Dominic Stone
The heart is a complex organ, with its muscles and chambers working together in a carefully coordinated process to pump blood to the rest of the body. When the heart's electrical signals are out of sync, it can lead to ventricular dyssynchrony, a condition where the ventricles or chambers of the heart pump out of sync. This disruption can cause a range of issues, including reduced pump function and inefficient blood flow. As a result, dyssynchrony of the heart can lead to muscle problems and even heart failure in some cases. The condition is often treated with cardiac resynchronization therapy, which uses a pacemaker to correct the electrical signals and improve the heart's function.
| Characteristics | Values |
|---|---|
| Definition | Dyssynchrony of the heart, or ventricular dyssynchrony, occurs when the ventricles of the heart are uncoordinated and unable to contract at the same time. |
| Causes | - Diseases that damage the heart muscle. |
- Ventricular dysfunction.
- Scar tissue from a heart attack.
- Electrical conduction delay, including left bundle branch block and right bundle branch block.
- Erratic electrical impulses.
- Dilation and hypertrophy. | | Diagnosis | - Electrocardiogram (ECG).
- Echocardiogram.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan. | | Treatment | - Cardiac resynchronization therapy, which uses a cardiac pacemaker. | | Symptoms | - Heart failure.
- Nausea.
- Abdominal swelling.
- Tenderness or pain. |
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What You'll Learn
Heart muscle activation
The heart muscle, or myocardium, is composed of individual cardiac muscle cells or cardiomyocytes. These cells are joined by intercalated discs to form long fibres. Each cardiomyocyte contracts in coordination with its neighbouring cells, working together to efficiently pump blood from the heart.
Cardiac muscle cells are spontaneously contractile, with electrical activity initiated and coordinated by the nervous system. An action potential triggers the release of calcium from the sarcoplasmic reticulum, elevating intracellular calcium concentration and activating the muscle. This electrical activity spreads from cell to cell, causing the cell's myofilaments to slide past each other in a process called excitation-contraction coupling.
The heart has four chambers, two upper (atrium) and two lower (ventricle), with one atrium and one ventricle on both the right and left sides. The ventricles are responsible for moving blood to the organs of the body. When the ventricles are uncoordinated, this is called ventricular dyssynchrony and can disrupt blood flow in the heart. Ventricular dyssynchrony is caused by erratic electrical impulses that cause the chambers of the heart to pump out of sync. It is often associated with heart failure and can be diagnosed through an electrocardiogram (ECG).
Cardiac resynchronization therapy, which uses a cardiac pacemaker, may be used to treat dyssynchrony. The pacemaker cells carry the impulses that are responsible for the beating of the heart, generating and sending out electrical impulses that cause the heart to contract.
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Ventricular dysfunction
The most common causes of ventricular dysfunction include underlying health issues such as coronary artery disease (CAD), heart attack, aortic stenosis, blood clots in the lungs, and left ventricular cardiomyopathy. Other risk factors include increasing age, diabetes, high blood pressure, and certain medications.
The symptoms of ventricular dysfunction may initially be mild or mistaken for a cold or allergy. However, as the condition progresses, individuals may experience constant coughing, shortness of breath during physical activity or at rest, weight gain, and swelling (edema) in the ankles, legs, or abdomen. Over time, ventricular dysfunction can lead to serious complications, including cardiogenic shock, an enlarged heart, and abnormal heart rates and rhythms (arrhythmia).
It is important to note that ventricular dysfunction is distinct from ventricular dyssynchrony, which refers to the uncoordinated contractions of the ventricles, disrupting blood flow in the heart. Ventricular dyssynchrony is often associated with heart failure and can be caused by ventricular dysfunction, scar tissue from a heart attack, electrical conduction delays, or diseased heart muscle.
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Bundle branch blocks
Ventricular dyssynchrony is caused by erratic electrical impulses that cause the chambers of the heart to pump out of sync. The heart muscle must activate and pump in a coordinated process to push blood to the rest of the body. When the ventricles are uncoordinated, this is called ventricular dyssynchrony and can disrupt blood flow in the heart.
A bundle branch block is either a complete or partial interruption of the electrical pathways inside the wall of the heart between the two lower chambers (ventricles). The electrical impulses within the heart muscle cause it to beat or contract. These impulses travel along a pathway, including two branches called the right and left bundles. If one or both of these branch bundles are damaged, the electrical impulses can become blocked, and the heart beats irregularly.
A block in the right bundle branch can occur in people who otherwise seem normal. However, it can cause the right ventricle to contract a little later than it normally would, and the heart may eject slightly less blood. A block in the left bundle branch can sometimes be benign and not cause problems, but it always interferes with using an electrocardiogram to diagnose heart disease.
In most people, bundle branch blocks do not cause symptoms. However, rarely, symptoms may include fainting (syncope) or feeling as if you're going to faint (presyncope). If both bundles are blocked, the heart may beat very slowly, which can require a pacemaker.
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Diseased heart muscle
The heart is a muscle, and like any other muscle in the body, it can become diseased. Cardiomyopathy is a disease that weakens the heart muscle, making it harder for the heart to pump blood around the body. The word "cardiomyopathy" means "heart muscle disease". The condition can affect people of any age, sex, or race. There are several types of cardiomyopathy, and many causes and risk factors. For example, peripartum cardiomyopathy affects some women during pregnancy or soon after. Cardiomyopathy can cause the heart muscle to become thicker, stiffer, or larger than normal, which can lead to an irregular heartbeat, heart failure, or even cardiac arrest.
Cardiomyopathy is not the only disease that can affect the heart muscle. Other conditions, such as granulomatosis with polyangiitis (GPA), sarcoidosis, amyloidosis, lupus, polyarteritis nodosa, vasculitis, or muscular dystrophy, can also cause inflammation and disease in the heart muscle. Viral infections can also lead to myocarditis, an inflammation of the heart muscle.
In some cases, emotional or physical stress can lead to temporary heart problems. This can cause the heart muscle to become suddenly weakened or "stunned", changing the shape of the left ventricle, one of the heart's main chambers. This condition is known as Takotsubo syndrome or stress-induced cardiomyopathy.
Ventricular dyssynchrony is another condition that can affect the heart's muscle function. It occurs when the ventricles, the lower chambers of the heart, do not pump at the same time or are out of sync. This can disrupt blood flow in the heart and is often associated with heart failure. Ventricular dyssynchrony can be caused by diseased heart muscle, ventricular dysfunction, scar tissue from a heart attack, or electrical conduction delays.
Treatment options for diseased heart muscles vary depending on the specific condition. For cardiomyopathy, treatments include medications, procedures, healthy lifestyle changes, implanted devices such as pacemakers or defibrillators, and therapy to lower stress levels. In severe cases, a heart transplant may be necessary. For ventricular dyssynchrony, cardiac resynchronization therapy using a cardiac pacemaker can help correct the electrical signals and improve heart function.
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Dyssynchronous papillary muscle contraction
Dyssynchronous contraction of the papillary muscles is a major contributing factor in functional mitral regurgitation (FMR). Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The mitral valve opens and closes due to dimensional changes in the papillary muscles during the cardiac cycle. When the papillary muscles are dyssynchronous, it impacts the process of mitral valve opening and closure.
Intraventricular dyssynchronous contraction of the papillary muscles introduces unequal contraction by the papillary muscle-bearing walls, which has an adverse effect on FMR. This unequal contraction is caused by intraventricular conduction delay. Papillary muscle dyssynchrony is related to the diastolic phase of functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy.
Ventricular dyssynchrony is caused by erratic electrical impulses that cause the chambers of the heart to pump out of sync. It is often associated with heart failure and caused by left bundle branch block. It can be treated with cardiac resynchronization therapy, which uses a cardiac pacemaker to correct the electrical signals in the heart.
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Frequently asked questions
Dyssynchrony of the heart, or ventricular dyssynchrony, occurs when the ventricles of the heart are unable to coordinate their contractions. The ventricles are responsible for moving blood to the organs of the body. When the ventricles are uncoordinated, it can disrupt blood flow in the heart.
The most common causes of ventricular dyssynchrony are diseases that damage the heart muscle. Several different heart issues cause ventricular dyssynchrony, including ventricular dysfunction, scar tissue from a heart attack, electrical conduction delay, and diseased heart muscle.
Dyssynchrony of the heart can be treated with cardiac resynchronization therapy (CRT), which uses a cardiac pacemaker to correct the abnormal electrical signals in the heart.
