The heart is our fiery motor, a muscular pump that works throughout life. Unfortunately, there are interruptions in his work, too. Improper lifestyle, burdened heredity, injuries can lead to the development of heart failure. Left ventricular diastolic dysfunction often develops against the background of high blood pressure. Why is this happening?

What are the signs of left ventricular diastolic dysfunction type 1? First of all, these are symptoms caused by fluid retention in the body. A person complains of swelling, especially in the evening. They are concentrated most often in the region of the lower extremities. The patient may notice heart pain due to myocardial ischemia, complain of shortness of breath, especially after exercise.

Normally, the heart works in two modes alternately: in systole it contracts, in diastole it relaxes. Dysfunction also means a violation of the normal functioning of any tissue or organ. As a result, the following definition is obtained: diastolic dysfunction of the left ventricle is a violation of the functioning of the left ventricle in the relaxation phase. Why is the left ventricle so important? The fact is that, while contracting, it pushes oxygenated blood into the aorta. From the aorta, through countless vessels, blood is carried to all tissues and organs, saturating them with oxygen. The left ventricle is the starting point of the systemic circulation. If the function of the left ventricle is impaired, the vast majority of the tissues of the human body will suffer from a lack of oxygen.

But after all, the article talks about diastole, and the importance of the left ventricle lies precisely in the fact that it pushes blood into systole, is there a mistake here? Absolutely no contradictions, and here's why: diastole is important because it is during this phase that the heart muscle itself receives much-needed oxygen. It is carried by blood through the coronary or coronary arteries. There are two of them - right and left, they depart from the beginning of the aorta. If the diastole is defective, the left ventricle does not receive oxygen to the proper extent. Metabolism in myocardial cells is disturbed, ischemia occurs. With prolonged ischemia, some of the cells die, and connective tissue grows in their place. This process is called fibrosis (sclerosis). Fibrosed tissue can no longer perform the same function as muscle cells. Naturally, the left ventricle, subjected to such undesirable influences, will not be able to contract fully. We get a violation already in systole, which leads to significant consequences, described a little higher in the text.

In addition to violations of the relaxation phase - the first stage of diastole, the causes of which have already been described above (ischemia, fibrosis), there may be violations of the following two stages - passive filling of the left ventricle with blood (the process is normally provided by the pressure difference between the left atrium and the left ventricle) and active filling ventricular blood (provided by contraction of the muscle cells of the left atrium; with atrial fibrillation, for example, the left atrium cannot contract to the desired degree, and dysfunction occurs).

What types of left ventricular diastolic dysfunction are distinguished by doctors? There are three of them in total. The first type is hypertrophic. When the heart cannot cope with the load, it tries to compensate for its weakness by increasing the volume and number of muscle cells. The wall of the left ventricle is significantly thickened. At the same time, the relaxation of the left ventricle becomes slower than usual. This type is considered a pathology of mild severity and you should not be afraid of it. The second type is more serious. To slow down the relaxation of the left ventricle, there is an increase in pressure in the left atrium. Thus, both the first and second stages of diastole are violated. The second type is also called pseudonormal. The third type is restrictive, the most severe. The heart failure is so severe that the patient often needs a heart transplant. If this procedure is not possible, the mortality of patients increases.

Diagnostics of diastolic dysfunction of the left ventricle is carried out by the method of echocardiography, or, as it is called in a simpler and more accessible way, ultrasound of the heart. A well-collected anamnesis also plays a role, from which you can find out the onset of the onset of symptoms, their severity and adjust the treatment taking into account existing diseases.

Ischemia is a constant companion of people who have hypertension. This happens because in this condition, the lumen of the coronary arteries is narrowed more than it should be. Individuals with impaired cholesterol metabolism also suffer, but it is important to remember that clinical signs begin to appear only when the plaque has already closed 70 percent or more of the lumen of the coronary artery.

Treatment of type 1 diastolic dysfunction of the left ventricle is aimed at normalizing the heart rate (normally 60-80 beats per minute), correcting blood pressure (normally 120/80 mm Hg), eliminating the consequences of ischemia. In addition to drug treatment, it is important to review the lifestyle, promote the recovery of the diet and the correct psychological attitude of the patient. All this allows you to forget about the disease and live fully.

When type 1 left ventricular diastolic dysfunction is diagnosed, what it is, what are the symptoms of the disease, how to diagnose the disease are questions that interest patients with such a heart problem. Diastolic dysfunction is a pathology in which the blood circulation process is disturbed at the time of relaxation of the heart muscle.

Causes and symptoms

Scientists have found that cardiac dysfunction is most common in women retirement age men are diagnosed less frequently.

Blood circulation in the heart muscle occurs in three steps:

1. 1. Muscle relaxation.
2. 2. A pressure difference occurs inside the atria, due to which the blood slowly moves into the left heart ventricle.
3. 3. As soon as the contraction of the heart muscle occurs, the remaining blood flows sharply into the left ventricle.

Due to a number of reasons, this well-established process fails, as a result of which the diastolic function of the left ventricle is impaired.

There can be many reasons for this disease. Often it is a combination of several factors.

The disease occurs against the background of:

1. 1. Heart attacks.
2. 2. Retirement age.
3. 3. Obesity.
4. 4. Myocardial dysfunction.
5. 5. Violations of blood flow from the aorta to the cardiac ventricle.
6. 6. Hypertension.

Most heart diseases provoke left ventricular diastolic dysfunction. This important muscle is negatively affected by addictions such as alcohol abuse and smoking, the love of caffeine also causes an additional load on the heart. Environment has a direct effect on the state of this vital organ.

The disease is divided into 3 types. Type 1 left ventricular diastolic dysfunction is, as a rule, changes in the functioning of organs against the background of old age, as a result of which the volume of blood in the heart muscle decreases, but at the same time, the volume of blood ejected by the ventricle, on the contrary, is increased. As a result of this, the first step in the work of the blood supply is disrupted - relaxation of the ventricle.

Type 2 left ventricular diastolic dysfunction is a violation of atrial pressure, inside the left it is higher. The filling of the heart ventricles with blood occurs due to the difference in pressure.

Type 3 disease is associated with a change in the walls of the organ, they lose their elasticity. At the same time, the atrial pressure greatly exceeds the norm.

Symptoms of left ventricular dysfunction may not appear for a long time, however, if the pathology is not treated, the patient will experience the following symptoms:

1. 1. Shortness of breath that occurs after physical activity and at rest.
2. 2. Increased heartbeat.
3. 3. Cough for no reason.
4. 4. Feelings of tightness in the chest, lack of air is possible.
5. 5. Heart pains.
6. 6. Edema of the legs.

Diagnosis of pathology

After the patient complains to the doctor about symptoms characteristic of dysfunction of the left ventricle, a number of studies are prescribed. In most cases, the work with the patient is carried out by a narrow specialist - a cardiologist.

First of all, the doctor prescribes general tests, on the basis of which the work of the body as a whole will be evaluated. They pass biochemistry, a general analysis of urine and blood, determine the level of potassium, sodium, hemoglobin. The doctor will evaluate the work of the most important human organs - the kidneys and liver.

In case of suspicion, thyroid tests will be ordered to determine the level of hormones. Often hormonal imbalances Negative influence on the whole body, while the heart muscle must cope with double work. If the cause of dysfunction lies precisely in the violations of the thyroid gland, then the endocrinologist will deal with the treatment. Only after adjusting the level of hormones will the heart muscle return to normal.

An ECG study is the main method for diagnosing problems of this nature. The procedure lasts no more than 10 minutes; electrodes are placed on the patient's chest to read information. During ECG monitoring, the patient must follow several rules:

1. 1. Breathing should be calm, even.
2. 2. You can not pinch, you need to relax the whole body.
3. 3. It is advisable to undergo the procedure on an empty stomach, after eating, 2-3 hours should pass.

If necessary, the doctor may prescribe an ECG using the Holter method. The result of such monitoring is more accurate, because the device reads the information during the day. A special belt with a pocket for the apparatus is attached to the patient, and electrodes are installed and fixed on the chest and back. the main task- lead a normal life. An ECG can detect not only LVDD (left ventricular diastolic dysfunction), but also other heart diseases.

Simultaneously with the ECG, an ultrasound of the heart is prescribed, it is able to visually assess the condition of the organ and track the blood flow. During the procedure, the patient is placed on the left side and the sensor is moved along the chest. No preparation for the ultrasound is required. The study can reveal many heart defects, explain chest pain.

The doctor makes the diagnosis on the basis of general tests, the results of ECG monitoring and ultrasound of the heart, but in some cases an extended study is required. The patient may be prescribed an ECG after exercise, a chest x-ray, an MRI of the heart muscle, and coronary angiography.

Therapeutic measures

If the work of the left ventricle is impaired by type 1, the doctor begins to treat the patient. At first, the disease does not make itself felt, so they start taking action later.

Timely prescribed treatment and the implementation of simple preventive rules in many cases can save the patient from chronic problems with blood circulation in the heart muscle. The doctor prescribes a complex of drugs, each of which performs its function.

If the LV diastolic function is impaired by type 1, the doctor prescribes ACE inhibitors - these are drugs aimed at lowering pressure, they are often prescribed to patients with hypertension. This drug group of drugs has been used for several decades, which confirms its safety and effectiveness. Inhibitors regulate pressure, have protective cardiac functions, and relax the walls of myocardial vessels. The doctor may prescribe Captopril, Perindopril, Fosinopril and other drugs in this group.

With pronounced symptoms, in case of heart dysfunction of degree 4 or degree 3, the doctor prescribes serious drugs of different groups. Diuretic drugs are used, they normalize the body's water balance, as a result of which the blood volume is adjusted. It can be Uregit, Mannitol, Ethacrynic acid.

Medicines are prescribed that reduce the number of heart contractions, but at the same time increase the strength of each beat - glycosides. This is a strong group of drugs, an overdose threatens with serious side effects, the patient may begin to suffer from auditory and visual hallucinations, bleeding, temporary clouding of the mind, and headaches.

Prevention of thrombosis is carried out with the help of Aspirin Cardio. Patients with cardiovascular diseases are at high risk of blood clotting, resulting in blockage of blood vessels - thrombosis.

Often with ventricular dysfunction, an increased level of cholesterol in the blood is fixed, which increases the chance of myocardial infarction and strokes. The doctor conducts therapy with statins, they affect the liver, as a result, it reduces the production of cholesterol. The most popular statins are Atorvastatin, Lovastatin, Niacin. In some cases, cholesterol is adjusted with the help of a diet, the patient is forbidden to eat fatty, salty, spicy foods, and sweets are undesirable.

In modern terminology - systolic heart failure. However, in the late 1970s - 80s it became clear that a significant proportion of patients with a clinical picture of heart failure have normal contractile function of the heart, normal values ​​of the left ventricular ejection fraction. Such a clinical picture in modern terminology is described as diastolic heart failure.

The study of diastole and, in fact, diseases associated with its changes, began as early as 1877, when Francois-Franck, on the basis of experiments, concluded that the maximum filling of the left ventricle with blood occurs in early diastole. In 1906, Hendorson described the three phases of diastole, and in 1921, Wiggers and Katz found that the contribution of the left atrium to left ventricular filling can be increased in people with altered LV properties. In 1927, Meek experimentally established that the phase of active myocardial relaxation in diastole affects myocardial contractility. In 1949, Wiggers introduced the term "intrinsic elasticity" to describe the behavior of the LV myocardium during diastole, i.e. made an attempt to describe the main state of the myocardium in diastole - relaxation.

In 1975 W.H. Gaasch in a series of experimental and clinical work determined the differences in diastole in healthy people and patients with cardiovascular diseases, using a change in pressure in the LV cavity and a change in its volume. In particular, it was found that the volume of blood during passive filling of the left ventricle is reduced in patients with cardiovascular diseases. In 1983-1984 N.N. Echeverria, A.N. Dougherty, R. Souter introduced the term "diastolic heart failure" into clinical practice.

Diastolic heart failure (DSF) is a clinical syndrome with symptoms and signs of heart failure, normal LV EF and impaired diastolic function.

Clinically, diastolic heart failure manifests itself as a slight limitation of physical activity (FC I according to the NYHA classification of the Association for the Study of Heart Disease) and the presence of symptoms at rest (FC IV).

Normal diastolic function of the left ventricle - its ability to "take" the volume of blood necessary to maintain adequate cardiac output, without an increase in mean pulmonary venous pressure (> 12 mm Hg). LV diastolic dysfunction occurs if the proper volume of blood can enter the LV only by increasing its filling pressure or if it is not able to increase filling during exercise and thereby provide an adequate increase in cardiac output. Any increase in LV filling pressure is always indicative of diastolic dysfunction. Almost all patients with systolic dysfunction of the left ventricle of the heart have violations of its diastolic function.

Diastole is limited by the time interval from the closure of the aortic valve to the closure of the mitral valve. Two key mechanisms occur in diastole - LV relaxation and filling. Relaxation of the left ventricle begins already in the second half of systole (during the period of slow blood ejection), reaches a maximum during the isovolumetric relaxation phase, and ends already during LV filling, which consists of phases of rapid filling, delayed filling (diastasis) and atrial systole.

LV diastolic function depends on the ability of the myocardium to relax, which depends on the functioning of the sarcoplasmic reticulum of cardiomyocytes.

The LV diastolic function also depends on the mechanical properties of the myocardium - elasticity (change in the length of muscle fibers depending on the force applied to them), compliance (change in ventricular volume for a given change in pressure) and stiffness (characteristic, inverse of compliance). Passive characteristics of the heart reflect the ability of the left ventricle to stretch as blood enters it.

At a young age, LV filling is due to a high pressure gradient at the beginning of diastole, which is formed by high speed relaxation and elastic properties of the myocardium. In this situation, the LV is mostly filled with blood in the first half of diastole.

Aging, hypertension, coronary artery disease lead to a significant slowdown in relaxation processes. In such a situation, the filling of the LV with blood occurs mainly not in the first half of diastole, but in the systole of the left atrium.

The diastolic function of the myocardium is significantly affected by the state (size, volume) of the left atrium, the speed of the transmitral blood flow and the number of heartbeats.

A change in the volume of blood entering the left atrium changes its contractility in full accordance with Starling's law. The increased force of left atrial contraction generates a shock jet that alters the LV filling rate and time-shifts subsequent phases, increasing myocardial stiffness. These changes are evident in AV block, high heart rate, and left atrial volume overload.

Symptoms and signs of diastolic dysfunction of the left stomach

Patients with diastolic heart failure present the same complaints as patients with heart failure - a feeling of lack of air, fatigue, palpitations.

In patients with diastolic heart failure, hypertension is more common and postinfarction cardiosclerosis is less common. Such patients are usually older than patients with systolic heart failure, and are often overweight. For patients with diastolic form of heart failure, atrial fibrillation is characteristic (among elderly patients - up to 75%).

In patients with diastolic heart failure, signs of venous stasis and associated symptoms (edema, wheezing in the lungs, swelling of the jugular veins, dyspnea) are less common than in patients with the classical, systolic form of the disease.

When auscultating patients with diastolic heart failure, 4 heart sounds can often be heard. Although the detection of the third heart sound is more typical for patients with systolic heart failure. With severe diastolic dysfunction, especially with a restrictive type of LV filling, this sign is found very often.

The largest clinical and epidemiological study of the clinical picture of circulatory failure - a study performed in the Russian Federation (EPOCHA-O-CHF) in 2001-2002.

The data obtained showed a trend towards an increase in the prevalence of diastolic heart failure in recent years. Normal LV systolic function is recorded in 35-40% of patients with heart failure. The prevalence of diastolic heart failure varies with age. In patients under the age of 50 years, the diastolic form is diagnosed in 15% of patients, in those over 70 years old - already in 50% of patients.

The incidence of heart failure with normal LV systolic function depends on the severity of the examined patients and the criteria for assessing systolic function. Thus, among patients hospitalized with cardiac decompensation, normal LV EF is recorded in 20-30% of patients, and in terminal heart failure - in 5-10% of patients. At the same time, in outpatient practice, the prevalence of heart failure with normal LV systolic function, diagnosed using “soft” criteria (for example, based on an excess of ejection fraction by 40%), reaches 80%. Thus, as the severity of heart failure increases, the contribution of isolated diastolic dysfunction as the main cause of heart failure decreases.

Prognosis of diastolic heart failure

• The frequency of repeated hospitalizations in patients with DHF and in patients with systolic insufficiency does not differ - approximately 50% per year.
• Mortality in patients with DHF is 5-8% per year (with systolic circulatory failure - 15% per year). In recent years, there has been no decrease in the mortality rate in DHF.
• Mortality in diastolic heart failure depends on the cause of HF, with its non-ischemic genesis - 3% per year.

Diagnostics of diastolic heart failure

The diagnosis of diastolic dysfunction is verified if the patient has 3 criteria.

• Symptoms or signs of heart failure.
• Normal or slightly reduced LV contractility (LV EF>45% and its end-diastolic size index<3,2 см/м 2).
• Signs of impaired relaxation or filling of the left ventricle, its increased rigidity, obtained with instrumental research methods.

The basis for the diagnosis of diastolic heart failure is echocardiography.

Diastolic elevation of the base of the left ventricle. With diastolic dysfunction, the maximum velocity of the early diastolic rise of the LV base (E m) is below 8 cm/s. In addition, the ratio of the maximum wave velocities of the transmitral blood flow E and E >15 indicates an increased end-diastolic pressure in the left ventricle (>12 mm Hg), E/E m<8 - о нормальном, а при Е/Е m 8-15 необходимы дополнительные данные.

The commonly accepted biochemical marker for diastolic heart failure is the brain natriuretic peptide (NT-pro-BNP) precursor. Diastolic heart failure is characterized by an increase in the level of this peptide.

Treatment of diastolic heart failure

Treatment of myocardial ischemia. IHD is one of the main factors predisposing to diastolic disorders. These or other disorders of diastole are detected in more than 90% of patients with coronary artery disease. Improving diastolic function in conditions of coronary artery disease is possible with the use of drugs (β-acetrenoblockers, calcium antagonists) and measures for myocardial revascularization.

Treatment of arterial hypertension. In patients with hypertension, LV diastolic dysfunction is one of the earliest and most common manifestations of myocardial dysfunction, especially at the stage of myocardial hypertrophy. Normalization of blood pressure is one of the simple and at the same time effective ways to improve LV diastolic filling.

Decrease in LV filling pressure (reduction of its preload). The most important principle in the treatment of this condition is the reduction of LV preload (use of diuretics). An excessive reduction in preload dramatically reduces LV filling volume and reduces cardiac output. In these cases, the tactics of slowly reducing the preload on the left ventricle is justified. Taking diuretics is accompanied by excessive activation of the renin-angiotensin system, so it is advisable to combine them with blockers of the renin-angiotensin system (ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists).

Maintenance and / or restoration of sinus rhythm, preservation of the contractile function of the left atrium. The contractile function of the left atrium plays an important role in ensuring normal exercise tolerance in diastolic heart failure, the progression of which dramatically increases the risk of atrial fibrillation. With atrial fibrillation, the doctor chooses the tactics of "rhythm control" or "frequency control". Careful implementation of the requirements of the chosen tactics prevents the progression of diastolic heart failure.

Patients with diastolic heart failure should have target heart rate levels: with coronary artery disease - 55-60 per minute. With CHF, a decrease of 16% of the initial heart rate (80-84 per minute) is accompanied by a decrease in the risk of death. To reduce heart rate, β-blockers, phenylalkylamines, and If channel blockers are used.

Diastolic dysfunction of the left ventricle is a violation of natural processes, when blood fills the region of the ventricle itself, and the heart at this time is in a relaxed state.
Such a pathology must be treated as early as possible and not ignored, since it is considered a phenomenon that precedes the development of heart failure with the left ventricular type.
In the future, the patient develops pulmonary edema and asthma of a cardiac nature.

Causes and symptoms

Ventricular dysfunction is a pathology in which normal processes are disturbed when blood fully fills a part of the heart during its relaxation, which is called diastole. According to statistics, this problem most often occurs in women. The same applies to older people.

In a normal state, blood fills the body in stages:

• first, the myocardium relaxes;
• then there is a difference in pressure, so that there is a passive flow of blood fluid into the ventricle from the atrium;
• further the atrium contracts, so there will be fullness.

Various reasons lead to the fact that one of these three phases is violated. In the future, this will lead to the fact that an insufficient volume of blood enters the ventricle, and this cannot provide a normal output. As a result, a person gradually develops an insufficient left ventricular type.

Factors due to which diastolic dysfunction of the left ventricle manifests itself lead to the fact that relaxation gradually worsens, the walls of the ventricle become less elastic. As a rule, this is due to the fact that the myocardium is compacted. This is affected by such diseases:

• hypertrophic type cardiomyopathy;
• aortic stenosis (the mouth of the aorta gradually narrows);
• hypertensive disease.

In addition, hemodynamic processes can be disturbed for other reasons:

1. Constrictive pericarditis. The pericardium thickens, and because of this, the heart chambers are gradually pinched.
2. Primary amyloidosis. Amyloid is deposited, which causes atrophy of the muscle fibers. Because of this, the walls of the myocardium become less elastic.
3. Pathologies of the coronary blood vessels that lead to cardiac ischemia and the development of myocardial stiffness due to the fact that scars are formed.

Risk factors are diseases of the endocrine system, such as diabetes and obesity.

Signs of the disease may not appear at first, but then they will gradually begin to interfere with the patient's normal life. Allocate symptoms:

1. Dyspnea. It occurs at first only during intense physical exertion, but then it will spontaneously manifest itself, even when the patient is at rest.
2. Cough. Its intensity increases when a person lies down, so it is better to sit down or stand up when the next coughing fit begins.
3. Fatigue. It is difficult for the patient to endure any load, even the smallest. He gets tired quickly.
4. The heartbeat is accelerating.
5. Nocturnal dyspnea of ​​paroxysmal type.
6. Disturbances in the rhythm of the heart. This symptom is quite common. The patient complains of atrial fibrillation.

Types and treatment

Patients may have a different type of such a disease. Disorders in the left ventricle develop gradually. Depending on their degree, the following forms of the disease are distinguished:

1. Left ventricular dysfunction type 1. In this case, there are problems with the relaxation of this part of the organ. This stage of the development of pathology is considered the initial. The stomach does not relax enough. Most of the blood enters the ventricle when the atrium contracts.
2. Second type. It is also called pseudonormal. At this phase, the pressure index rises in the atrial cavity, and it is completely reflex. And the ventricle is filled due to the presence of a difference in pressure.
3. Third type. Also known as restrictive. This stage is considered terminal. It is associated with the fact that the pressure in the atrial cavity increases. The elasticity of the walls of the ventricle gradually decreases, which is due to the strong rigidity.

Before starting treatment, a diagnosis is required. It includes procedures such as:

• echocardiography and dopplerography of both chambers;
• radionuclide ventriculography;
• electrocardiography;
• x-ray examination.

These techniques in the early stages of the development of the disease help to prevent the appearance of irreversible changes.

Therapy must be comprehensive.

Find out your risk level for heart attack or stroke

Take a free online test from experienced cardiologists

Testing time no more than 2 minutes

7 simple
questions

94% accuracy
test

10 thousand successful
testing

To correct hemodynamic processes, a number of measures are required. First, you should always control your blood pressure. Secondly, you need to lower your heart rate. Thirdly, it is always necessary to maintain water and salt metabolism. This will reduce the preload. In addition, remodeling of left ventricular hypertrophy is required.

Medical therapy

Drug therapy includes taking such drugs:

1. Adrenoblockers. Means help to slow down the rhythm of the heart, lower blood pressure, improve myocardial nutrition at the cellular level.
2. Angiotensin receptor antagonists and angiotensin-converting enzyme inhibitors. These are two different types of drugs, but they have a similar effect. Such agents have a beneficial effect on myocardial remodeling, increase the elasticity of its tissues, and lower blood pressure.
3. Diuretics. Such funds are designed to remove excess fluid reserves in the body, which will reduce shortness of breath.
4. calcium antagonists. When the amount of this compound in myocardiocytes decreases, the myocardium can relax normally.
5. Nitrates. They are auxiliary means that are used if there are signs of ischemia.

All these activities and drugs will help eliminate the problem with the heart. But such a pathology is serious and entails serious consequences, so you can’t ignore the symptoms, but it’s also forbidden to treat yourself.