Myocardial Remodeling - Diagnosis and Treatment

Introduction

Myocardial infarction or heart attack is a common heart disease affecting individuals of all ages. It is due to damage to the heart, poor blood flow, or weak heart muscles that result in a heart attack. A heart attack is a life-threatening condition that requires immediate care from a health professional. Post myocardial infarction, the heart undergoes multiple changes to compensate for the loss or damage. This process of undergoing changes is called remodeling. Remodeling plays an important role in regulating the blood flow to the heart and restoring functions.

Remodeling can be affected by various factors, like certain medications and chronic heart illness. Proper treatment aids in better results, thereby preventing further damage to the heart. Hence, it is important to understand the causes of the infarction and the remodeling process.

What Is Myocardium?

Myocardium refers to the layers of the muscles surrounding the heart. These muscles are made of cardiomyocytes. They are extremely responsible for maintaining the functions of the heart and pumping blood around the body. Any inflammation in the myocardium may affect the heart muscle, thereby reducing the ability of the heart to pump blood. Myocarditis causes chest pain and irregular heart rhythm or arrhythmias.

What Is Myocardial Infarction?

Myocardial infarction is commonly referred to as a heart attack, a medical emergency caused due to poor blood supply. A block in the arteries can affect the blood flow to the heart. If the blood flow is not restored quickly, the condition may be fatal.

What Are the Causes of Myocardial Infarction?

A block in the arteries supplying the heart is the major cause of myocardial infarction. It generally occurs due to plaque deposits, a sticky substance that adheres to the artery walls. Sometimes, patients with high cholesterol also have fat accumulation in the artery walls, which narrows the diameter, thereby reducing the flow of blood.

What Are the Symptoms of Myocardial Infarction?

There are a number of symptoms involved in heart attacks, which are more common than others. Some of them are mentioned below.

• Chest pain.

• Fatigue.

• Shortness of breath.

• Insomnia or lack of sleep.

• Sweating profusely.

• Anxiety.

• Lightheadedness.

• Heart palpitations.

• Indigestion.

• Heartburn.

• Nausea.

• Stomach discomfort.

How to Diagnose Myocardial Infarction?

A thorough history and physical examination are conducted by the health care professional to enable appropriate diagnosis and treatment. In addition, a few diagnostic tools are also involved, which help to understand the condition of the heart clearly. Some of the additional diagnostic tools are mentioned below.

• Blood Tests - The damage to the heart muscle causes an elevation in cardiac troponin, a chemical marker that appears in blood circulation.

• Electrocardiogram - It is the first and foremost test conducted to check heart waves. Any abnormal heart rhythm directly infers heart problems.

• Nuclear Heart Scans - This method uses a radioactive dye, which is passed through the blood vessel. It is combined with computed tomography and positron emission tomography for better and more accurate results.

• Echocardiogram - It uses high-frequency ultrasound waves to create images of the inner and outer portions of the heart. It is a common procedure performed in heart patients to check their functions as it is non-invasive.

What Is Myocardial Remodeling?

The typical changes undergone by the heart to compensate for the diseased condition are called myocardial remodeling. It is a deleterious process. The characteristic features of myocardial remodeling include cardiac enlargement, cardiac dysfunction, and molecular changes. It is caused due to various pathological conditions of the heart, of which myocardial infarction is the primary cause. Cardiac remodeling has a significant effect on overall heart health. The remodeling is a crucial procedure in heart failure patients.

What Causes Myocardial Remodeling?

The mechanical stress undergone by the heart muscles due to any underlying disease may result in changes in the heart, which is called myocardial remodeling. In earlier stages, some of the remodelings enabled the ventricles to compensate for the damage that occurred. Ventricles are heart chambers that hold the blood within the heart, and as the heart beats, the blood is pushed out for circulation.

The heart comprises four chambers: two atria and two ventricles. It also has two valves that help to regulate the blood flow to and from the heart. During any heart disease, the structure and functions of the heart are disturbed. To compensate for the changes, the heart undergoes transitions like cardiac enlargement and thickening heart walls to ensure smooth blood flow.

How Is Cardiac Remodelling Measured?

Cardiac remodeling can be measured with the help of various diagnostic tools like echocardiography and magnetic resonance imaging scans which are imaging techniques that are non-invasive but give a clear picture of the heart. These tests can be repeated a few times as they have limited radiation exposure.

How Long Does It Take for a Heart to Remodel?

The remodeling process may vary with each individual, depending on the age and underlying heart condition. It is a dynamic, ongoing process that takes about 24 months to remodel after an acute infarction. Long-term deterioration may result in increased end-systolic volume and less wall thickening.

Can Myocardial Remodeling Be Reversed?

It is possible to reverse remodeling with the use of specific drugs. These drugs inhibit the progression of remodeling, which may be useful in certain heart conditions. However, a few drugs are pivotal in enhancing the remodeling process. The list of drugs is mentioned below.

• Beta-blockers.

• ACE inhibitors.

• SGLT 2 inhibitors.

• Aldosterone inhibition with spironolactone.

Conclusion

The heart undergoes remodeling post-myocardial infarction to compensate for the damages that occur and restore the heart's functions. The remodeling process can be boosted with the help of a few drugs which act actively on the heart. Maintaining a healthy heart is crucial to enjoying a healthy life. Any damage to the heart can be serious, and the affected individuals have complications. Maintaining a healthy diet and exercising regularly have proven to improve heart life. Hence, it is important to take necessary precautions to protect the heart.