

Cardiomegaly in the fetus and newborns is called congenital or idiopathic.
Its cause is a hereditary predisposition to the disease. The prognosis for this form of the syndrome is unfavorable. Acquired cardiomegaly in children and adults is a consequence of health problems such as:

• arterial hypertension;
• heart defects;
• cardiac ischemia;
• emphysema;
• myocarditis;
• pneumosclerosis.

It should be noted: the disease cardiomegaly is not always associated with pathologies of the cardiovascular system. It can be caused by disturbances in the functioning of other organs.

LIFE AFTER COVID-19: HOW TO RESTORE YOUR HEART WORK?

More than 30% of patients who have had COVID-19, within one to two weeks after recovery, begin to experience shortness of breath, heart rhythm disturbances, increased blood pressure up to a hypertensive crisis, fatigue and decreased performance1,2. All these symptoms are a manifestation of post-Covid syndrome, the duration of which can be up to six months. What modern medicine knows about post-Covid syndrome, and whether it is worth waiting several months for it to pass, was discussed with a cardiologist and therapist at a pharmaceutical press event as part of World Heart Day.

Post-Covid syndrome manifests itself in a whole spectrum of diverse symptoms and disruptions in the functioning of the cardiovascular, autonomic, and nervous systems, and is also expressed in dysfunction of the gastrointestinal tract1. When the COVID-19 virus enters the body, it negatively affects certain receptors, which are most present in the vessels of the lungs, heart, kidneys, and intestines, thereby jeopardizing the functioning of all these organs. As a rule, patients who have had COVID-19 complain of increased blood pressure, tachycardia, weakness, pain in muscles and joints, anxiety, increased fatigue and irritability. All these symptoms indicate the presence of post-Covid syndrome, which manifests itself 1-2 weeks after suffering an infectious disease, and by the 30th day every second patient exhibits its symptoms, not seeing any improvement until the 110th day after recovery3. The severity and duration of post-Covid syndrome depends on the degree of intoxication of the body, the severity of the disease, the level of involvement of the nervous system, age, the presence of complications and concomitant diseases.

As recent studies have shown, a lack of potassium and magic in the blood, microelements that are excreted from the body during coronavirus infection, can provoke the development of post-Covid syndrome. In 20% of patients who have had COVID-19 and were treated in a hospital, potassium deficiency is detected - hypokalemia2. Typically, a slight decrease in blood potassium levels does not cause acute symptoms, but if the blood plasma potassium level is <3.5 mmol/L, the patient may experience serious problems in the functioning of the cardiovascular system.

Elizaveta Yuryevna Ebzeeva, Candidate of Medical Sciences, Associate Professor, Head of the Academic Department of the Department of Therapy and Multimorbid Pathology of the Federal State Budgetary Educational Institution of Continuing Professional Education "Russian Medical Academy of Continuing Professional Education", therapist:

“With potassium deficiency during post-Covid syndrome, patients experience chest pain, increased blood pressure, anxiety and depression, heart rhythm disturbances - often in severe form, including ventricular fibrillation, which can lead to rapid death. At the same time, a lack of magnesium, less than 0.65 mmol/l, increases symptoms when potassium levels decrease, causing dizziness, severe fatigue, irritability, and sleep problems. For patients with such complaints, I recommend using the drug "Panangin". It is able to compensate for the lack of potassium and magnesium in the blood, minimizes the symptoms of asthenia, improves well-being and reduces the risk of disorders in the cardiovascular system.”

Patients suffering from arterial hypertension are at particular risk during coronavirus, and there are about 45% of them in our country4. At the same time, more than 30% of patients who have had COVID-19 may experience disturbances in the regulation of blood pressure, up to the development of a hypertensive crisis, the manifestations of which can be a sharp increase in blood pressure, dizziness, and headache)5. The main risk factors for increased blood pressure in post-Covid syndrome are considered to be old age, excess body weight, and concomitant chronic diseases - for example, diabetes.

Dmitry Aleksandrovich Napalkov, Doctor of Medical Sciences, Professor of the Department of Faculty Therapy No. 1 of the Institute of Clinical Medicine named after N.V. Sklifosovsky, Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after I.M. Sechenov", cardiologist:

“I worked in the “red zone” of a Covid hospital, and now I am providing outpatient treatment to patients who have had COVID-19 and have a history of arterial hypertension or acquired it after a coronavirus infection. Often, when patients arrive at Covid clinics, they stop taking medications that normalize blood pressure and, unfortunately, rarely return to taking this therapy after recovery. But stopping antihypertensive drugs can lead to the risk of developing a heart attack, stroke, thrombosis, arrhythmia and other pathologies. Now there are fixed combination drugs that can maintain normal blood pressure levels for a long time, throughout the day. Moreover, such fixed combinations can regulate cholesterol levels and also reduce the risk of developing cardiovascular complications. In addition, taking fixed combination drugs increases the achievement of target blood pressure levels in patients by 30% - due to increased adherence to therapy. After all, instead of several tablets, the patient needs to take only one or two.”

Despite the fact that post-Covid syndrome can drag on for several months, bringing real discomfort to a person, there are a number of preventive measures that will help the body recover faster and reduce the risk of cardiovascular complications.

What is important to remember about post-Covid syndrome:

• Main symptoms: weakness, shortness of breath, increased blood pressure, tachycardia, fatigue, memory impairment, irritability, sleep problems, constipation, diarrhea, muscle and joint pain.
• Every second patient who has had a coronavirus infection suffers from post-Covid syndrome. It develops over 1-2 weeks and can last up to six months.
• Every fifth patient who has had COVID-19 and was treated in a hospital has a potassium deficiency. A biochemical blood test should be done and if low levels of potassium (<3.5 mmol/l) and magnesium (<0.65 mmol/l) are detected, start taking medications that restore the deficiency of these microelements (for example, Panangin).
• People suffering from arterial hypertension should consult a specialist to select medications to normalize blood pressure. If it is impossible or unwilling to take several medications per day, discuss with a specialist the prescription of fixed combination medications (double or triple combination): instead of 3-4 tablets per day, you will need to take 1-2 capsules.

Link to publication: pharmjournal.ru

Symptoms of cardiomegaly

Cardiomegaly is a clinically hidden syndrome. It is always disguised as signs of other diseases or occurs without obvious symptoms. In most patients, cardiomegaly manifests itself:

• tachycardia;
• pain in the heart area;
• shortness of breath;
• increased fatigue;
• peripheral edema;
• orthopnea.

Most often, the disease is discovered accidentally in adults during a regular medical examination.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Features of the disease and the weight of a healthy heart

The human heart muscle is a hollow organ with a cone shape. The heart is divided into two ventricles and atria. Normally, the length of the organ is from 10 to 15 cm, and the width is from 8 to 11 cm. The weight of the muscle in women ranges from 203 to 302 g, and in men – from 274 to 385 g.

Typically, cardiomegaly is a disorder that is not independent, but occurs due to the presence of other pathologies. It occurs in people of any age and gender. With cardiomegaly, there is an increase in size from 2 to 3 times of one or both ventricles. The muscle stretches and its walls thicken, which is why it ceases to perform its functions efficiently. Blood circulation becomes inadequate, which affects the entire body as a whole. The weight of the organ increases by 2 times or more.

In the congenital form of the disease, from the first day of life, the child’s heart volume is more than 3 cm in length, 4 cm in width and 1.8 cm in thickness. In infants, the pathology can only be congenital, and the prognosis in this case is unfavorable. Only one in two newborns will survive the disease, and a quarter will suffer from severe heart failure. Among surviving children with congenital pathology, every third child dies under the age of 3 months.

In adults, cardiac cardiomegaly is acquired. Without the presence of the disease, enlarged heart muscle is possible only in professional athletes and people with a hypersthenic structure. Its manifestations are often similar to other disorders in the condition of the organ. The pathology has a code according to ICD 10: I51.7.

Degrees of the disease

There are three degrees of the disease depending on how much the thickness of the heart wall is increased. Changes often affect the tissues of the left ventricle.

Cardiomegaly of 1-2 degrees in most patients is asymptomatic or with a minimal number of manifestations.

1. First. The growth of cardiac tissue is insignificant. Myocardial enlargement ranges from 1.2 to 1.5 mm.
2. Second. Myocardial thickening reaches limits of 1.5 to 2 mm.
3. Third. The enlargement of the heart becomes significant, and the patient experiences severe symptoms of the disorder. The thickness of the myocardium becomes more than 2 mm.

Patients seek medical help, most often only when severe symptoms develop.

Differential diagnosis of cardiomegaly

To identify “bull heart” syndrome (as cardiomegaly is informally called), cardiologists use the following diagnostic methods:

• palpation of the cardiac region, listening to the heart;
• CT scan;
• echocardiography;
• Ultrasound of the heart;
• ECG;
• chest x-ray;
• blood analysis;
• biopsy (taking a tissue sample from the inner surface of the ventricles of the heart) is extremely rare.

A doctor may suspect cardiomegaly if he detects heart murmurs characteristic of this disease and protrusion of the organ upon palpation. Quite often, changes in size are visible on x-rays. But the most reliable information for cardiomegaly is provided by ultrasound.

Forecast

It is impossible to completely cure the problem of myocardial failure, and the development of heart failure often ends in death. Properly prescribed therapy only helps to improve the patient’s quality of life.

It is quite difficult to accurately predict the consequences of a bull's heart. It is necessary to take into account the general health of the patient, the severity of the underlying disease, as well as the adequacy of the prescribed treatment.

Congenital cardiomegaly is considered the most life-threatening type of disease; its prognosis is unfavorable. But to save life, treatment must begin immediately after the initial symptoms of the acquired syndrome are detected on an x-ray. In this case, the likelihood of slowing down the hypertrophic process and reducing the risk of complications increases.

Treatment of cardiomegaly

Treatment of cardiomegaly (with the exception of bull's heart syndrome in newborns) begins with eliminating the causes that caused the disease. Both drug therapy and surgical methods can be used here. For example, for arterial hypertension, medications reduce blood pressure, and for kidney disease, they remove excess fluid from the body. If cardiomegaly is caused by damage to the heart valves, a cardiac surgeon

restores them surgically.

In situations where the cause of the pathology is drugs or alcohol, the patient’s condition will improve only if he gives up the bad habit. Treatment results directly depend on the stage and causes. Some patients manage to recover completely, others have to take medications for the rest of their lives. In severe cases, a heart transplant is performed.

Prevention of cardiomegaly

Since cardiomegaly (with the exception of the congenital form) is not an independent disease, prevention is aimed at preventing the development of provoking diseases. It is important to exclude risk factors that lead to increased blood pressure, coronary heart disease, and lung problems. It is also necessary to give up smoking, drugs, and alcoholic beverages.

Prevention of congenital cardiomegaly includes:

• registration before 12 weeks of pregnancy;
• compliance with medical recommendations;
• rejection of bad habits;
• eating only healthy foods.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.