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| {{SK}} Left ventricular remodeling, LV remodeling | | {{SK}} Left ventricular remodeling, LV remodeling |
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| ==Overview== | | ==[[Ventricular remodeling overview|Overview]]== |
| '''Ventricular remodeling''' refers to the changes in size, shape, and function of the heart after injury to the [[left ventricle]]. The injury is typically due to [[acute myocardial infarction]] (usually transmural or ST segment elevation infarction), but may be from a number of causes that result in increased pressure or volume overload (forms of strain) on the heart. Chronic [[hypertension]], [[congenital heart disease]] with intracardiac shunting, and [[valvular heart disease]] may also lead to remodeling. After the insult occurs, a series of histopathological and structural changes occur in the left ventricular myocardium that lead to progressive decline in left ventricular performance. Ultimately, ventricular remodeling may result in diminished contractile ([[systolic]]) function and reduced [[stroke volume]].
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| Medically speaking, "ventricular remodeling" implies a decline in function (even though the word "remodeling" usually implies improvement). The term "reverse remodeling" in cardiology implies an improvement in ventricular mechanics and function after a remote injury.
| | ==[[Ventricular remodeling historical perspective|Historical Perspective]]== |
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| ==Pathophysiology== | | ==[[Ventricular remodeling classification|Classification]]== |
| The [[cardiac myocyte]] is the major cell involved in remodeling. [[Fibroblast]]s, [[collagen]], the interstitium, and the [[coronary vessel]]s to a lesser extent, also play a role. A common scenario for remodeling is after myocardial infarction. There is myocardial [[necrosis]] (cell death) and disproportionate thinning of the heart. This thin, weakened area is unable to withstand the pressure and volume load on the heart in the same manner as the other healthy tissue. As a result there is dilatation of the chamber arising from the infarct region. The initial remodeling phase after a myocardial infarction results in repair of the necrotic area and scar formation that may, to some extent, be considered beneficial since there is an improvement in or maintenance of LV function and [[cardiac output]]. Over time, however, as the heart undergoes ongoing remodeling, it becomes less elliptical and more spherical. Ventricular mass and volume increase, which together adversely affect cardiac function. Eventually, [[diastolic]] function, or the heart's ability to relax between contractions may become impaired, further causing decline.
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| ==Treatment== | | ==[[Ventricular remodeling pathophysiology|Pathophysiology]]== |
| Many factors influence the time course and extent of remodeling, including the severity of the insult, secondary events (recurrent ischemia or infarction), [[neurohormone|neurohormonal]] activation, genetic factors and [[gene expression]], and treatment. Medications may attenuate remodeling. [[ACE inhibitor|Angiotensin-converting enzyme (ACE) inhibitors]] have been consistently shown to decrease remodeling in animal models or transmural infarction and chronic pressure overload. Clinical trials have shown that ACE inhibitor therapy after myocardial infarction leads to improved myocardial performance, improved [[ejection fraction]], and decreased mortality compared to patients treated with placebo. Early correction of congenital heart defects, if appropriate, may prevent remodeling, as will treatment of chronic [[hypertension]] or [[valvular heart disease]]. Often, reverse remodeling, or improvement in left ventricular function, will also be seen.
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| | ==[[Ventricular remodeling causes|Causes]]== |
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| | ==[[Ventricular remodeling differential diagnosis|Differentiating Ventricular remodeling from other Diseases]]== |
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| | ==[[Ventricular remodeling epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Ventricular remodeling risk factors|Risk Factors]]== |
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| ==Related chapters== | | ==[[Ventricular remodeling natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * [[Ventricular Restoration: The Dor Procedure]]
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| * [[Reverse remodeling]]
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| ==References== | | ==Diagnosis== |
| {{Reflist|2}}
| | [[Ventricular remodeling history and symptoms|History and Symptoms]] | [[Ventricular remodeling physical examination|Physical Examination]] | [[Ventricular remodeling laboratory findings|Laboratory Findings]] | [[Ventricular remodeling other imaging findings|Other Imaging Findings]] | [[Ventricular remodeling other diagnostic studies|Other Diagnostic Studies]] |
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| *Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000 Mar 1;35(3):569-82.
| | ==Treatment== |
| | [[Ventricular remodeling medical therapy|Medical Therapy]] | [[Ventricular remodeling surgery|Surgery]] | [[Ventricular remodeling primary prevention|Primary Prevention]] | [[Ventricular remodeling secondary prevention|Secondary Prevention]] | [[Ventricular remodeling cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ventricular remodeling future or investigational therapies|Future or Investigational Therapies]] |
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| *Sutton, MG, Sharpe, N. Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation 2000; 101:2981
| | ==Case Studies== |
| | [[Ventricular remodeling case study one|Case#1]] |
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| *Konstam, MA, Kronenberg, MW, Rousseau, MF, et al. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. Circulation 1993; 88:2277. | | ==Related Chapters== |
| | * [[Stomach]] |
| | * [[Gastroenteritis]] |
| | * [[Infection]] |
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| *Greenberg, B, Quinones, MA, Koilpillai, C, et al. Effects of long-term enalapril therapy on cardiac structure and function in patients with left ventricular dysfunction. Results of the SOLVD echocardiography substudy. Circulation 1995; 91:2573.
| | {{Gastroenterology}} |
| | [[Category:Inflammations]] |
| | [[Category:Conditions diagnosed by stool test]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Infectious disease]] |
| | [[Category:Overview complete]] |
| | [[Category:Disease]] |
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| *Doughty, RN, Whalley, GA, Gamble, G, et al. Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. J Am Coll Cardiol 1997; 29:1060.
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| *Cohn JN. Cardiac Remodeling, UpToDate v.13.1 www.uptodateonline.com. Accessed July 17, 2005. | | ==Related chapters== |
| | * [[Ventricular Restoration: The Dor Procedure]] |
| | * [[Reverse remodeling]] |
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| | [[Category:Cardiology]] |
| [[Category:Cardiomyopathy]] | | [[Category:Cardiomyopathy]] |
| [[Category:Cardiology]]
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| [[Category:Disease]] | | [[Category:Disease]] |