What is myocardial fibrosis?
Myocardial fibrosis, or fibrosis of the myometrium is the formation of scar tissue in the heart muscle. It arises when the heart’s fibroblasts produce collagenous tissue in response to cardiac damage. The most common cause is a “heart attack”.
Scar formation is the step of the wound healing process, but this scar lacks the properties of a healthy heart. A larger number of scars can cause blood flow obstruction and thus result in heart failure.
In other words, myocardial fibrosis is the accumulation of extracellular matrix (ECM) proteins in the cardiac interstitium when the heart is damaged.
What is myocardium?
The heart is comprised of three layers:
- Endocardium
- Myocardium
- Epicardium
The myocardium is the muscular layer that lies in between the inner endocardium and the outer epicardium. It makes up the bulk of the heart and contains muscles that are responsible for pumping blood into the body.
It is composed of specialized cells called cardiomyocytes, which have a special cellular feature correlating to their contractile function.
Also Read: Pulmonary Hypertension
What is the function of the myocardium?
The myocardium controls the relaxation and contraction of the heart walls to pump and receive blood from the body. In addition, it also provides a scaffold for heart chambers.
| Definition | The middle muscular layer of the heart |
| Function | Contraction and relaxation of the heart; Stimuli conduction; Scaffold of the heart chambers |
What are the types of myocardial fibrosis?
There are two types of myocardial fibrosis:
- Replacement
- Interstitial
- Replacement fibrosis: This happens when the scar tissue is formed in response to the muscle death.
- Interstitial fibrosis: It happens when scar tissue is formed between the space of muscle cells, but not related to their death.
Interstitial fibrosis is divided into two subtypes:
- Reactive
- Infiltrative
- Reactive interstitial fibrosis happens when there is increased pressure or blood flow to the heart.
- Infiltrative interstitial fibrosis happens when there is a deposition of proteins and some molecules called “glycosphingolipids”. It is mostly seen in cases of amyloidosis.
Both types can be present at the same time together.
What are the symptoms of myocardial fibrosis?
Myocardial fibrosis is the result of an underlying heart disease or damage to the heart. The most common cause is heart failure.
Symptoms of heart failure include:
- Shortness of breath
- Irregular heart rate
- Swelling in the lower body
- Swelling around abdomen
- Weakness
- Fatigue
- Wheezing
- Trouble breathing while lying down
- Persistent cough with white or pink mucous sometimes
- Dizziness
- Nausea with poor appetite
- Rapid weight gain
Also Read: Why the Risk of Heart Disease is higher during winters than in summers
What causes myocardial fibrosis?
It is caused by chronic or acute damage to the heart. It can be because of:
- Heart attack
- Blood pressure overload
- Blood volume overload
- Inflammation
- Toxicity
- Genetic mutations
Myocardial infarction (heart attack): This is the most common cause of myocardial fibrosis. It is caused by the lack of blood flow to a part of the heart due to blockage in the arteries. Lack of blood supply results in the death of heart cells. Fibrosis develops when the dead cells are replaced by scar formation.
Blood pressure overload: Myocardial fibrosis can also develop in response to the conditions causing an overload of blood pressure. Scar formation starts when heart walls are damaged because of increased pressure. These include:
- High blood pressure
- Pulmonary arterial hypertension
- Pulmonary valve stenosis
- Aortic stenosis
Blood volume overload: There are many conditions leading to increased blood volume in the heart such as aortic or mitral regurgitation. They can cause a backflow of blood through the heart.
Inflammation: Inflammatory conditions can cause scar formation in the heart. These include:
- Myocarditis
- Infections
- Sarcoidosis
Toxicity: Toxicity because of some medications or chemotherapy can damage the heart cells and lead to scar formation.
Genetic mutations: Some hereditary conditions also lead to myocardial fibrosis e.g.:
- Hypertrophic cardiomyopathy
- Pompe disease
- Fabry disease
Also Read: Troponin Test
What is the pathophysiology of myocardial fibrosis?
When the heart cells are damaged, fibroblasts become activated and differentiate into myofibroblasts. Myofibroblasts increase the production of proteins and get them deposited in the extracellular matrix (ECM). Collagen, which is already present in the myocardium increases in case of myocardial fibrosis. This increased production of collagen makes the myometrium stiffer and difficult to break with proteinase. As collagen increases, fibrosis occurs which restricts the oxygen supply to the myometrium. Myocardial fibrosis causes electrical and structural changes in the myometrium and results in arrhythmias, heart failure, and ischemia.
How do we diagnose myocardial fibrosis?
- An electrocardiogram is the first diagnostic test for myocardial fibrosis. ECG uses sound waves to capture the pictures of the heart when blood flows inside the heart and throughout your body. It allows us to see whether the heart is functioning well or not. If any abnormality is found in the ECG, the doctor advises an MRI scan.
- The MRI done to check the heart is a “Cardiovascular magnetic resonance (CMR) scan”. It uses magnetic and sound waves to scan the structure of the heart and the blood vessels.
- Biomarkers for fibrosis can be measured in biopsies and blood tests.
Also Read: Exercise for the sake of your heart
Can myocardial fibrosis be reversed?
If detected early, it can be successfully reversed. It is only possible with an effective regeneration treatment and when the fibrosis has been confined to the interstitium and not associated with the high levels of crosslinked ECM. However, when it has progressed to an advanced stage, the chances of reversible changes are less.
What is the life expectancy of a patient with myocardial fibrosis?
The overall life expectancy of myocardial fibrosis patients is 65% at 5 years and 59% at 10 years.
How does homoeopathy help in myocardial fibrosis?
Myocardial fibrosis is a result of an underlying cardiovascular disorder. Cardiovascular diseases can range from mild to severe, such as heart attacks. There are several homoeopathic medicines available in such cases, but the selection depends upon the individuality of the patient. The medicines are:
- Latrodectus: A picture of angina pectoris is present in this medicine. It works well when the patient is having violent precordial pain extending to the axilla and down the arm and forearm to the fingers with numbness.
- Aurum metallicum: This medicine helps when there is a sensation as if the heart stopped beating for two or three seconds. There are palpitations with rapid, feeble, and irregular pulse.
- Aconitum: It is given when the person is having a heart attack. Cold sweat and icy coldness of face. Constant pressure is felt in the chest with oppressed breathing on least motion.
- Crataegus oxyacanthine: It is a heart tonic and acts on the muscles of the heart. This medicine helps in lowering the pulse and blood pressure reduction. In cases of chronic heart disease, with extreme weakness. Arrhythmia.
- Spigelia: It is an important remedy for diseases of the heart with precordial pain and aggravation from movement. Irregular and weak pulse rate. Craving for hot water, which relieves. Violent palpitations.
