Prevention and treatment of reverse pulsation

When the heart contracts, the anterior wall of the left ventricle strikes the chest wall in the precordial region early in systole, causing the corresponding part of the rib question tissue to pulsate outward, called apical pulsation. After myocardial infarction of the left ventricle, the entire myocardium of the ventricular wall is necrotic. In about 10-38% of cases, the necrotic myocardium is gradually replaced by fibrous scar tissue, forming a ventricular wall tumor. The thin layer of the ventricular wall in the lesioned area bulges outward, and the heart loses mobility or shows paradoxical motion during contraction. The evolution of coronary artery obstruction, myocardial infarction, myocardial fibrosis, and left ventricular wall tumors was well understood as early as 1881. The prognosis of LV ventricular wall tumors is closely related to the extent of LV myocardial involvement and the volume of the ventricular wall tumor. Those with small tumors and limited myocardial involvement of the left ventricle, who are clinically asymptomatic or present with only mild shortness of breath, may survive for more than 10 years after acute myocardial infarction. If the extent of the lesion is so large that the systolic blood expulsion function of the left ventricle is severely affected, the ejection fraction is significantly reduced, and the clinical presentation of congestive heart failure is present, then the 5-year survival rate is reduced to about 10-20%. Surgical treatment should be considered for larger left ventricular wall tumors that present clinically with congestive heart failure, angina pectoris, ventricular tachycardia, and embolism of the body circulation. In cases of angina pectoris, coronary artery bypass grafting should be performed at the same time as the removal of the ventricular wall tumor, depending on the condition of the coronary artery branch lesion. In cases of severe heart failure, difficult to control by medical treatment, large ventricular wall tumors occupying more than 50% of the free wall of the left ventricle, lesions in multiple branches of the coronary arteries, and generally reduced systolic function of the left ventricular myocardium in non-ventricular wall tumor areas, surgical treatment has a high surgical mortality rate and should be carefully considered. If the ventricular wall tumor is small in size and clinically asymptomatic, the development of the disease can be closely monitored and surgical treatment is not required urgently.