Alcoholic heart disease in the elderly
Introduction
Introduction to alcoholic heart disease in the elderly As early as 1884, Bollinger found in the autopsy that the long-term drinking of beer was significantly enlarged, calling it the heart of Munich beer. Since the 20th century, a large number of clinical and animal tests have shown that long-term excessive drinking can cause cardiomyopathy characterized by decreased cardiac output. Since 1985, many scholars have advocated the use of alcoholic heart disease (alcoholic heart disease). Because its cause is mainly alcohol, and the systolic function can be significantly improved after abstinence, and its pathology is not limited to the heart muscle. basic knowledge The proportion of sickness: 0.01% Susceptible people: the elderly Mode of infection: non-infectious Complications: arrhythmia heart failure
Cause
Elderly alcoholic heart disease
Toxicity of alcohol and its metabolites (30%):
The toxicity of alcohol (ethanol) and its metabolite acetaldehyde is undoubtedly the most important factor in this disease. Recent studies in Australia have shown that after the decline in social alcohol consumption, the incidence and mortality of this disease are reduced, but some studies It also showed that there was only a weak correlation between alcohol consumption and alcohol duration and left ventricular dysfunction; there was no simple linear correlation between alcohol concentration and myocardial damage.
Secondary nutritional deficiency and the role of cobalt (20%):
In the past, it is often said that long-term excessive drinking has a bad habit of reducing food intake, resulting in a lack of protein and vitamins. In the process of alcohol metabolism, vitamin consumption is increased, especially B vitamins, so that people think that secondary nutrition Lack is also one of the causes. It is known that many patients do not have nutritional deficiencies, and the treatment of protein and B vitamins is limited. The toxic effect of the foam enhancer cobalt contained in beer is also considered to be the cause of this disease. However, since 1970, beer production usually does not use cobalt as an additive.
Difference in individual tolerance (20%):
The difference in alcohol tolerance among drinkers is a very important issue in the pathogenesis of this disease. Studies have shown that the alcohol content in the blood of drinkers can reflect the individual's alcohol consumption and reflect the individual's resistance to alcohol. Differences in sexuality, some national laws stipulate that the blood alcohol content exceeds 100mg%, it is forbidden to drive a motor vehicle, but some drinkers have a blood alcohol content of 50mg%, that is, exercise, sensory and cognitive dysfunction.
The cause of this disease may have a variety of factors, alcohol is undoubtedly the most important factor, individual differences in alcohol tolerance, and even genetic factors, may also be involved in the occurrence of this disease.
Pathogenesis
Pathogenesis
Since alcohol has the most important status in the etiology of this disease, the research on its role in the pathogenesis is also more common. The main points are now introduced as follows.
(1) Alcohol directly damages the myocardial cell membrane, so that the membrane barrier protection disappears, and the potassium and sodium ion balance which maintains the normal membrane potential is destroyed, leading to disorder of information transmission between cells.
(2) Long-term drinking causes a decrease in the number of voltage-dependent calcium channels on the cell membrane and a decrease in activity, so that calcium ions enter the cell and the myocardial contractility decreases.
(3) Long-term drinking changes the structure of myosin and troponin, which changes the cross-bridge cycling between contractile proteins and also changes the troponin C complex. The sensitivity of calcium causes a decrease in myocardial contractility.
(4) The organ damage caused by alcohol is very similar to the damage of organelles caused by lipid peroxidation. Therefore, it is speculated that lipid peroxidation is related to the occurrence of this disease, but the administration of sufficient antioxidant vitamin E does not prevent alcohol. Myocardial damage, so further research is needed.
2. Pathological changes
(1) Gross pathology: The appearance of the heart was grayish white, the heart chamber was enlarged, the left ventricle was thickened, the myocardium was soft, the weight was increased, and the endocardial fibrous thickening was occasionally seen. About 60% of the patients had a wall thrombus.
(2) Light microscopy: It can be seen that the myocardial cells are hypertrophied, the nucleus becomes smaller, the number is reduced, some of the myocardial cells disappear, and the intercellular spaces and perivascular fibers proliferate.
(3) Electron microscopy: visible myocardial cell damage, mitochondria, sarcoplasmic reticulum swelling, vacuolization, muscle fibers contain a large number of lipids, it is worth noting that regardless of macroscopic or microscopic observation, this disease and dilated cardiomyopathy, No special difference.
Prevention
Elderly alcoholic heart disease prevention
Alcoholic heart disease is quite common in European and American countries, but it is rare in Asian countries. If the disease can be diagnosed early, stop drinking, and actively treat, the prognosis is good. Otherwise, the prognosis is bad. The literature report is rare at home and abroad and needs to be paid attention to by geriatric researchers.
Complication
Elderly alcoholic heart disease complications Complications arrhythmia heart failure
Mainly complicated by arrhythmia, heart failure, atrial fibrillation, liver dysfunction and so on.
Symptom
Alcoholic heart disease symptoms in the elderly Common symptoms Tachycardia edema Heart palpitations Heart failure Breathing difficulties Hepatic insufficiency Heart expansion Fatigue Angina arrhythmia
Mainly complicated by arrhythmia, heart failure, atrial fibrillation, liver dysfunction and so on.
Drinking history
Studies to date have shown that the relationship between the amount of alcohol consumed and the duration of alcohol abuse and the occurrence of this disease is not clear enough, but most scholars believe that the amount of alcohol in drinking per day exceeds 142g, which lasts for more than 5 years. Some scholars advocate that it is included in daily drinking. The amount of alcohol exceeds 60g as a premise of diagnosis, and some scholars believe that the duration of long-term excessive drinking should be more than 10 years, the alcohol content of alcohol (g%) and the amount of alcohol that may cause disease.
2. Characteristics of the disease
In Europe and the United States, the disease is more common in men aged 40 to 55 years old, but older people are also more common. There is no special research on elderly patients in China. The patients are often asymptomatic during long-term excessive drinking, but if Electrocardiogram or echocardiography may often reveal a potential abnormality, and the patient progresses rapidly in the event of heart failure.
3. Typical performance
The disease can be divided into classic type, ischemic type and arrhythmia type, but the most common type is classic.
In the early stage of classic onset, due to decreased blood output, only fatigue without special causes, shortness of breath, palpitations, cough during exercise, exercise tolerance, and nocturia; followed by paroxysmal nocturnal dyspnea, the main signs are sinus Sexual tachycardia, mild diastolic pressure, decreased pulse pressure, jugular vein engorgement, enlarged heart, weakened heart sounds, non-ejection clicks on both sides of the heart, diastolic gallop, mitral valve and Tricuspid valve area contraction early, mid-stage hairy murmur, hepatomegaly and peripheral edema, ischemic type with atypical chest pain or angina pectoris, ECG ST-T changes; late stage may also appear pathological Q wave, arrhythmia type Arrhythmia as the main performance, can present various types of arrhythmia, especially atrial fibrillation, room early, room speed, ventricular tachycardia.
Each type can have general signs of excessive intake of alcohol, such as alcoholic multi-blood appearance, skin telangiectasia, multiple peripheral neuritis, liver abnormalities.
Examine
Elderly alcoholic heart disease check
Laboratory tests: Alcohol not only damages cardiomyocytes, but also damages organs such as the liver. Studies have shown that 12 to 24 hours after heavy drinking, serum -glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), aspartate Both aminotransferase (AST) and lactate dehydrogenase (LDH) are elevated and last for 2 to 3 weeks after stopping drinking, but some patients are completely normal. In addition, due to the lack of nutrients in alcoholics, especially It is the vitamin B group including B12 deficiency, so the average red blood cell volume (MCV) is increased, the cell destruction of the alcoholics is increased, the sputum degradation is increased, and the uric acid is also often elevated. Although the above changes are not specific, the diagnosis of the disease is , with auxiliary meaning.
Electrocardiogram
ECG changes can be the only manifestation of the preclinical stage of the disease. The main abnormalities are:
1 left ventricular hypertrophy;
2 bilateral atrial hypertrophy;
3ST-T anomaly, prolonged QT interval;
4 origin and conduction arrhythmia, especially atrial fibrillation;
5 Late visible QRS wave amplitude reduction and mild abnormal Q wave.
2. Echocardiography
Early asymptomatic patients can see a certain degree of ventricular hypertrophy or dilatation. Askanas et al reported 85 male patients with alcoholic symptoms without cardiac symptoms, 45% had ventricular septum and left ventricular hypertrophy and increased cardiac weight, but ejection fraction, wall motion And left ventricular peripheral shortening rate and other cardiac function indicators, no abnormalities, late left ventricular diastolic and end-systolic diameter increased, the ratio of ventricular septum and left ventricular posterior wall thickness increased, left and right atrioventricular dilatation, wall compliance decreased, The cardiac function indexes were reduced, the left ventricular ejection fraction was often <0.40, and the atrioventricular wall thrombosis was formed.
3. Chest X-ray image
Different degrees of heart enlargement may occur in the early stage, but the heart activity is normal. As the heart expands further, the heart activity is weakened, the lung is congested, and pulmonary edema and pleural effusion may occur in the late stage.
Diagnosis
Diagnosis and identification of alcoholic heart disease in the elderly
Diagnostic criteria
Prerequisite
Has a long history of excessive drinking, and the amount of alcohol and alcoholic duration of drinking per day meets or exceeds the conditions in the above-mentioned drinking history.
2. Prerequisites
After drinking for several years, there is arrhythmia, decreased cardiac function, clinical manifestations of heart enlargement or laboratory evidence.
3. Diagnosis conditions
After the cessation of drinking and active treatment, the above-mentioned necessary conditions completely disappeared or significantly reduced.
Differential diagnosis
Elderly patients should be diagnosed with this disease as much as possible. If not completely excluded, two or more types of heart disease should be considered.
Coronary heart disease
The disease and alcoholic heart disease can be manifested as arrhythmia in the early stage, and the heart can be enlarged in the late stage. Both of them can have angina pectoris, ECG ST-T changes and abnormal Q waves, so the elderly patients are identified, sometimes very Difficulties, but the disease has the following characteristics, can be identified with alcoholic heart disease:
1 have special risk factors and arteriosclerosis;
2 Early ECG ischemic manifestations are regional;
3 Echocardiography wall motion may be a segmental activity abnormality, if necessary, dipyridamole or dobutamine induced test;
4 coronary angiography often shows specific changes.
2. Dilated cardiomyopathy
This disease is the most difficult to identify with alcoholic heart disease. As mentioned above, there is no characteristic difference between the two endomyocardial biopsy. The literature points out the following two points, which have reference value:
1 alcoholic heart disease before treatment ECG showed that left ventricular hypertrophy combined with bilateral atrial fertilizer is mostly seen, this disease is rare;
2 After the treatment of alcoholic heart disease, the heart function, especially the heart function, may be completely or partially restored, and the disease is poorly restored.
3. Hypertensive heart disease
The disease has the following characteristics and can be distinguished from alcoholic heart disease:
1 has a long history of systolic or diastolic blood pressure;
2 echocardiography showed left ventricular centripetal hypertrophy and increased left ventricular myocardial weight;
3 sudden increase in hypertension or complicated coronary heart disease, heart failure and ventricular dilatation can occur, antihypertensive treatment can quickly correct heart failure;
4 administration of antihypertensive drugs such as angiotensin-converting enzyme inhibitors that do not enhance sympathetic tone or renin activity, long-term treatment of calcium channel blockers, can reverse hypertrophic myocardium.
4. Valvular heart disease
The etiology of elderly patients with this disease is mainly degenerative heart valve disease, rheumatic valvular heart disease and congenital bicuspid aortic valve. According to medical history, characteristics of valve murmur, characteristics of echocardiographic valve changes and murmur after treatment of cardiac function improvement Enhancement and other alcoholic heart disease are easier to identify.
5. Pulmonary heart disease
The disease has the following characteristics and can be distinguished from alcoholic heart disease:
1 often have a history of chronic chest disease and emphysema;
2 clinical often have right ventricular hypertrophy or right heart dysfunction;
3 chest X-ray examination showed pulmonary hypertension:
4 blood gas analysis first PaO2 decreased, followed by PaCO2 increased.
6. beriberi heart disease
The disease can also occur in long-term overdose drinkers, the heart performance is quite similar to alcoholic heart disease, but the disease can be quickly improved and gradually cured after treatment with a large number of vitamin B1.
