Enlarged heart

Introduction Refers to the increase in heart volume, usually a certain part of the heart, or a general heart enlargement. Cardiac enlargement is one of the important signs of organic heart disease, which can be caused by heart expansion and/or cardiac hypertrophy. Clinically simple heart dilatation or hypertrophy is rare, and in most cases, both often exist simultaneously. Cardiac enlargement can be an increase in a single ventricle or atrium, or it can be a limitation or a general increase. Rheumatic mitral regurgitation, aortic regurgitation, aortic stenosis, etc. can cause heart enlargement.

Cause

Etiology classification

First, the ventricle is enlarged

(a) left ventricular enlargement

1, rheumatic mitral regurgitation

2, aortic valve insufficiency

3, aortic stenosis

4, hypertensive heart disease

5, coronary atherosclerotic heart disease

6, the arterial catheter has not heard

7, aortic coarctation

8, tricuspid atresia combined with atrial septal defect

9, heart disease caused by nodular polyarteritis

(two) right ventricular enlargement

1. Pulmonary heart disease

(1) Acute pulmonary heart disease

(2) Subacute pulmonary heart disease

(3) Chronic pulmonary heart disease

2, congenital pulmonary stenosis

3, ventricular septal defect

4, Faro syndrome

5, primary pulmonary hypertension

6. Eisenmenger's disease and Eisenmenger syndrome

Second, the atrial enlargement

(1) Left atrial enlargement

1, mitral stenosis

2, mitral regurgitation

3, left atrial ventricular tumor

(two) right atrial enlargement

1, atrial septal defect

2, tricuspid stenosis

3, tricuspid regurgitation

4, right atrial tumor

Third, universal heart enlargement

(a) bilateral heart failure

(two) myocarditis

1, rheumatic myocarditis

2, viral myocarditis

3, diphtheria myocarditis

4, syphilitic myocarditis

5, idiopathic myocarditis

6, allergic myocarditis

7, other infectious myocarditis

(three) cardiomyopathy

1, primary cardiomyopathy

(1) Dilated cardiomyopathy

(2) hypertrophic cardiomyopathy

(3) Restricted cardiomyopathy

(4) peripartum cardiomyopathy

(5) Keshan disease

2, secondary cardiomyopathy

(1) anemia heart disease

(2) hyperthyroidism

(3) Department of fluid edema heart disease

(4) Systemic lupus erythematosus

(5) Heart disease caused by systemic scleroderma

(6) beriberi heart disease

(7) Alpine heart disease

(8) cardiac amyloidosis

(4) Ebstein deformity

(5) Dislocation of large blood vessels

Fourth, localized heart enlargement

(a) Pericardial cyst and pericardial tympanic cavity

(b) ventricular aneurysm

(three) cardiac tumor

mechanism

Cardiac hypertrophy is mainly caused by excessive myocardial systolic load (afterload), while cardiac enlargement is mainly due to excessive myocardial diastolic load (preload). Under normal circumstances, when the current afterload increases, the heart can rely on some of its own reserve mechanism to meet the various needs of the body within a certain period, but when the pathological condition, the reserve capacity of the heart decreases, the load that the normal heart can tolerate The limits are also intolerable, causing excessive preload and/or postload, which leads to an increase in the heart.

(1) Excessive preload

The preload, or volumetric load, refers to the amount of blood returning to the heart or the end of ventricular end-diastolic volume. According to Starling's law, within a certain limit, the cardiac output increases with the increase of the preload. Above this limit, the cardiac output decreases after the preload increases, thereby increasing the ventricular end-diastolic volume and causing the heart to expand.

(2) Excessive afterload

The post-load, also known as the pressure load, refers to the ejection impedance of the ventricular systole, which increases with increasing peripheral resistance. When there is a half-month stenosis, systemic hypertension and pulmonary hypertension, the peripheral resistance increases, resulting in cardiac hypertrophy.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) general radiography check ECG

First, medical history

A medical history is very important for the diagnosis of the disease. A history of a cold before the onset may indicate viral myocarditis. Previous or recent history of soreness and arthritis has prompted rheumatic heart disease. Pediatric patients should first consider the possibility of congenital heart disease when the heart is enlarged, and the elderly are mostly coronary atherosclerotic heart disease. Patients with a history of chronic cough and cough are mostly pulmonary heart disease. Women with rheumatic, anemia, and congenital heart disease should be thought of as a heart enlargement during pregnancy. People with malnutrition, especially vitamin B1 deficiency, should be suspected of beriberi heart disease.

For patients with enlarged heart, a detailed history should be asked, which is necessary for the diagnosis of the cause of the disease, often providing important and valuable clues for us to diagnose the disease.

Second, physical examination

Patients with congenital heart disease may have symptoms such as stunting traits (toes) and hair sets. When a heart murmur or tremor is found, the type of disease can be judged based on its location and nature. The heart of the patient with enlarged left heart expands to the left side, and the heart boundary expands to the left when the right heart is enlarged, while the heart boundary expands to both sides when the whole heart is enlarged. In addition, all kinds of diseases have their primary manifestations. If there are signs of emphysema, most of them are chronic pulmonary heart disease. If the patient has nervous expression, exophthalmos, goiter, sweating or finger twitch, the thyroid should be considered. Hyperactive heart disease.

Third, laboratory inspection

Patients with viral myocarditis have positive virus antibodies. Patients with rheumatic heart disease have increased erythrocyte sedimentation rate, anti-streptolysin "O" positive, C-reactive protein-positive and drum protein. Patients with coronary heart disease may have elevated blood cholesterol and increased blood stagnation. These performances have an auxiliary diagnostic value.

Fourth, equipment inspection

X-ray and echocardiography can help us understand the shape and type of heart enlargement more intuitively, and have higher sensitivity and specificity for the diagnosis of diseases. Electrocardiogram can reflect the pathological changes of the heart more objectively, but it lacks specificity for the diagnosis of the cause.

Differential diagnosis

Pericardial tamponade: The pericardial cavity is the space between the parietal pericardium and the visceral pericardium on the surface of the heart. A small amount of light yellow liquid in the normal pericardial cavity lubricates the surface of the heart. Traumatic heart rupture or pericardial vascular injury caused by blood accumulation in the pericardial cavity called blood pericardial or pericardial tamponade, which is the cause of rapid death of cardiac trauma. M-mode ultrasound showed the ventricle activity curve of the pericardium. When the pericardial tamponade, the direction of the anterior wall of the right ventricle changed, and the diastolic phase showed a centripetal movement, that is, the posterior displacement.

Cardiac hypertrophy: There are many reasons, including hypertensive left ventricular hypertrophy, septic heart failure, anterior cardiac infarction, athlete's heart, biceps counterflow, aortic stenosis, proliferative obstructive cardiomyopathy, pulmonary hypertension, cardiopulmonary disease , dilated cardiomyopathy, endocarditis, pericardial hydrops, left ventricular aneurysm, mitral stenosis and so on. When doctors do physical examinations, they sometimes notice the phenomenon of heart hypertrophy. Into an electrocardiogram and chest X-ray photography, most of the heart hypertrophy can be diagnosed. For a more accurate diagnosis, cardiac ultrasound is the most accurate.

Heart enlargement: refers to the enlargement of the heart chamber and the change of heart shape. When the heart chambers are enlarged, the shape of the heart also changes, and there are three heart types on the posterior anterior chest radiograph. 1. Mitral valve type: common in mitral valve disease, chronic pulmonary heart disease, cardiac septal defect, pulmonary artery stenosis, etc., manifested as right heart bulging, the left lower edge of the heart is blunt, the heart is full or curved The aortic node is small and the heart shadow is pear-shaped. 2. Aortic type: Common in hypertension and aortic valve disease, the left apex extends to the left and left, the heart and waist are depressed, the aortic node is prominent, and the heart shadow is boot-type. 3. General: common in myocarditis, heart failure, pericardial effusion. It appears that the heart shadow increases toward both sides and is more symmetrical.

Ventricular hypertrophy: caused by excessive load on the ventricle (diastolic or systolic) and is a common consequence of organic heart disease. It can also be said that due to cardiovascular blockage, the heart can not withstand long-term overload work and has been deformed. ECG changes can be used as an important basis for diagnosing ventricular hypertrophy and related factors.

Cardiac hypertrophy: This is a slower but more effective compensatory function, mainly in the case of long-term stress overload, increased myocardial volume, increased contractility, allowing the heart to maintain a normal blood circulation, and at the same time Reserve power. However, this compensatory function also has its disadvantages, mainly because of hypertrophic myocardial aerobic increase, and the coronary blood supply is often unable to be met, resulting in myocardial ischemia, which will eventually lead to a decline in myocardial contractility. Hypertrophic cardiomyopathy is characterized by cardiac hypertrophy. It is characterized by ventricular muscle hypertrophy, typically in the left ventricle, with interventricular septum, occasionally concentric hypertrophy. The onset is slow. About 1/3 have a family history. Most of the symptoms begin before the age of 30. Men and women are equally suffering. The main symptoms are: 1. Difficulty breathing. 2, chest pain, more often appear after fatigue, like angina, but can not be typical. 3, fatigue, dizziness and fainting, more often occur during activities. 4, heart palpitations.

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