10. Cardiomegaly syndrome

Cardiomegaly (KMG) is a significant increase in heart size due to its hypertrophy and dilatation or accumulation of metabolic products, or the development of neoplastic processes. Causes:

1. Coronary heart disease:

a) atherosclerotic cardiosclerosis;

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2. postinfarction cardiosclerosis;

3. aneurysm of the heart;

2. Heart defects:

1. acquired defects;

2. congenital malformations.

3. Arterial hypertension:

1. hypertension;

2. secondary hypertension.

4. Myocarditis.

5. Cardiomyopathies:

1. primary;

2. secondary.

6. The accumulation of fluid in the pericardial cavity, etc.

SYMPTOMS:

1. rhythm and conduction disturbance;

2. physical data: expansion of borders, muffling or deafness of tones, weakening of 1 tone at the apex, manifestation of the protodiastolic or presystolic rhythm of the golop (3 and 4 tones), noise of relative mitral and tricuspid insufficiency (Rivero-Carvallo noise), less often - diastolic noise of functional mitraloo stenosis (Flint) and diastolic murmur of relative pulmonary insufficiency (Graham-Steel).

Specific signs are determined by the disease that led to KMG:

Pic 3.6 Total heart enlargement (cardiomegaly)

11. Syndrome of fluid accumulation in the pericardium (hydropericardium) The reasons for the accumulation of exudate:

1. rheumatic heart disease

2. tuberculosis

3. acute leukemia

4. pleuropneumonia

5. renal failure (uremic pericarditis)

6. myocardial infarction

7. traumatic heart damage

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The reasons for the accumulation of transudate:

1. heart failure

Complaints: intense, persistent and increasing shortness of breath. The patient takes a sitting position with an inclination forward or knee ¾ elbow, pressing against the pillow. There are pains in the region of the heart, which intensify with breathing, coughing, body movements and are not stopped by nitroglycerin.

Examination: cyanosis, swelling of the face and neck (Stokes collar), swelling of the cervical veins, especially on inhalation due to compression of the superior vena cava by pericardial effusion, swelling on the legs, enlargement and pain of the liver, ascites. Swelling in the region of the heart and smoothness of the intercostal spaces.

With a large amount of effusion in the pericardial cavity, the patient occupies a sitting position with the body tilted forward, with his forehead resting on a pillow (Breitman symptom).

In rare cases, the patient is in the position of ―Muslim in prayer‖ (Girtz symptom - patients kneel and press their faces and shoulders to the pillow).

In some patients (especially often in men), it can be seen that the upper abdomen is not involved in breathing (Winter's symptom).

With percussion, there is a sudden transition from a clear sound over the lungs to a dull and ―hip‖ sound in the region of the heart (Auerbruger symptom).

Palpation: the apical impulse is weakened and displaced inwards from the left border of relative cardiac dullness.

Percussion: the sound above the region of the heart is dull, in some cases it has a ―wooden‖ shade. Absolute dullness of the heart usually coincides with relative dullness.

Auscultation: heart sounds are muffled or not heard, it is possible to listen to the noise of pericardial friction in the 3-4 intercostal space to the left of the sternum in the area of absolute cardiac dullness. The noise is scratching or scratching and is not carried out anywhere. He is better heard in an upright position or sitting, when the patient is tilted forward or when the head is thrown back. The pericardial friction noise is synchronized with heart contractions and usually has two amplifications - during systole and during diastole.

Radiological effusion in the pericardial cavity is characterized by a significant increase and change in the silhouette of the heart shadow. The waist of the heart is smoothed out and the shadow of the heart takes on a trapezoidal or triangular shape.

ECG: reduction of the voltage of the teeth, a change in the ST segment and the T wave in all standard leads.