reverse beat
Introduction
Introduction When the heart contracts, the anterior wall of the left ventricle hits the chest wall of the precordial region at the early stage of contraction, causing the ribs of the corresponding site to pulsate outward, called the apical beat. After left ventricular myocardial infarction, the ventricular wall is completely necrotic. About 10 to 38% of cases of necrotic myocardium are gradually replaced by fibrous scar tissue to form ventricular aneurysms. The ventricular wall of the thin layer of the lesion bulges outward, and the heart loses its mobility or exhibits abnormal movement when it contracts. The evolution of coronary artery obstruction, myocardial infarction, myocardial fibrosis, and left ventricular ventricular aneurysm was fully recognized as early as 1881.
Cause
Cause
Left ventricular ventricular aneurysm causes loss of myocardial contractility in the lesion and can produce reverse pulsations. When the ventricle contracts, the ventricular wall tumor bulges outward and retracts when dilated, resulting in a decrease in left ventricular outflow. Normal myocardial contractility is enhanced, tension is increased, and myocardial oxygen demand is increased. When the ventricular aneurysm volume exceeds the left ventricular end-diastolic volume by more than 15%, the left ventricular end-diastolic pressure increases. Due to damage to the left ventricular bleeding function, left heart failure is caused and gradually worsens. Once the thrombus in the ventricular aneurysm falls off, systemic embolism can be produced.
Examine
an examination
Related inspection
Cardiovascular electrocardiogram
Most patients with left ventricular aneurysm have a history of angina and myocardial infarction. Common clinical manifestations are shortness of breath, left heart failure, angina pectoris, arrhythmia, and systemic arterial embolism. The severity of clinical symptoms is closely related to the size of the aneurysm and the number and function of the myocardium in the normal part of the left ventricle.
Physical examination: The apical area can be found in a diffuse systolic or double pulsation. Auscultation examination may hear a third heart sound or a fourth heart sound.
Chest X-ray examination showed local bulging of the apex of the left margin of the heart, weakened or reversed pulsation, stagnation of the lung field, enlargement of the left atrium and left ventricle.
Diagnosis
Differential diagnosis
Electrocardiogram examination often showed old myocardial infarction in the anterior wall of the heart, bundle branch block and ST segment elevation. The left ventricular long-axis section supercardiographic examination showed that the myocardial part of the lesion was bulged, and the wall of the heart and the normal left ventricle showed abnormal movement.
Selective left ventricular angiography can show the location, volume and tumor thrombus in the ventricular aneurysm, and can determine and calculate left ventricular end-diastolic pressure, blood ejection fraction and end-diastolic volume.
Selective coronary angiography can show the location and extent of coronary artery branching, providing important information for the development of surgical treatment options.
