Overload of the right side of the heart causes. Load on the right atrium. Signs and symptoms of stress

The human heart consists of four chambers: two atria and two ventricles, which, alternately contracting, pump blood throughout the body. The largest vessel, the aorta, departs from the left ventricle. From the aorta, oxygen-rich arterial blood flows to all cells and tissues of the human body.

As soon as gas exchange has occurred in the blood, the blood has given up oxygen and is saturated with metabolic products and carbon dioxide; it flows through the superior and inferior vena cava into the right atrium. This closes a large circle of blood circulation that connects the left ventricle and the right atrium. Thus, venous blood from tissues and organs enters the right atrium.

1 Why does the load increase?

Right atrial hypertrophy

The load on the right atrium is determined by the amount of blood that enters it, as well as how the blood is released during atrial contraction. If an excess amount of blood enters, the pressure on the chamber walls will increase, which will inevitably be accompanied by overload. If there is a problem with the valve between the atrium and the right ventricle in the form of a narrowing, blood from the atrium will flow out with difficulty, and some of the blood will be retained in the atrium.

This also increases the pressure on its walls and increases the load. Over time, if overload of the right atrium persists for a long time, its walls thicken, muscle tissue grows, and hypertrophy occurs - this is a protective mechanism that occurs to preserve the pumping function of the heart. Due to hypertrophy, the atrium can push out an increased volume of blood that enters it. But the reserve capacity of the heart is not limitless, and after the thickening of the walls, stretching and expansion of the right atrium occurs - dilatation. This condition leads to a serious illness - heart failure.

2 Causes of overload

In the practice of cardiologists, overload of the left atrium is more common, but the right atrium can also be subject to excessive load. The reasons for this phenomenon are:

chronic pulmonary diseases (bronchial asthma, chronic bronchitis, emphysema),
pathology of the tricuspid valve (its narrowing or insufficiency),
congenital heart and vascular defects,
cardiomyopathies, endocarditis, myocarditis,
endocrine diseases (thyrotoxicosis),
chest injury or deformation.

All these reasons lead to an increase in pressure in the pulmonary artery, and the formation of chronic pulmonary heart occurs.

3 Clinical picture of right atrium overload

ECG for right atrial hypertrophy

As a rule, patients’ complaints appear in the later stages, when pronounced hypertrophy or expansion of the atrium occurs, or during an acute attack of stress on the right side of the heart. For a long time, a person may not even know that one of the chambers of his heart is experiencing overload. In the initial stages it is asymptomatic and diagnosed only by ECG.

With severe exertion, complaints may include shortness of breath during physical activity, or at rest, dry cough, hemoptysis, general weakness. If the diagnosis is not carried out on time, the patient does not receive treatment, not only the right, but also the left parts of the heart suffer, and circulatory failure develops in a large circle.

Signs of which include heaviness and pain in the right hypochondrium, ascites, nausea, vomiting, swelling of the feet, ankles, and legs. Heart failure develops. You should be aware that overload can occur acutely and suddenly. And also suddenly pass without a trace. This condition can develop during an asthmatic attack, pneumonia, when, after relief of symptoms or cure, the clinical manifestations go away, the cardiogram returns to normal, and the patient’s condition returns to normal.

4 How to diagnose right atrial overload?

It is necessary to carefully collect complaints and anamnesis. If a person has a lung problem, severe kyphosis, scoliosis, or a history of chest trauma, the doctor should remember that these conditions can cause increased stress on the heart. Diagnostic aids are:

ECG - the P wave is high, more than 2.5 mm in height, in leads II, III, avF and wide, double-humped in ECG leads v1, v2
EchoCG - the muscular wall of the right atrium will be thickened, or, on the contrary, thinned, and the chamber cavity will be increased in volume and stretched. Changes on EchoCG are typical if the overload is prolonged, leading to changes in the heart muscle. If there is an acute attack leading to an increase in the load on the atrium, there will be no obvious signs on EchoCG. Also, for asthenic, young people, ECG signs may be characteristic of overload. But they will be a variant of the norm.

5 How to reduce overload?

Relieving an attack of bronchial asthma

Relieving the load on the right atrium involves treating the diseases that cause it. After treating pulmonary pathology, stopping an attack of asthma, normalizing the functioning of the valves, the load on the right chambers of the heart decreases and the overload clinic also decreases. In addition to treating the underlying disease, heart function can be supported with metabolic drugs that help saturate myocardial cells with nutrients and oxygen.

It is necessary to take care of the heart by eliminating risk factors: completely quitting smoking and alcohol, eating foods low in animal fats and salt, and dosed physical activity recommended by a doctor. It is necessary to monitor cholesterol levels, prevent weight gain, and maintain psycho-emotional peace. It is necessary to take care of your health, not to self-medicate and, at the first signs of increased stress on the heart, consult a specialist.

Right atrial hypertrophy: symptoms and treatment

Dilatation of the left atrium: causes and treatment

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A Complete Overview of Right Atrial Hypertrophy

From this article you will learn: what is right atrial hypertrophy, what is the mechanism of its development. Types of hypertrophy, causes of occurrence and characteristic symptoms. Distinctive signs of right atrial hypertrophy on the ECG, treatment and prognosis.

Hypertrophy (thickening of the chamber walls) of the right atrium is not a heart disease, but a characteristic symptom, the result of cardiovascular pathologies or regular physical activity (the norm for professional athletes).

Against the background of certain pathological processes (tricuspid valve stenosis, increased pressure in the pulmonary arteries), the filling and pressure in the right atrium becomes excessive. To ensure normal blood flow and protect the chamber from rupture, the myocardium builds up layers (thickens), and the strength and frequency of atrial contractions increases.

As a result, the patient develops arrhythmia, and characteristic symptoms of venous congestion in the lungs appear - cough, asthma-like shortness of breath.

Pathology always appears against the background of diseases (pulmonary, cardiovascular), blood flow disorders in the systemic or pulmonary circulation (the exception is working hypertrophy - thickening of the myocardial layer in response to regular physical activity, “athlete’s heart”).

It can be cured completely if the cause of hypertrophy is eliminated in time (for example, tricuspid valve stenosis, pulmonary disease), the thickness of the muscle walls decreases, the functions of the heart are restored (the strength of atrial contractions decreases, the heart rhythm normalizes).

If the cause cannot be eliminated, over time this thickening may become more complicated:

heart rhythm disturbances (supraventricular extrasystole);
formation of cor pulmonale (dysfunction of the right ventricle due to pathologies in the pulmonary vessels);
congestion (venous insufficiency);
lead to death as a result of pulmonary embolism.

Treatment for pathology is prescribed by a cardiologist.

Mechanism of development and types of hypertrophy of the right atrium

With defects of the tricuspid valve (this is the three-cuspid septum between the right atrium and the ventricle), the opening through which blood normally flows freely from the atrium into the ventricle is greatly narrowed or does not close enough. This disrupts intracardiac blood flow:

after filling the ventricle at the time of diastole (relaxation), an extra portion of blood remains in the atrium;
it puts more pressure on the myocardial walls than during normal filling and provokes their thickening.

With pathology in the pulmonary circulation (pulmonary diseases), blood pressure in the pulmonary vessels and in the right ventricle increases (the pulmonary or pulmonary circulation begins from there). This process prevents the free flow of the required volume of blood from the atrium into the ventricle; part of it remains in the chamber, increases pressure on the walls of the atrium and provokes the growth of the muscular layer of the myocardium.

Diagram of the pulmonary and systemic circulation. Muscle layer of the myocardium. Click on photo to enlarge

Most often, right atrial hypertrophy develops against the background of cardiovascular disorders, but sometimes it becomes a consequence of regular physical activity or myocardial necrosis.

Depending on the factor under the influence of which the thickening of the chamber walls appeared, there are:

Regenerative hypertrophy due to scarring at the site of necrosis (after a heart attack). The atrial myocardium grows around the scar, trying to restore cell function (conduction and contraction).
Replacement as a way for the heart muscle to compensate for circulatory deficiencies under the influence of various pathologies and negative factors.
Working – a form that develops under the influence of regular physical activity (professional training), as a protective mechanism for increased heart rate, hyperventilation of the lungs, increased pumped blood volume, etc.

Working hypertrophy is typical not only for athletes, but also for people with heavy physical labor (miners).

Causes of pathology

Characteristic symptoms, signs on ECG

In the initial stages, until severe heart failure (impaired heart function and blood supply to organs and tissues) occurs, hypertrophy is asymptomatic, without affecting the quality of life.

Over time, signs of pulmonary congestion begin to appear - shortness of breath, coughing and tingling in the heart, fatigue with moderate exertion.

Subsequently, if the process progresses, other changes in the heart muscle join the hypertrophy of the right ventricle (ventricular dilatation, cor pulmonale, impaired blood supply, rhythm and function of the heart), typical pronounced signs of cardiovascular failure appear - shortness of breath with little physical activity and at rest , reduction in working capacity to complete disability.

Symptoms often appear some time after suffering pulmonary diseases (bronchitis, pneumonia).

Signs of RA hypertrophy on the ECG

An informative diagnostic method for determining pathology is electrocardiography; characteristic signs of right atrium hypertrophy on the ECG appear:

sharpening and increasing the height of the P wave (this way the excitation of the atria is recorded; normally the P wave is flat with a rounded apex);
an increase in the amplitude (width of the image on paper) of the P wave (normally does not exceed 0.2 seconds, graphically displayed using large cells on ECG paper).

Right atrial hypertrophy on the ECG. Click on photo to enlarge

To confirm ECG data, the doctor may prescribe other diagnostic methods - duplex ultrasound scanning, which can be used to assess the degree of hypertrophy and other changes in the heart (dilatation of the right ventricle, increase in overall size).

Treatment methods

Right atrial hypertrophy can be cured completely if the cause that caused it occurs is eliminated in time. In some cases, the pathology goes away on its own, after recovery (for pulmonary diseases).

Treatment is chosen depending on the disease and the reasons that led to its appearance:

when the pressure in the pulmonary vessels increases, vasodilator bronchodilators, anti-inflammatory, antiarrhythmic agents that improve the metabolism of the heart muscle are prescribed;
for congenital or acquired defects of the heart, valves or blood vessels, surgical correction of the defect is performed.

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Forecast for life

The prognosis for the development of the pathology depends entirely on the underlying disease (or complex of pathologies) against which it appeared. If hypertrophy is diagnosed in the early stages, before irreversible changes in the heart (dilatation of the right atrium) have yet occurred and the cause is easy to eliminate (for example, tricuspid valve stenosis), the pathology can be cured completely.

If hemodynamic disturbances (the movement of blood inside the heart and through the vessels) have become pronounced, it will be more difficult to eliminate the pathology. Under such conditions, hypertrophy of the right atrium is quickly accompanied by changes in other chambers of the heart (dilatation of the right ventricle), arrhythmia, heart failure and impaired blood supply develop, first in the pulmonary and then in the systemic circulation.

Why does the load on the right atrium increase?

The right atrium receives blood from the systemic circulation through the vena cava. After the blood has given up all its nutrients and oxygen, it becomes venous and enters the right side of the heart.

In some cases, overstrain of the heart muscle occurs; you need to understand in what situations this occurs and why these conditions are dangerous.

Situations leading to overload

Right atrium overload can occur in the following situations:

More blood enters the atrium than it should normally, or as a result of problems with the valve, not all the blood is pushed out during contraction; some of the blood remains in the atrium cavity.
As a result of various diseases, the load on the right side of the heart muscle increases, mainly chronic lung diseases.

How blood moves in the heart

In other words, strain on the heart muscle may be caused by increased blood volume or increased blood pressure.

In order to pay attention to such situations in time, we will analyze them in more detail.

Cause: Excess blood

This condition most often occurs with defects, namely stenosis or insufficiency of the tricuspid valve (tricuspid). This valve separates the ventricle from the atrium on the right.

The causes of damage to this valve are most often rheumatism, it is also possible as a result of bacterial endocarditis, relative insufficiency of the tricuspid valve may occur with enlargement and stretching of the left parts of the heart muscle.

Mitral valve defects (stenosis)

Congenital defects of the pulmonary artery lead to the appearance of an increased volume of blood first in the ventricle, followed by overload of the atrium.

High blood pressure

Increased pressure load occurs with lung diseases such as chronic obstructive bronchitis, bronchial asthma, and emphysema.

First of all, during these diseases, the load on the ventricle increases, which becomes difficult to push blood into the pulmonary vessels.

Following the overload of the ventricle, its enlargement and expansion occurs, then the same changes occur in the atrium.

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Diagnostics

There are no specific and specific clinical signs by which right ventricular overload can be determined. The presence of such a problem can be suspected if you have chronic lung diseases, as well as problems with the valves.

These abnormalities are usually detected during electrocardiography. Signs of this disorder are specific changes in the “P” wave. Such changes may be temporary and disappear from the cardiogram after recovery, or they may be a sign of incipient atrial hypertrophy.

During an ultrasound examination of the heart muscle, it is possible to detect increased pressure and also measure the volume of blood that is in different parts of this organ. This study also makes it possible to identify disorders in all parts of the heart and in large vessels.

Some conditions may require cardiac surgery, mainly valve replacement, so an ultrasound examination of the heart is mandatory in all patients where overload is detected.

The prognosis of the disease and the correct and timely initiation of treatment depend on the timeliness of the diagnosis.

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Treatment and prognosis

If the appearance of overload of the right atrium is associated with the appearance of pneumonia, with an attack of bronchial asthma and other acute conditions, then these changes go away on their own after the underlying disease is cured.

When it comes to chronic diseases, both from the heart and blood vessels, and from the lungs, then completely get rid of these chronic diseases is no longer possible. It is necessary to reduce the burden on the cardiovascular system by treating exacerbations of these diseases. Treatment of chronic bronchitis will help reduce pressure in the blood vessels of the lungs, and overload of the heart can be avoided.

Most often, signs of overload of the right atrium appear after the ventricle enlarges, and this process ends with the formation of a “pulmonary heart.”

When such changes occur, the onset of heart failure is inevitable, rhythm disturbances and arterial hypertension may occur. Following changes in the right side of the heart, an enlargement of the left side of the heart appears, and heart failure progresses.

Considering all of the above, if signs of right atrium overload are detected on the electrocardiogram, it is necessary to find out the cause of this condition, perform an ultrasound of the heart, and x-ray of the lungs. Treatment of the identified underlying disease should begin as early as possible, before the process becomes chronic and “cor pulmonale” appears.

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During the medical examination, she felt general weakness, was bothered by a dry cough, shortness of breath during physical activity, and increased sweating at night. Margarita associated these symptoms with long-term smoking and constant stress at work. The woman came with the ECG results for a consultation with a cardiologist, who did not reveal any cardiac pathology.

He recommended examining the lungs and contacting a pulmonologist. A chest x-ray revealed inflammation of the left lung. The patient consulted a pulmonologist, although no pathological wheezing was detected in the lungs; she was prescribed antibiotics, expectorants, and vitamins. A month later, all changes both on the cardiogram and on the x-ray disappeared, the woman was completely cured.

Brief information: Signs of right atrium overload on the electrocardiogram, especially if these changes are the only ones and are not combined with other changes in the heart, sometimes help to suspect an acute process in the lungs.

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ECG: signs of load on the right atrium. Norm?

I did an ECG in January, the doctor said it was sinus tasycardia.

I did an ECG that week, and the conclusion said that there was a rapid heartbeat and signs of strain on the right atrium. I was told it was due to asthma.

A secondary condition does not play an independent role in the initial stages; adequate treatment of the underlying disease (bronchial asthma) is required to reduce intrathoracic pressure and resistance to blood flow.

Right atrial hypertrophy: causes, signs, diagnosis, how to treat, prognosis

Hypertrophic changes can develop in any organ that contains muscle fibers, but most often this occurs in the heart. The heart muscle, or myocardium, is designed in such a way that with increasing load on it, that is, with increasing effort to perform the pumping function, the number of myocytes (muscle cells) increases, as well as the thickening of the muscle fiber. Typically, such changes affect those areas that are most susceptible to overload, or in which normal muscle tissue is replaced by scar tissue. In the latter case, the myocardial zones around the scar tissue thicken compensatoryly so that the heart as a whole can pump blood.

parts of the heart and hypertrophy

Hypertrophy can involve both muscle in all parts of the heart and in individual chambers (in the wall of the atria or ventricles). Each type of myocardial hypertrophy has its own causes.

Why does hypertrophy of the right atrium myocardium occur?

Enlargement of the right atrium is rarely isolated, that is, it is almost always combined with hypertrophy of other parts of the heart (usually the right ventricle). It usually develops because the myocardium of the right atrium is overloaded due to high pressure or increased volume.

In the first case, the muscle fibers constantly have difficulty pushing blood into the right ventricle through the tricuspid (three-leaf) valve. In the second case, the myocardium of the right atrium is constantly overstretched if blood from the right ventricle is refluxed into the atrial cavity (under normal conditions this should not happen). That is, hypertrophy develops gradually, gradually in cases where the causative disease remains undetected and untreated for a long time. The time this process may take varies individually - in some patients, hypertrophy can form within a few months from the onset of the disease, in others the myocardium remains in a normal state for decades. But in any case, the compensatory abilities of the heart (to carry out increased load) sooner or later weaken, the heart becomes exhausted, and decompensation of chronic heart failure develops.

Diseases that can trigger the development of myocardial hypertrophy are the following:

1. Pathology of the bronchopulmonary system

In severe cases of certain diseases, for example, bronchial asthma (especially hormone-dependent), chronic obstructive bronchitis, emphysema, frequent recurrent pneumonia, bronchiectasis, hypertrophy of the myocardium of the right ventricle first develops, and subsequently the right atrium.

2. Pathology of the right heart

In this case, we are talking about defects of the tricuspid valve - its insufficiency or stenosis of its opening. With insufficiency of the valve ring, volume overload of the atrium on the right occurs, since with each contraction of the heart, blood does not completely flow from the atrium into the ventricle, and part of it is thrown back. This process is called regurgitation. As a result, with each contraction, the atrium receives an increased amount of blood (a portion of blood obtained from the vena cava, which carries blood from the entire body into the cavity of the right atrium, as well as a portion of blood thrown back from the ventricle), and its wall is overstretched. The myocardium becomes thicker and stronger - hypertrophy develops.

With stenosis of the right atrioventricular orifice, the situation is different. As a result of the fact that the valve ring becomes narrower than normal, the myocardium of the right atrium has to work with greater load - pressure overload of the myocardium occurs. After some time, the heart muscle thickens, and the atrium cavity increases, since not all the blood can be pushed out in one heartbeat into the cavity of the right ventricle.

3. Pathology of the pulmonary artery and its valve

The pulmonary artery is a large vessel that arises from the right ventricle and carries blood flow to the lungs to saturate it with oxygen. With congenital pathology of the pulmonary valve, called stenosis, it is more difficult for the myocardium of the right ventricle to push blood into the lumen of the artery, as a result of which it hypertrophies. Then hypertrophy of the right atrium gradually increases.

4. Myocardial remodeling

This process implies the development of post-infarction cardiosclerosis, due to which scar tissue forms in place of the necrotic heart muscle. The remaining portion of normal cardiomyocytes gradually thickens, leading to compensatory hypertrophy. Typically, this process involves the left ventricle, but in rare cases, the development of right ventricular infarction may occur, as a result of which remodeling also affects the wall of the right atrium.

5. Postmyocardial cardiosclerosis

The formation of scar tissue in this case is caused by inflammatory changes in the heart muscle, or myocarditis. Myocarditis can be caused by viruses, fungi or bacteria, and inflammation can develop in the muscle of any of the chambers of the heart. Several months or years after the inflammation, compensatory hypertrophy of the right atrium myocardium develops if it is damaged.

6. Coronary heart disease

Acute or chronic lack of oxygen in the heart muscle, caused by blockage of the coronary artery with an atherosclerotic plaque or thrombus and being the pathogenetic basis for myocardial ischemia, leads to disruption of the contractile function of those cardiomyocytes that are susceptible to these processes. Wherein neighboring areas the myocardium thickens compensatoryly. A moderate increase in the myocardium of the right atrium is formed when the blockage is localized in the lumen of the artery that supplies the atrial heart muscle.

7. Hypertrophic cardiomyopathy

It is a disease resulting from genetic defects and is characterized by uniform thickening of the myocardium. Hypertrophic CMP is more often recorded in young children and can involve the myocardium of the right atrium.

What are the signs of right atrial hypertrophy?

The symptoms of this pathology can remain blurred for a long time, since the symptoms of the underlying disease (lung disease, heart attack, myocarditis, etc.) come to the fore. However, patients experience the following symptoms:

Shortness of breath during physical activity or at rest, dry hacking cough (caused by stagnation of blood in the pulmonary circulation and pulmonary hypertension),
Heaviness in the right side and periodic pain in the right hypochondrium (due to increased blood supply in the liver and overstretching of its capsule),
Swelling of the lower extremities, increasing in the morning, after a long horizontal position of the body,
Feeling of heart failure,
Paroxysms of atrial fibrillation and supraventricular tachycardia, provoked by improper functioning of the sinus node located in the right atrium appendage, as well as incorrect and chaotic contractions of overstretched and thickened muscle fibers of the right atrium.

The occurrence of any of the listed symptoms, especially in persons with existing heart or lung pathology, requires immediate consultation with a doctor for examination and additional diagnostics.

How to diagnose right atrial hypertrophy?

GPP on X-ray

In order to confirm or exclude this pathology in a patient, the doctor, in addition to a clinical examination, prescribes examination methods such as:

Echo-CS, (echocardioscopy, or ultrasound of the heart), which allows you to visualize the heart and its internal structures, as well as clarify the type of defect, if any,
X-ray examination of the organs of the chest cavity, which visualizes changes not only in the right atrium, but also in the right ventricle (the contour of the atrium merges with the contours of the superior vena cava, pulmonary artery and the contour of the right ventricle).

The main routine research method is an electrocardiographic study, which is used to determine the following signs of right atrium hypertrophy on the ECG:

An increase in the amplitude and width of the P wave (above 2.5 mm and wider than 0.1 sec) - the so-called P-pulmonale (high, pointed, biphasic),
The P wave is higher and wider along the right chest leads (V1, V2),
The electrical axis of the heart is deviated to the right or sharply to the right.

Video: ECG signs of hypertrophy of the right atrium and other chambers of the heart

Treatment of right atrial hypertrophy

This pathology is a fairly serious problem that requires treatment of the causative disease. In most cases, when the provoking factor is eliminated, the right atrium muscle ceases to experience constant overload and can return to normal size. Among the therapeutic measures used to treat causative diseases, the following can be noted:

Competent and timely treatment of pulmonary pathology (use of inhalers for bronchial asthma, antibacterial therapy for pneumonia, surgical treatment for bronchiectasis, etc.).
Timely surgical correction of heart defects.
Prevention of myocardial remodeling after infarction and myocarditis using drugs with antihypoxic and cardioprotective effects. The first group includes antihypoxants such as Actovegin, Mildronate, Mexidol and Preductal. From the second group, antihypertensive drugs are prescribed - ACE inhibitors or angiotensin II receptor antagonists (ARA II). They significantly reduce the rate of myocardial hypertrophy and are able to delay the development of chronic heart failure. Enalapril, quadripril, perindopril, etc. are usually prescribed.
Complex treatment of coronary heart disease. Nitroglycerin, beta-blockers (metoprolol, bisoprolol, nebivalol, etc.), ACE inhibitors, antiplatelet agents that prevent blood clots (aspirin) and lipid-lowering drugs that normalize cholesterol levels in the blood (statins) are mandatory.

Regarding the treatment of myocardial hypertrophy itself, it should be noted that ACE inhibitors and beta blockers significantly reduce the development of decompensation of heart failure with hypertrophy of the right heart.

Forecast

If we talk about the consequences of right atrium hypertrophy, it is worth noting that the natural course of the process, without treatment, inevitably leads to severe chronic heart failure. The heart of such patients is not able to withstand normal household activities. They often experience severe heart rhythm disturbances and attacks of acute heart failure, which can cause death. If the causative disease is successfully treated, then the prognosis for right atrial hypertrophy becomes favorable, and the quality and life expectancy increase.

Isolated hypertrophy in the absence of heart failure is not dangerous to human health.

The essence of the problem

Hypertrophy of the left ventricle of the heart is often a consequence of overload or malfunction of the valve apparatus. This is the main diagnostic sign of hypertrophic cardiomyopathy. The left ventricle of the heart is a cavity, a muscular formation that is capable of contracting and pushing blood. This chamber begins the systemic circulation.

There are several types of hypertrophy: eccentric, concentric and with obstruction. Each form has its own characteristics. Eccentric left ventricular hypertrophy is most often formed due to insufficiency of the valve located between the left parts of the heart. Its development is based on an excess of normal blood volume in this part of the heart.

The weight of the left ventricle increases and it stretches. Such changes negatively affect heart contractions. High load leads to decreased cardiac output. The concentric form of LVH is different in that the blood is thrown back, and the myocardium requires more force to push it into the aortic lumen. This is accompanied by thickening of the walls of the heart chamber. Sometimes a decrease in the ventricular cavity is observed.

Main etiological factors

The causes of myocardial hypertrophy are different. The development of this pathology is based on cardiac overload. It is possible under the following conditions:

hypertension;
stenosis of the aortic and mitral valve;
aortic or mitral valve insufficiency;
congenital segmental narrowing of the aorta (coarctation);
salt deposits on valves;
the presence of atherosclerotic lesions of the aorta;
hyperthyroidism (thyrotoxicosis);
pheochromocytoma (adrenal tumors);
diabetes mellitus;
cardiomyopathy;
obesity;
alcoholism.

The following risk factors for left ventricular overload are identified:

hard physical labor;
an increase in circulating blood volume due to obesity;
smoking;
stress;
infectious diseases (endocarditis);
dyslipidemia (blood lipid disorder);
playing sports.

Enlarged LV is often found in professional athletes (weightlifters, runners), as well as in people engaged in heavy work (loaders).

Thickening of the walls of the heart chambers may have a hereditary predisposition. The risk group includes men over 50 years of age. The condition of the heart muscle largely depends on lifestyle. Nutrition is of great importance. Excess fat, simple carbohydrates and salt can lead to LV enlargement.

Clinical signs

Signs of left ventricular hypertrophy are absent for a long time. Symptoms appear only when a person cannot compensate for the resulting changes in blood circulation. Concentric hypertrophy of the left ventricular myocardium can be manifested by the following symptoms:

dizziness;
pain in the heart;
shortness of breath;
swelling of the lower extremities;
sleep disturbance;
decreased ability to work;
weakness;
feeling of a sinking heart;
fainting;
lability of blood pressure;
heart rhythm disturbances such as atrial fibrillation or extrasystole.

Most of these patients experience pain in the heart area similar to angina pectoris. Increased blood pressure is common. A typical manifestation of myocardial hypertrophy is shortness of breath. In the early stages it bothers you when working, and then appears at rest. In severe cases, cardiac asthma develops. Many patients are bothered by periodic attacks of suffocation.

Acrocyanosis (blue discoloration of fingers, nose, lips) is possible. All these symptoms are caused by the underlying disease, which led to left ventricular hypertrophy. If the cause is hypertrophic cardiomyopathy, then the outcome of such a pathology can be non-violent death due to sudden cardiac arrest.

Examination and treatment plan

Enlargement of the left or right parts of the heart can only be detected during instrumental examination. ECG, signs of hypertrophy and ultrasound results are critical in making the diagnosis. The following studies are needed:

Ultrasound of the heart;
auscultation and percussion;
tonometry;
carrying out load tests (bicycle ergometry and treadmill test);
heart murmur analysis;
plain X-ray examination;
General and biochemical blood test.

The presence of LV hypertrophy is indicated by the following changes:

presence of shortness of breath, dizziness and fainting;
displacement of the borders of the heart to the left;
systolic murmur in the aorta;
increase in pressure;
slight enlargement of the heart.

The electrocardiogram reveals a change in the R wave in the chest leads. In V6 and V5 a negative

T wave. During ultrasound, the degree of thickening of the wall of the left ventricle is assessed. It is necessary to treat left ventricular hypertrophy of the heart after consultation with a cardiologist. Treatment with folk remedies is ineffective.

The following medications are most often prescribed to patients with LVH:

beta blockers (Metoprolol, Atenolol);
ACE inhibitors (Perindopril, Enalapril);
calcium channel blockers (Verapamil);
drugs that restore normal heart rhythm;
sartans.

In heart failure with severe edema, diuretics are indicated. For heart pain, the doctor may prescribe nitrates (Nitroglycerin). The treatment regimen for left ventricular hypertrophy with heart failure includes cardiac glycosides. To thin the blood and reduce the risk of blood clots, antiplatelet agents and anticoagulants are indicated. Thus, LV enlargement requires adequate treatment and specialist consultation.

Signs of LVH on ECG

LVH or left ventricular hypertrophy is an increase in the volume of the structural unit of the heart (left ventricle) due to increased functional loads that are incompatible with capabilities. Hypertrophy on the ECG is not the cause of the disease, but its symptom. If the ventricle extends beyond its anatomical size, then the problem of myocardial overload already exists.

Severe signs of LVH on the ECG are determined by a cardiologist; in real life, the patient experiences symptoms of heart disease, which determine dilatation (pathological enlargement of the heart chamber). The main ones include:

instability of heart rhythm (arrhythmia);
symptom of short-term cardiac arrest (extrasystole);
persistently elevated blood pressure;
extracellular hyperhydration of the extremities (edema due to fluid retention);
lack of oxygen, impaired frequency and depth of breathing (shortness of breath);
pain in the heart area, chest area;
short-term loss of consciousness (fainting).

If symptoms appear on a regular basis, this condition requires consultation with a doctor and an electrocardiographic examination. A hypertrophied ventricle loses its ability to contract fully. Impaired functionality is displayed in detail on the cardiogram.

Basic ECG concepts for the left ventricle

The rhythmic work of the heart muscle creates an electric field with electrical potentials having a negative or positive pole. The difference between these potentials is recorded in leads - electrodes attached to the patient’s limbs and chest (indicated “V” on the graph). The electrocardiograph records changes in signals that arrive over a certain time range and displays them as a graph on paper.

A fixed time period is reflected on the horizontal line of the graph. Vertical angles (teeth) indicate the depth and frequency of impulse changes. Teeth with a positive value are displayed upward from the time line, with a negative value - downward. Each tooth and lead are responsible for recording the functionality of a particular cardiac section.

Indicators of the left ventricle are: waves T, S, R, segment S-T, leads – I (first), II (second), III (third), AVL, V5, V6.

The T-wave is an indicator of the recovery stage of the muscle tissue of the ventricles of the heart between contractions of the middle muscular layer of the heart (myocardium);
Q, R, S - these teeth show agitation of the cardiac ventricles (excited state);
ST,QRST, TP are segments indicating the horizontal distance between adjacent teeth. Segment + tooth = interval;
Leads I and II (standard) – display the anterior and posterior walls of the heart;
III standard lead – fixes I and II according to a set of indicators;
V5 – lateral wall of the left ventricle in front;
AVL – lateral cardiac wall anterior to the left;
V6 – left ventricle.

Schematic representation of S-T segment elevation in V1 and V2, indicating LVH

The electrocardiogram evaluates the frequency, height, degree of jaggedness and location of the teeth relative to the horizontal in the leads. The indicators are compared with the norms of cardiac activity, changes and deviations are analyzed.

Left ventricular hypertrophy on the cardiogram

When compared with the norms, the signs of left ventricular hypertrophy on the ECG will have the following differences.

Learn more about changing tine values

Left ventricular hypertrophy is visually determined by the height and width of the R wave in leads V5 V6 (increased wave parameters), compared to leads V1, V2. Transformation of the T-wave in leads V5, V6 indicates left-sided pathology in the case of:

negative tooth value;
doublings (two parts of one tooth);
the first half “looks” down, and the second half looks up.

A slight displacement of the S-T segment up or down relative to the horizontal line is a sign of thickening of the walls of the left ventricle. Significant displacement is an indicator of myocardial infarction or ischemic heart disease (coronary heart disease).

The S-wave in the presence of a hypertraffiated ventricle changes as follows:

in leads: III, AVF, V1, V2 – increased depth of the tooth;
in leads: AVL, V5, V6, I – weakly expressed;
jaggedness is observed.

Deviations from the norm of the parameters of the Q, R, S waves are called the voltage of the cardiogram. If the teeth are located below normal by more than 0.5 mV, a low-voltage potential will be recorded on the cardiogram. Voltage changes always indicate the presence of cardiac pathology.

Electrocardiogram of the heart with LVH (signs of pathology are circled in red)

Causes of hypertrophy

Left ventricular hypertrophy detected during an ECG means the presence of excessive load on the heart and myocardial diseases:

narrowing of the aortic lumen in the valve area (aortic stenosis). Due to the transformation of the valve leaflets, blood flow is disrupted, and the heart is forced to work in emergency mode;
change in the volume of the left ventricular wall towards thickening (hypertrophic cardiomyopathy). The thickness of the walls impedes blood circulation, which increases the load on the myocardium;
persistently high blood pressure (hypertension).

Deformation can occur due to reasons that depend directly on the patient himself. First of all, these are the following factors: eating habits leading to obesity, irrational physical activity. LVH is common to many athletes, since excessive load on the heart during training provokes an increase in the volume and mass of the organ, systematic psycho-emotional overload (state of stress), healthy image life (smoking, alcohol, lack of fresh air, harmful products food).

Dangerous consequences

The left ventricle is responsible for oxygen saturation and movement of arterial blood into the aorta and further through all small vessels to nourish the organs. As the volume increases, the blood presses on the walls, the connective tissue displaces the muscle tissue, and the ventricle ceases to cope with its functional duties.

Pathology can even lead to death

What such changes threaten is determined by the following diagnoses:

coronary heart disease - a violation of the blood supply to the heart due to thickening of the walls of the gastric chamber;
myocardial infarction – death (necrosis) of part of the heart muscle;
ventricular extrasystole (arrhythmia) – failure of the heart rhythm;
atrioventricular or ventricular block - cessation of the passage of electrical impulses between the atria and ventricles, leading to hemodynamics;
heart failure is a low contractility of the heart muscle, often leading to death.

Timely detection of LVH will help prevent serious complications. The most informative in terms of diagnosing pathology is the electrocardiographic examination method.

Prevention of LVH

The main preventive measures include:

elimination of bad habits (alcohol and nicotine addiction);
a healthy diet (eliminating foods containing low-density lipoproteins, the so-called bad cholesterol, while increasing the intake of high-density lipoproteins, the “good cholesterol”);
body weight control (obesity always negatively affects heart function);
balanced physical activity appropriate for age;
regular exposure to fresh air (active oxygen stimulates proper cardiac activity).

Cardiac overload - a guide to clinical electrocardiography in children

a) hypertrophy of “obturation”, developing as a result of stenotic processes and having a “concentric” character. This hypertrophy is proportional to the degree of stenosis and has a progressive course -

Such hypertrophy is typical for cases when the right ventricle must adapt to the systemic circulation. There is no “adaptive” left ventricular hypertrophy -

c) “overload” hypertrophy occurs due to hemodynamic and functional effects on the myocardium due to the presence of shunts, and is naturally associated with the severity of anatomical defects.

the amplitude of the Rj wave is increased,

In the precordial leads:

In ECG leads from the limbs:

In the precordial leads:

in leads Vj_2 there is a deep wave S - in V6 there is a ventricular complex of the form qRR` or qRS of slightly increased amplitude,

Cardiac overload - Guide to clinical electrocardiography in children

It is impossible to finish the section on hypertrophies without dwelling on a debatable issue - the diagnosis of the type of hemodynamic overload of the ventricular myocardium. Based on hemodynamic disturbances leading to hypertrophy of the ventricular myocardium, the Mexicans E. Cabrera and J. Mopgo in 1952 created and popularized the concept of electrocardiographic diagnosis of ventricular overload. Naturally, at certain stages, excessive intensification of the work of the heart muscle leads to the appearance of peculiar electrocardiographic changes. The latter were used by the authors to validate their concept. At the same time, a number of authors, and in particular R. Grant (1957), criticized this concept, based on the fact that the electrocardiogram can only reflect structural changes in the myocardium and conduction disturbances and cannot be a carrier of information about the hemodynamic situation. However, the criticism, as clinical experience has shown, did not have sufficient grounds. One can hardly agree that even a sudden resistance to the expulsion of blood from the ventricles and overstretching of the volume chambers leaves the myocardium intact. We have seen overloads both long-term and short-term. For example, during acute pneumonia in young children, electrocardiographic signs of “hypertrophy” of the right ventricular myocardium are clearly detected, which disappear after the process is completed in the lungs.

There are systolic and diastolic overloads. The first is based on acutely occurring or long-term increased resistance to blood flow from the cavity of the right or left ventricles during systole. Systolic overload is also called “pressure overload.” Diastolic overload is caused by the load of increased blood volume on the myocardium of the right or left ventricles, which occurs due to the overflow of the chamber with blood during diastole.

Systolic overload is accompanied by high energy costs, increased oxygen consumption, an increase in systolic blood pressure in the heart cavity and large vessels, and the eventual development of concentric hypertrophy.

With diastolic overload, energy costs are low, the increase in blood pressure in the cavity is small, hypertrophy is moderate and develops extremely slowly (gradually), the heart chamber is enlarged, often significantly.

In the development of overloads, several stages can be distinguished, on which the brightness of electrocardiographic changes depends.

The concepts of “overload” and “hyperfunction” are practically the same. They complement each other. Hemodynamic overload during systole or diastole corresponds to isometric and isotonic types of myocardial hyperfunction. It is necessary to distinguish between acute and chronic overload. The latter, as a rule, leads to the development of myocardial hypertrophy. Thus, hypertrophy appears later as a result of overload (hyperfunction). After the development of hypertrophy, they coexist. It is possible to identify signs of acute overload, or rather to diagnose the latter, only in dynamics when it sharply increases or decreases.

MYOCARDIAL OVERLOAD OF THE LEFT VENTRICLE

Systolic overload of the left ventricular myocardium in children occurs in conditions such as stenosis and coarctation of the aorta, systemic or symptomatic hypertension, i.e., when there is increased resistance to the ejection of blood from the cavity of the left ventricle. The electrocardiographic expression of systolic overload of the left ventricular myocardium is reduced to an increase in the voltage of the R wave, downward displacement of the ST segment and inversion of the T wave in the left precordial leads (Fig. 90).

Diastolic overload of the myocardium of the left ventricle in children occurs with a patent ductus arteriosus, aortic and mitral insufficiency, with chronic carditis with a large cavity of the left ventricle, with myocardial insufficiency, etc. The electrocardiogram in such cases documents a high amplitude R wave and a fairly deep Q wave in the left precordial leads The T wave is of high amplitude, pointed, and the ST segment is slightly raised, but can also be lowered with a steepness directed upward (Fig. 91).

It should be noted that in the clinic of adult patients, and even in older children with acquired heart defects, it is not always possible to document the above signs of overload on an electrocardiogram. Thus, with obvious systolic and diastolic overload, only a high R wave in the left precordial leads can be recorded on electrocardiograms without changes in the ST segment and T wave or deviations in the graph of the latter are extremely insignificant.

At the same time, in an advanced stage of the disease with pronounced dilatation and hypertrophy, both conditions can be combined with classic ST changes - T (“strain pattern”) and high R amplitude in the left precordial leads. The Qv 6 wave may be absent in the presence of obvious diastolic overload.

Rice. 90. Electrocardiogram of Georgy Zh., 10 years old. Diagnosis: renal artery stenosis, symptomatic arterial hypertension, blood pressure 220/130 mmHg. Art.

Therefore, in recent years, despite all the attractiveness of the concept of overloads, interest in the latter has cooled. However, this may be justified in adult therapy clinics. In pediatric clinics, the concept of overload should be supported. It has been proven that with congenital heart defects, especially in young children suffering, for example, from a ventricular septal defect without pulmonary hypertension, there is a high degree of correlation between hemodynamic parameters and electrocardiographic changes.

Defending the concept of overload, E. Donzelot et al. developed criteria, based on those proposed by E. Cabrera and J. Mogow, for the hemodynamic assessment of hypertrophy in congenital heart defects. They described three types of hypertrophy:

Rice. 92. Electrocardiogram of Natasha P., 1 year 1 month. Diagnosis: endomyocardial fibroelastosis. Left ventricular overload of obstructive type.

We present an electrocardiographic picture of these types of hypertrophy.

Left ventricular hypertrophy of the “obstructive” type.

In ECG leads from the limbs:

AQRS is deviated to the left, but may also be to the right,

the amplitude of the Rj wave is increased,

electrical position of the heart is semi-vertical or vertical,

the T wave is negative, symmetrical, pointed (usually in leads II, III).

In the precordial leads:

large amplitude Ry4 b with deep SVl_3,

negative tooth Tu4_6 (Fig. 92).

Left ventricular hypertrophy “overload”: .

In ECG leads from the limbs:

AQRS deviated to the left by more than +20%

the Tj n,aVL tooth is flattened or negative.

In the precordial leads:

increase in the time of internal deviation QRSy6,

tooth Tu4_5 and especially Tub are flattened, merge with the isoline or are negative

signs of blockade of the left posterior branch of the atrioventricular bundle (His) (in 1/2 observations).

ECG for ventricular overload

The term “overload” implies dynamic ECG changes that appear in acute clinical situations and disappear after the patient’s condition normalizes. ECG changes are usually in the ST segments and T waves.

Left ventricular overload

The cause of overload of the left ventricle can be: long-distance running, intense training in athletes, physical overexertion, hypertensive crisis, attack of cardiac asthma... In these cases, the following is observed on the ECG in most cases:

in the left chest leads V5, V6 - a decrease in the ST segment and a flattening or negative T wave;
in leads I, aVL, overload of the left ventricle can manifest itself with a horizontal electrical axis of the heart;
in leads III, aVF, overload of the left ventricle can manifest itself when the electrical axis of the heart is vertical.

Right ventricular overload

The cause of overload of the right ventricle can be: pneumonia, an attack of bronchial asthma, in an asthmatic condition, acute pulmonary failure, pulmonary edema, acute pulmonary hypertension... In these cases, the following is observed on the ECG in most cases:

Systolic and diastolic ventricular overload

Systolic overload (resistance overload) of the ventricles occurs when there is an obstacle in the way of expulsion of blood from the ventricles that impedes blood flow (narrowing of the outlet from the ventricle; increased pressure in the pulmonary or systemic circulation). In such cases, the ventricle contracts, overcoming external resistance in systole, and its hypertrophy develops (ventricular dilatation is mild).

Diastolic overload (volume overload) of the ventricle occurs as a result of its overflow with blood, and the ventricle is overfilled with blood in diastole with an increase in the amount of residual blood in it. The cause of diastolic overload is valve insufficiency or increased blood flow, resulting in an increase in diastolic filling and muscle fiber length, leading to increased contractions of the ventricle. With diastolic overload, dilatation of the ventricle mainly occurs (hypertrophy is mild).

Left ventricular systolic overload

Common causes of left ventricular systolic overload:

aortic stenosis;
hypertonic disease;
symptomatic and arterial hypertension;
coarctation of the aorta.

ECG signs of left ventricular systolic overload:

qV5,V6< 2 mm;
high R V5,V6 > R V4 with deep S V1,V2;
the ST segment V5,V6 is located below the isoline, the T wave V5,V6 is negative (similar changes in the ST segment and T wave are usually observed in leads I, aVL);
the activation time of the left ventricle in leads V5, V6 is increased and exceeds 0.04 s.

Right ventricular systolic overload

ECG signs of systolic overload of the right ventricle:

high R V1,V2 (R V1 ≥ S V1), a high late R wave is often observed in lead aVR;
the ST segment V1,V2 is located below the isoline, the T wave is negative (similar changes in the ST segment and T wave are often observed in leads II, III, aVF);
deviation of the electrical axis of the heart to the right;
the activation time of the left ventricle in leads V1, V2 is increased and exceeds 0.03 s.

Diastolic overload of the left ventricle

ECG signs of left ventricular diastolic overload:

q V5,V6 > 2 mm, but less than a quarter of the R wave V5,V6 and less than 0.03 s;
high R V5,V6 > R V4 with deep S V1,V2;
the ST segment V5,V6 is located on the isoline or slightly higher, the T wave V5,V6 is positive (often high and pointed).

Diastolic overload of the right ventricle

A sign of diastolic overload of the right ventricle on the ECG is the appearance in leads V1, V2 of complete or incomplete blockade of the right bundle branch:

The ECG looks like rsR’ or rSR’;
The electrical axis of the heart is usually deviated to the right.

Left ventricular overload

Left ventricular hypertrophy (LVH) is a thickening of its wall, leading to dysfunction of the mitral and aortic valves. As hypertrophy develops, the septum separating the ventricles of the heart changes, and its walls lose elasticity and mobility. The two main reasons this happens are volume and pressure overload, as it requires a stronger muscle contraction to release blood. The thickening can be either uniform or concentrated in any particular part of the left cardiac ventricle.

LVH can be hereditary or acquired. Moderate left ventricular hypertrophy in itself is not a disease. It represents the symptoms of a specific disease or even a whole series of them. In most cases, LVH is a condition acquired as a result of hypertension, heart disease and other serious pathologies.

If for the limbs of the body an increase in muscle mass due to increased load is positive, then for the heart muscle the situation is different - the vessels supplying the heart with blood are not able to grow at the same rate as muscle mass, so the nutrition of the heart is disrupted. Zones of abnormal activity and bypass conduction develop. This and the weakening of the heart walls of the left ventricle leads to multiple attacks of arrhythmia.

Due to disturbances in the blood vessels and the fact that the volume of the heart muscle reaches a critical size, ischemia and focal necrosis occur. The weight of the heart can be twice as high as normal. What happens is that the vascular surface area relative to the myocardium decreases, and the distance between the vessels and muscle fibers increases. Because of this, the myocardium needs a larger volume of oxygen than usual (by 50%). Any kind of additional deficiency in oxygen supply further worsens the situation.

A particular danger in the acquisition of LVH is the intense and sudden load on the myocardium. This is especially true for people who lead a sedentary lifestyle, as well as smokers and alcohol abusers. Although left ventricular hypertrophy is not fatal, this does not mean that it is safe for the patient. LVH can cause myocardial infarction or stroke with all the ensuing serious consequences for the body.

In accordance with changes in the structure of the heart, two types of hypertrophy are distinguished.

The first of these is concentric hypertrophy. With it, the heart is increased in size, and the volume of the cavities of the ventricles is reduced. The concentric form occurs due to high blood pressure in hypertension as one of the complications in the cardiovascular system.
The second type is eccentric hypertrophy, when the heart is enlarged, but its cavities are expanded. This occurs when the heart cavities are overloaded with volume. An eccentric form occurs with heart disease and as a result of myocardial infarction.

LVH is a compensatory reaction of the body aimed at supplying its tissues with blood. Most often, the pathology develops against the background of aortic valve disease and mitral valve insufficiency. It is not easy to recognize it by its symptoms, because the signs of the immediate disease come to the fore.

Cardiac hypertrophy often occurs in young people suffering from stable high pressure. The mortality rate in this case is 4%.

To determine whether a patient has hypertrophy, appropriate diagnostic methods are used, including: echocardiogram (simple or two-dimensional), magnetic resonance and positron emission tomography, as well as Doppler echocardiogram. Voltage signs of left ventricular hypertrophy through an ECG help to identify pathology.

Causes of left ventricular hypertrophy

LVH in 90% of cases is provoked by arterial hypertension (hypertension). It may also be hereditary, due to cardiomegaly or cardiomyopathy. The causes of hypertrophy are divided into two main groups. The first group is physiological reasons, when pathology develops as a result of heavy loads accompanying an active lifestyle. Most often this concerns athletes or people whose profession involves heavy physical labor. The second group is pathological causes. They can be both hereditary and acquired. The first include heart defects, as a result of which the outflow of blood from the left ventricle and other cardiac pathologies are disrupted. The second reasons include bad habits, obesity, and excessive stress on the body.

Heredity plays a significant role in the development of hypertrophy. It can be provoked by:

cardiac ischemia;
cardiomyopathy, in which the ventricles of the heart become abnormally dense and, as a result, it is subjected to additional stress;
excess weight and stress (indirect causes of pathology, but no less dangerous);
mitral valve insufficiency;
aortic stenosis;
lung diseases (they affect the functioning of the kidneys, which, in turn, affect the left atrium);
congenital heart defect (if during 9 months of pregnancy the development of the fetal heart did not occur correctly);
ventricular septal defect, in which blood from the two parts of the ventricles mixes and, when reaching the organs and tissues, does not deliver required quantity oxygen (at the same time, both parts of the heart begin to function in an enhanced mode, trying to restore normal nutrition to the body, and this represents an additional burden).

MYOCARDIAL OVERLOAD OF THE LEFT VENTRICLE

Rice. 90. Electrocardiogram of Georgy Zh., 10 years old. Diagnosis: renal artery stenosis, symptomatic arterial hypertension, blood pressure 220/130 mmHg. Art.

Rice. 92. Electrocardiogram of Natasha P., 1 year 1 month. Diagnosis: endomyocardial fibroelastosis. Left ventricular overload of obstructive type.

Such hypertrophy is typical for cases when the right ventricle must adapt to the systemic circulation. There is no “adaptive” left ventricular hypertrophy;

c) “overload” hypertrophy occurs due to hemodynamic and functional effects on the myocardium caused by the presence of shunts, and is naturally associated with the severity of anatomical defects.

We present an electrocardiographic picture of these types of hypertrophy.

Left ventricular hypertrophy of the “obstructive” type.

In ECG leads from the limbs:

AQRS is deviated to the left, but may also be to the right,

the amplitude of the Rj wave is increased,

electrical position of the heart is semi-vertical or vertical,

the T wave is negative, symmetrical, pointed (usually in leads II, III).

In the precordial leads:

large amplitude Ry4 b with deep SVl_3,

negative tooth Tu4_6 (Fig. 92).

Left ventricular hypertrophy “overload”: .

In ECG leads from the limbs:

AQRS deviated to the left by more than +20%

the Tj n,aVL tooth is flattened or negative.

In the precordial leads:

in leads Vj_2 there is a deep S wave; in V6, the ventricular complex has the form qRR’ or qRS of slightly increased amplitude,

increase in the time of internal deviation QRSy6,

tooth Tu4_5 and especially Tub are flattened, merge with the isoline or are negative

signs of blockade of the left posterior branch of the atrioventricular bundle (His) (in 1/2 observations).

Why does the heart work “above normal”?

The term “hypertrophy” means excess tissue, enlargement of the organ; in this case, we can talk about excessive thickening of the walls of the left ventricle, which does not exclude the possibility of a simultaneous increase in the mass of the atrium and right sections.

The main “work” of the ventricles of the heart is the pumping function. They pump blood non-stop all their lives. To do this, they have 2 groups of muscle formations:

spiral (internal and external) during contraction reduce the heart in longitudinal size, predominate in the right ventricle;
constrictor (squeezing) - when working, they reduce the cross-section of the organ, most developed in the left.

Life requires the heart to contract faster, increase the speed of blood flow and the volume of blood pumped. This is necessary under conditions of physical activity and stress. The need is regulated by the brain and hormones. Hyperfunction entails hypertrophy of the organ.

Cardiac hypertrophy can be called “working” if it is associated with an increased need of the body. In this case, the myocardium goes through 3 stages:

Formation - hyperfunction is accompanied by a moderate increase in cell mass; substances that provide energy balance (glycogen, ATP molecules, phosphocreatine) accumulate in the cardiocytes.
Compensation - the thickened wall of the ventricle maintains blood circulation at the proper level with maximum costs for the restoration of enzymatic systems, the myocardium is nourished by a deep network of internal capillaries, oxygen deficiency is already possible.
Decompensation is an irreversible stage when all reserves of the heart muscle are depleted, cell atrophy occurs and they lose their functional usefulness, being replaced by scar or fatty tissue. The left ventricle is not able to push through the entire incoming volume of blood; some remains and accumulates, which leads to the formation of a congestive wave and heart failure.

Hypertrophy in heart disease

In the compensation stage, muscle hypertrophy should be regarded as an important adaptive property of the heart. It allows the myocardium to perform intensive work for a long time. The likelihood of decompensation depends on the functional state of muscle tissue and its reserve capabilities.

The right parts of the heart suffer more from aortic valve defects and mitral stenosis. Left ventricular overload is most often associated with arterial hypertension and increased resistance (90% of cases).

During the compensation stage, the heart cavity lengthens, which is called “active dilation.” Subsequently, the chamber expands (passive dilatation). It is known from practice that hypertrophy of the left ventricular muscle well compensates for aortic valve defects and mitral regurgitation in children.

Great importance in prognosis and treatment is given to compensatory hypertrophy of the right ventricular muscle in acute left ventricular infarction. It has been established that it is the second, less adapted, ventricle that takes on an increased load in order to “help” in pumping blood. This means that coronary insufficiency, most often resulting from ischemia in the left coronary arteries, must be treated taking into account possible hypertrophy of the right ventricle.

Another mechanism for the growth of myocardial mass is observed in cardiomyopathies.

How does hypertrophy develop in cardiomyopathy?

Such a complex disease as cardiomyopathy manifests itself in childhood if the parents are carriers of a hereditary mutant gene. It can manifest itself both in people of working age and in the elderly. It is important that the risk of sudden death with this disease increases to 50%.

The reserves of energy materials in some myofibrils are sharply depleted. Other cells begin to grow rapidly, trying to take over the pumping function.

Only in elderly people with existing hypertension and atherosclerotic vascular lesions, hypertrophy is aimed at overcoming increased resistance. No developmental defects or hypertension are detected in children.

The thickness of not only the ventricle, but also the septum increases, which reduces the internal dimensions of the cavity while significantly expanding the outer boundaries of the heart. The thickened myocardium compresses the coronary vessels, promoting the development of areas of ischemic tissue. The muscle itself loses elasticity and the ability to respond to the changed volume of blood flow.

As a result, patients consult a doctor with symptoms of coronary or heart failure.

How does hypertrophy manifest itself?

The most accessible diagnostic methods, ECG and ultrasound, are available in clinics. The signs of hypertrophy can be judged indirectly by the complaints of young people about:

pressing pain in the heart;
swelling in the legs and feet;
shortness of breath on exertion;
unmotivated weakness;
dizziness.

The most careful consideration should be given to those who:

decided to take up fitness and overloads himself with difficult workouts;
strives to lose weight by any means;
smokes a lot and does not give up alcoholic beverages (even fitness classes do not compensate for the harm);
has a hereditary family history of heart and vascular diseases.

Survey results

The ECG picture of hypertrophy consists of several signs:

the electrical axis is shifted to the left;
increased voltage in chest leads V5 and V6;
increased ST interval in V6;
negative T wave with unequal sides in V5 and V6, standard lead I and enhanced AVL;
wide QRS complex.

Ultrasound examination helps to judge the actual size of the heart chambers, establish wall thickness, direction and speed of blood flow. Using this method, it is possible to suggest the cause of hypertrophy with a high probability. In conclusion, special indicators are used that can be assessed by a trained doctor:

thickness of the myocardial wall in the area of the atria and ventricles;
relative thickness index;
asymmetry coefficient;
ratio of body mass and myocardium.

Magnetic resonance imaging is used to identify the site of damage and the severity of dystrophic changes.

Treatment

If the patient is identified at the stage of formation and compensation, then special treatment may not be required. Enough heart support:

optimal physical exercise;
work and rest schedule;
lack of excess weight;
proper nutrition with sufficient amounts of unsaturated fats and vitamins;
cessation of slagging and intoxication with nicotine and alcohol.

Depending on the severity of the patient’s condition and the likely possibilities of therapeutic measures, the patient is assigned a temporary or permanent disability group, a transfer to another job, and restrictions are recommended.

In drug therapy, preference is given to an antihypertensive set of drugs for hypertension, vasodilators for symptoms of ischemia and a previous heart attack.

In order to stop the progression of overload processes in the heart muscle, it is actively recommended medicines groups:

β-blockers - to reduce the oxygen demand of cells, restore rhythm (Atenolol, Nadolol, Metoprolol);
calcium channel blockers - actively help maintain normal blood pressure in the vessels and reduce resistance (Diltiazem, Verapamil);
ACE inhibitors - necessary in the treatment of hypertension and heart failure (Diroton, Enalapril);
sartans are a relatively new class of medications that help reduce the mass of hypertrophied muscles (Losartan, Candesartan).

Traditional methods of treatment

It is impossible to remodel the myocardium using folk remedies, returning it to its previous size and functions. For therapeutic purposes, well-known recommendations for lowering blood pressure, strengthening the vascular wall, and improving myocardial contractility are used.

It is better to buy plant materials in pharmacies, where quality, proper collection and drying are guaranteed.

You can make your own drops and tincture from lily of the valley. The collected flowers are placed in a dark bottle and filled with vodka. It takes 2 weeks to insist. After straining, take no more than 15–20 drops three times a day. It is suggested to pour boiling water over the remaining pulp for an hour, then drain the water, and take the flowers within 24 hours after 3 hours, no more than twice a week.
Garlic tincture with lemon and honey is recommended to almost all lovers of a healthy lifestyle. It helps delay the atherosclerotic process.
A decoction of St. John's wort leaves (100 g of dry herb per 2 liters of boiling water) with honey can be stored in the refrigerator. Not indicated for people with liver disease.

People with allergies to flowers and plants should use folk remedies with caution.

How to judge the results of therapy?

during a control study, a decrease in the size of the left ventricle is recorded;
signs of heart failure disappear;
the person is not bothered by arrhythmias, angina attacks, or hypertensive crises;
there is a need to remove disability and return to work in the profession;
the patient and those around him note an improved quality of life.

Although myocardial hypertrophy is not considered a separate disease, its manifestations cannot be ignored in the diagnosis of heart pathology and subsequent therapy.

Causes of left ventricular hypertrophy

An obstacle to normal release may be:

narrowing of the aortic opening (part of the blood remains in the LV cavity due to stenosis of the aortic valve);
insufficiency of the aortic valves (due to incomplete closure of the semilunar valves, after completion of contraction of the LV myocardium, part of the blood returns to its cavity).

Stenosis can be congenital or acquired. In the latter case, its formation is caused by infective endocarditis (as a result of calcification of the leaflets), rheumatism, senile vascular calcification (usually after 65 years), systemic lupus erythematosus, etc.

The causes of aortic valve insufficiency can also be congenital pathologies and hereditary pathologies of connective tissue, infectious diseases, syphilis, SLE, etc.

In this case, the ability of the arteries to stretch under the pressure of the blood flow is impaired. An increase in arterial stiffness leads to an increase in the pressure gradient, an increase in the load on the heart muscle and contributes to an increase in the number and mass of cardiomyocytes in response to overload.

Other common causes of left ventricular hypertrophy are:

increased physical activity, especially in combination with a low-calorie diet;
atherosclerosis;
arterial hypertension;
obesity;
endocrinopathies.

In the first case, the so-called “athletic heart” is formed - this is a complex of adaptive mechanisms leading to left ventricular hypertrophy in response to volume overload. That is, due to increased physical activity, the heart is forced to pump large volumes of blood, which leads to an increase in the number of muscle fibers.

As a result, the “performance” of the heart increases and adaptation to intense training occurs. However, long-term overload, especially in combination with fashionable low-calorie diets, contributes to the rapid depletion of compensatory mechanisms and the appearance of symptoms of heart failure (HF).

Endocrine disorders, obesity, atherosclerosis and arterial hypertension (hereinafter referred to as hypertension) can be either interconnected links in one chain or individual risk factors. Excess body weight leads to the formation of resistance (addiction) to insulin in peripheral tissues and the development of type 2 diabetes, metabolic disorders, hyperlipidemia, atherosclerosis and increased blood pressure.

As a consequence of hypertension, an overload of blood volume is created, and atherosclerotic plaques create obstacles in the path of the blood wave, disrupting its hemodynamic properties, and contribute to increased rigidity of the vascular wall. Left ventricular hypertrophy develops in response to increased workload on the heart.

Among the endocrinological causes of LVH, the “thyrotoxic heart” should also be distinguished. This means LV hyperfunction as a result of increased contractility of the heart muscle due to increased influence of the sympathetic nervous system and high output syndrome.

This leads to a sequential chain of pathogenetic mechanisms:

hyperfunction,
depletion of compensatory mechanisms and dystrophy,
cardiosclerosis,
outcome in heart failure.

Also, diseases of the kidneys and adrenal glands, leading to arterial hypertension, can lead to the formation of LVH.

Hereditary risk factors for the development of left ventricular hypertrophy also include syncope, severe arrhythmias, and sudden death syndrome in relatives of the patient. These data are important for excluding the familial form of hypertrophic cardiomyopathy.

Types of LVH

With asymmetric, pathological changes are observed in individual segments or walls of the LV.

According to the localization of the pathological process, the following are distinguished:

LVH with involvement of the interventricular septum (about 90 percent of cases);
midventricular;
apical;
combined lesion of the free wall and septum.

Symmetric hypertrophy of the left ventricle is characterized by the spread of the pathological process to all walls.

Based on the presence of outflow tract obstruction, it is classified:

obstructive cardiomyopathy, also called idiopathic hypertrophic subaortic stenosis (occurs in 25 percent of cases);
non-obstructive cardiomyopathy (diagnosed in 75% of cases)

According to the course and outcome, LVH is distinguished with:

stable, benign course;
sudden death;
progressive course;
development of atrial fibrillation and complications;
progressive heart failure (end stage).

Symptoms of the disease

The insidiousness of the disease lies in its gradual development and slow appearance of clinical symptoms. The initial stages of myocardial hypertrophy may be asymptomatic or accompanied by vague, nonspecific complaints.

Patients suffer from headaches, dizziness, weakness, insomnia, increased fatigue and decreased overall performance. Subsequently, chest pain and shortness of breath develop, increasing with physical activity.

Arterial hypertension is both one of the provoking factors in the development of LVH and one of the important symptoms of this disease. When the body's compensatory capabilities are depleted, complaints of unstable blood pressure arise, ranging from elevated numbers to a sharp drop, even to severe hypotension.

The severity of complaints depends on the form and stage, the presence of obstruction, heart failure and myocardial ischemia. Symptoms also depend on the underlying disease.

With aortic valve stenosis, the classic picture of the disease is manifested by a triad of symptoms: chronic heart failure, exertional angina and syncope (sudden fainting).

Syncope is associated with a decrease in cerebral blood flow as a result of a decrease in blood pressure, due to insufficient cardiac output during decompensation of the disease. The second cause of syncope is baroreceptor dysfunction and the vasodepressor response to a marked increase in left ventricular systolic pressure.

In young people and children, LVH can be detected completely accidentally during an examination.

What is the danger of hypertrophy?

obstruction of the excretory compartment;
progressive heart failure (HF);
severe rhythm disturbances, up to ventricular fibrillation (VF);
coronary heart disease;
cerebrovascular accident;
myocardial infarction;
sudden death syndrome.

Sometimes left ventricular myocardial hypertrophy can be asymptomatic and lead to premature death. This course is typical for hereditary forms of cardiomyopathies.

Stages of hypertrophy and energy processes

There are three stages during the course of the disease:

The stage of initial changes and adaptation (provoking factors lead to an increase in the number and mass of cardiomyocytes and increased consumption of energy reserves in cells). May be asymptomatic or with minimal, nonspecific complaints;
Stage of compensated course (characterized by the appearance and progression of clinical symptoms due to the gradual depletion of energy reserves in cells, oxygen deficiency, and ineffective heart function).
Hypertrophy of the left ventricular myocardium with decompensated course and severe heart failure.

The last stage is characterized by:

dystrophic changes in the myocardium,
ischemia,
dilatation of the LV cavity,
cardiosclerosis,
interstitial fibrosis,
extremely poor prognosis for survival.

Diagnostics

To clarify the stage of the disease, markers of chronic heart failure are examined.

Of the instrumental studies, the following are mandatory:

LVH on ECG,
daily ECG monitoring,
transthoracic resting cardiography (ECHO-CG) and stress ECHO-CG,
tissue Doppler study.

Echo-KG allows you to evaluate:

location of the site of myocardial hypertrophy,
wall thickness,
LV ejection fraction,
dynamic obstruction,
condition of the valve apparatus,
volume of the ventricles and atria,
systolic pressure in the LA,
diastolic dysfunction,
mitral regurgitation, etc.

Chest x-ray allows you to assess the degree of left ventricular enlargement.

If necessary, MRI and CT of the heart are performed.

To identify atherosclerotic changes in the coronary vessels, coronary angiography is performed.

Treatment of LVH

Treatment tactics depend on the severity and stage of the disease, the degree of heart failure and the LV ejection fraction.

The basis of therapy is the elimination of the provoking factor and treatment of concomitant diseases.

Patients with systolic dysfunction and ejection fraction less than 50% are treated according to the chronic HF treatment protocol.

The main drugs used for treatment are:

beta blockers,
ACE inhibitors,
calcium channel blockers,
angiotensin receptor blockers,
antiarrhythmic drugs,
diuretics.

Surgical treatment is indicated for patients with an obstructive form.

Forecast

The prognosis of the disease depends on the cause of LVH, the type of course of the disease (stable or progressive), the functional class of heart failure, the stage of the disease, the presence of obstruction and aggravating conditions (arterial hypertension, endocrine disorders).

Syncope attacks also indicate a decompensated course and a poor prognosis for survival.

However, in patients with an uncomplicated family history and a stable course of the disease, with complex timely treatment, six-year survival rates are about 95%.

According to WHO statistics, more than 5 million people die every year from heart pathologies. Right atrium overload (RAO) or its hypertrophy is rare among cardiac pathologies, but its significance is great because it entails changes in other body systems.

A little physiology

The human heart includes 4 chambers, each of which, for certain reasons, can enlarge and hypertrophy. Typically, hypertrophy is an attempt by the body to overcome any organ failure with this compensation. Hypertrophy of the heart does not become an independent disease - it is a symptom of other pathologies.

The main function of the heart is to create blood flow to provide all tissues and organs with nutrients and oxygen.

Situations with GPP

Venous blood from the venae cava enters the right atrium. Overload of the right atrium occurs when blood enters from the vena cava in excess or with pulmonary hypertension, when blood from the right atrium to the right ventricle cannot pass immediately and completely. As a result, the atrium cavity begins to gradually expand and the wall thickens.

Another reason for overload of the right atrium is hypertension in the pulmonary circulation, which leads to hypertension in the right ventricle. For this reason, blood from the PP cannot immediately pass into the ventricle, which also leads to GPP. The load on the right side of the heart also increases with chronic lung diseases. The main reason is excess blood and pressure.

This condition occurs when there is stenosis of the space separating the atrium from the ventricle. In this case, some of the blood gets stuck in the atrium. Most often, this defect occurs after a rheumatic attack, with bacterial endocarditis.

Another defect is the insufficiency of the specified valve, in which its valves do not close completely and some of the blood returns. This condition occurs during dilatation. Pressure load will occur with pulmonary pathologies: bronchitis, emphysema, asthma, genetic disease of the pulmonary artery. These diseases increase the volume of blood in the ventricle, and after this the atrium becomes overstrained. This is why overload of the right atrium and right ventricle are so often combined.

To restore normal blood flow, the atrium has to push blood out with greater force, and it hypertrophies. Overload of the right atrium develops gradually when the causative disease remains undiagnosed and untreated.

The time is individual for each patient, but the result is always depletion of the compensatory capabilities of the heart muscle and the onset of decompensated heart failure in a chronic course.

Other diseases leading to GPP

The development of right atrium overload can be provoked by:

Myocardial remodeling - this phenomenon is considered part of post-infarction cardiosclerosis, when a scar develops at the site of necrosis. Healthy cardiomyocytes become more voluminous - they thicken, which outwardly looks like hypertrophied muscle. It also most often involves the left ventricle. This creates another combination of right atrial overload and left ventricular diastolic overload.
Postmyocardial cardiosclerosis - scar tissue is formed by the same mechanisms, but after inflammatory processes in the myocardium.
Coronary heart disease - here we are talking about blockage of the coronary artery with a thrombus or plaque of atherosclerosis. This necessarily causes myocardial ischemia, and the contractile function of cardiomyocytes is impaired. Then the areas of the myocardium adjacent to the affected areas begin to thicken compensatoryly.
Hypertrophic cardiomyopathy - occurs due to gene disorders in which uniform thickening of the myocardium of the entire heart muscle occurs. It is more often typical for children and involves the myocardium of the right atrium, then overload of the right atrium in the child is recorded.

Of the congenital pathological conditions of the heart muscle, heart overload is caused by:

Defective septum between the atria. With such a deviation, the heart supplies blood to the right and left half of the heart under the same pressure, as a result of which the atrium receives an increased load.
- a rare defect in which the atrioventricular valve leaflets are adjacent to the right ventricle, and not to the atriogastric ring. Then the right atrium merges with part of the right ventricle and also hypertrophies.
Transposition of the great vessels - the main arteries of the cardiovascular system change their anatomical position - the main artery of the lungs is separated from the left parts of the heart, and the aorta is separated from the right. In these cases, GPP occurs in a child under 1 year of age. This is a very serious deviation.
Overload of the right atrium is also possible in adolescents prone to fanatical sports. Regular physical activity - common reason GPP.

Symptomatic manifestations of pathology

GPP itself has no symptoms. Only symptoms associated with the underlying disease, which are complemented by venous stagnation, may be of concern.

Then we can say that signs of overload of the right atrium are shortness of breath even with minor exertion, pain behind the sternum.

Circulatory failure and cor pulmonale may develop. With cor pulmonale:

shortness of breath in a horizontal position and with the slightest exertion;
cough at night, sometimes mixed with blood.

Insufficient blood flow:

heaviness in the right side of the chest;
swelling in the legs;
ascites;
dilatation of veins

There may also be causeless fatigue, arrhythmias, tingling in the heart, and cyanosis. If these complaints arose only during infections and for the first time, you can count on their disappearance after treatment. For monitoring, a dynamic ECG is performed.

Diagnostics

There are no specific signs of pathology. It is only possible to assume the presence of overloads if a person suffers from chronic lung pathologies or has problems with valves.

In addition to palpation, percussion and auscultation, an ECG is used, which is used to determine some signs of right atrium overload on the ECG. However, even these indicators may be present only temporarily and disappear after the processes are normalized. In other cases, a similar picture may indicate the beginning of the process of atrial hypertrophy.

Ultrasound helps determine the increase in pressure and the volume of blood located in various parts of the heart. This method can detect disorders in all parts of the heart and blood vessels.

Pulmonary heart (P-pulmonale)

With it, changes of a pathological nature occur in the pulmonary circulation, and this is main reason overload of the right atrium.

On the ECG this is reflected by a modified P wave (atrial wave). It becomes tall and pointed in the form of a peak instead of the smooth tip that is normal.

Functional overload of the right atrium on the ECG can also give an altered P - this is noted, for example, with overactivity of the thyroid gland, tachycardia, etc. Deviation of the heart axis to the right does not always occur only with HPP; it can also be normal in high asthenics. Therefore, other studies are used for differentiation.

If signs of right atrium overload are detected on the ECG, the patient is recommended to undergo echocardiography. It is considered safe for any category of patients and can be repeated many times over time. Modern devices can give answers about the thickness of the walls of the heart, the volume of the chambers, etc.

Together with echocardiography, the doctor may also prescribe Doppler ultrasound, then you can obtain information about hemodynamics and blood flow.

If there is a divergence of opinions, CT or radiography is prescribed. X-ray examination shows abnormalities of the right atrium and ventricle. Their contours merge with the contours of the vessels. In addition, an x-ray will show the condition of other structures of the chest, which is very valuable in case of pulmonary pathology as the root cause of HPP.

Consequences of GPP

In chronic diseases of the pulmonary system, the active alveoli are replaced by fibrous tissue, and the gas exchange area becomes smaller. Microcirculation is also disrupted, which leads to increased pressure in the pulmonary circulation. The atria have to actively contract, which ultimately causes their hypertrophy.

Thus, the complications and consequences of GPP are:

expansion of the heart chambers;
circulatory disorders, first in the small and then in the large circle;
formation of the pulmonary heart;
venous stagnation and insufficiency

If left untreated, pulse irregularities and attacks of heart failure may develop, which can lead to death.

Treatment

Normalizing the size of the atrium and improving the functioning of the heart muscle is only possible if the underlying disease - the cause of the pathology - is treated. Such treatment is always complex; monotherapy does not make sense.

In the presence of pulmonary pathology, these are bronchodilators (tablets and inhalers), antibacterial therapy for bacterial etiology of disorders, anti-inflammatory drugs.

For bronchiectasis, surgical treatment is used.

For heart defects the best way out is carrying out corrective operations. After heart attacks and myocarditis, it is necessary to prevent remodeling with the help of antihypoxic and cardioprotective drugs.

Antihypoxants are indicated: Actovegin, Mildronate, Mexidol and Preductal. Cardioprotectors: ACEs or angiotensin II receptor antagonists (ARA II). They can actually slow down the onset of chronic heart failure. More often than others, Enalapril, Quadropril, Perindopril, etc. are prescribed.

Nitrones, beta blockers (Metoprolol, Bisoprolol, Nebivalol, etc.), ACE inhibitors, antiplatelet agents that prevent the formation of blood clots, and statins that normalize the amount of cholesterol are required.

Also used in treatment are glycosides (according to indications) and antiarrhythmics, agents that improve metabolic processes in the heart muscle. Judging by the reviews, good results were obtained when prescribing Riboxin.

Relapse Prevention

If drug therapy is the prerogative of the doctor, greater responsibility falls on the patient himself. Without his participation, the efforts of doctors will not produce results. A person must definitely reconsider his lifestyle: give up smoking and alcohol, establish proper nutrition, eliminate physical inactivity, adhere to a daily routine, exercise moderate physical activity, and normalize body weight. If pathologies of the cardiovascular and pulmonary systems become chronic, they cannot be completely cured.

The condition can only be improved by preventing exacerbations of these pathologies. Then the load on the cardiac system decreases.

GPP and pregnancy

During pregnancy, the body undergoes enormous changes not only in terms of hormonal balance, but also in the functioning of internal organs. A difficult situation arises when diagnosing right atrium overload during pregnancy, which is considered in this situation to be an extragenital disease. The diagnosis must not only be established, but also the woman’s ability to bear a fetus and give birth.

The best option, of course, is to diagnose heart pathologies before conception, but this does not always happen. Most often, pregnant women with heart pathologies are hospitalized three times during gestation; this is done to monitor the condition over time.

When first admitted to the hospital, the defect is examined, the activity of the process is determined and the work of the blood circulation is assessed, taking into account the question of a possible termination of pregnancy.

Repeated hospitalization is necessary because the physiological stress of the body to maintain the functioning of the heart muscle in a woman reaches its peak. The third hospitalization helps doctors choose the method of delivery.

Preventive actions

Prevention of right atrium hypertrophy begins with a review of the lifestyle, which involves proper balanced nutrition and a rational work and rest schedule. If you are not a professional athlete and you do not necessarily need Olympic medals, do not show stubborn fanaticism in playing sports. This exhausts the body and exhausts the heart. The pressure in the circulatory system increases, and hypertrophy will not take long to occur. Daily walks of an hour a day, swimming, and cycling are quite enough.

Another problem is eliminating stress. They also have a very negative impact on the functioning of the heart and the entire body as a whole. Yoga, meditation, and relaxation can help solve the problem.

Right atrium hypertrophy is expressed by pain in the chest, respiratory problems, and fatigue. Often, unfavorable symptoms are preceded by: pneumonia, exacerbation of bronchial asthma, pulmonary artery embolism, etc. After treatment of the underlying disease, anxiety symptoms may subside and even disappear completely. In addition to the clinical manifestations of pulmonary problems, with hypertrophy there may be signs of venous stagnation. Alarming signs of right atrial hypertrophy are characterized by:

cough, shortness of breath, deterioration of respiratory function;
swelling;
paleness of the skin, cyanosis;
dulling of attention;
minor tingling, discomfort in the heart area;
heart rhythm pathology.

In most cases, hypertrophy is asymptomatic, and the manifestation of clinical symptoms is noted already in an advanced stage. Consult your doctor immediately if you notice rapid heartbeat, dizziness (loss of consciousness), swelling of the lower extremities.

Right atrial hypertrophy during pregnancy

Quite complex extragenital diseases during pregnancy include cardiovascular pathologies. Any pregnancy is characterized by gradual, constant, sometimes sudden dynamics with obvious physiological and hormonal changes. The cardiovascular system undergoes enormous stress during pregnancy, for this reason it is important to promptly establish the correct diagnosis, as well as assess a woman’s ability to bear and give birth. The ideal option would be to resolve the issue of permissibility of pregnancy before conception in order to prevent health risks and threats to the lives of mother and baby.

It is known that hypertrophy of the right atrium during pregnancy is not an independent disorder. The disease can be caused by both congenital and acquired pathologies, including during pregnancy. In order to control the condition, pregnant women with heart problems are recommended to be hospitalized three times during the entire period. The first placement in a hospital is necessary for a thorough examination of the defect, determining the activity of the pathological process and the functioning of the circulatory system, with consideration of the issue of possible termination of pregnancy. Readmission to the hospital is required due to peak physiological stress to maintain cardiac function. Staying in the hospital for the third time helps specialists determine the method of delivery.

ilive.com.ua

Atrial septal defects account for 30% of all cases of congenital heart defects in adults. The magnitude and direction of shunt are determined by the size of the defect and the relative compliance of the ventricles. In most adults, the right ventricle is more compliant than the left; as a result, discharge occurs from the left atrium to the right. A small shunt leads to a moderate volume overload of the right heart, and pulmonary artery pressure remains normal. The severity of pulmonary hypertension may be insignificant even with a large discharge. Only in rare cases does severe pulmonary hypertension develop, leading to right ventricular failure (liver enlargement, ascites) and right-to-left shunting (cyanosis, clubbing symptom, paradoxical emboli). Unlike ventricular septal defects, in which significant shunt results in volume overload in both ventricles, with atrial septal defects the shunt is smaller and affects only the right side of the heart.

Course and prognosis in the absence of treatment. Young patients with isolated atrial septal defects usually tolerate even large shunts well; right ventricular function and pulmonary vascular resistance are normal, and pulmonary artery pressure is normal or slightly elevated.

If the defect is complicated by mitral regurgitation, atrial arrhythmias and pulmonary hypertension often occur. With a medium-sized atrial septal defect in the absence of surgical treatment, patients usually live only to 30-50 years, although often to old age, especially if there is no severe pulmonary hypertension. In adulthood, with atrial septal defects complicated by atrial fibrillation and right ventricular failure, there is an increased risk of pulmonary and systemic artery embolisms (paradoxical embolisms). In the rare cases where an atrial septal defect leads to Eisenmenger syndrome, it occurs at a young age. Eisenmenger syndrome is characterized by high mortality; causes of death are embolism, arrhythmias and progressive right ventricular failure. With intact valves and in the absence of other congenital heart defects, infective endocarditis is rare. Pregnancy is usually well tolerated.

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Situations leading to overload

Right atrium overload can occur in the following situations:

More blood enters the atrium than it should normally, or as a result of problems with the valve, not all the blood is pushed out during contraction; some of the blood remains in the atrium cavity.
As a result of various diseases, the load on the right side of the heart muscle increases, mainly chronic lung diseases.

In other words, strain on the heart muscle may be caused by increased blood volume or increased blood pressure.

In order to pay attention to such situations in time, we will analyze them in more detail.

Cause: Excess blood

This condition most often occurs with defects, namely stenosis or insufficiency of the tricuspid valve (tricuspid). This valve separates the ventricle from the atrium on the right.

The causes of damage to this valve are most often rheumatism, it is also possible as a result of bacterial endocarditis, relative insufficiency of the tricuspid valve may occur with enlargement and stretching of the left parts of the heart muscle.

Congenital defects of the pulmonary artery lead to the appearance of an increased volume of blood first in the ventricle, followed by overload of the atrium.

High blood pressure

Increased pressure load occurs with lung diseases such as chronic obstructive bronchitis, bronchial asthma, and emphysema.

First of all, during these diseases, the load on the ventricle increases, which becomes difficult to push blood into the pulmonary vessels.

Following the overload of the ventricle, its enlargement and expansion occurs, then the same changes occur in the atrium.

Diagnostics

Some conditions may require cardiac surgery, mainly valve replacement, so an ultrasound examination of the heart is mandatory in all patients where overload is detected.

The prognosis of the disease and the correct and timely initiation of treatment depend on the timeliness of the diagnosis.

Treatment and prognosis

When it comes to chronic diseases, both from the heart and blood vessels, and from the lungs, it is no longer possible to completely get rid of these chronic diseases. It is necessary to reduce the burden on the cardiovascular system by treating exacerbations of these diseases. Treatment of chronic bronchitis will help reduce pressure in the blood vessels of the lungs, and overload of the heart can be avoided.

Most often, signs of overload of the right atrium appear after the ventricle enlarges, and this process ends with the formation of a “pulmonary heart.”

Brief information: Signs of right atrium overload on the electrocardiogram, especially if these changes are the only ones and are not combined with other changes in the heart, sometimes help to suspect an acute process in the lungs.

dlyaserdca.ru

Modern medicine has learned to correct many diseases that were previously considered fatal. In particular, this applies to various heart defects. But besides them, there are many more dangerous manifestations in the work of the heart that can lead to a sad outcome.

As we know from school biology lessons, the heart consists of four parts: two ventricles (they push blood into the bloodstream) and two atria (they receive blood from the circulation). Therefore, the diagnosis of “cardiac hypertrophy” most often affects only one part of the muscle and they arise for various reasons.

The load on the right atrium occurs for various reasons. This diagnosis only conceals that the atria are not working evenly. The right atrium is responsible for pumping blood to the lungs. This is where blood comes with oxygen, which is absorbed by all tissues. That is why, if an increased load on the right atrium is detected, the lungs must be checked. The work of the atria is directly related to the work of the lungs. And many pathologies give symptoms in both the heart and lungs.

Another cause of strain on the right atrium may be congenital heart disease. A defect such as atrial septal defect puts an improper load on the work of the heart muscle.

So, what exactly can lead to strain on the right atrium? This is high blood pressure. This is especially dangerous in the pulmonary artery. This happens with obstructive pulmonary disease or bronchitis.

Strain on the right atrium also occurs with pulmonary embolism. This occurs due to disruption of blood flow between the heart and lungs. To compensate for the lack of oxygen, the atrium has to work harder. A blood clot also forms and this already threatens other troubles.

Congenital heart defects include those defects that were acquired during fetal development. The reasons may also be different. Most often these defects relate to the pulmonary valve, mitral valve and tricuspid valve.

Ventricular hypertrophy occurs frequently and leads to right atrial hypertrophy. It is usually caused by diseases such as pulmonary hypertension, ventricular septal defect, and tetralogy of Fallot (a heart defect that occurs in newborn infants).

in the left chest leads V5, V6 - a decrease in the ST segment and a flattening or negative T wave;
in leads I, aVL, overload of the left ventricle can manifest itself with a horizontal electrical axis of the heart;
in leads III, aVF, overload of the left ventricle can manifest itself when the electrical axis of the heart is vertical.

Right ventricular overload

in the right precordial leads V1, V2 - a decrease in the ST segment and a flattening or negative T wave;
sometimes these ECG changes are determined in leads II, III, aVF.

Systolic and diastolic ventricular overload

Left ventricular systolic overload

Common causes of left ventricular systolic overload:

aortic stenosis;
hypertonic disease;
symptomatic and arterial hypertension;
coarctation of the aorta.

ECG signs of left ventricular systolic overload:

qV5,V6< 2 mm;
high R V5,V6 > R V4 with deep S V1,V2;
the ST segment V5,V6 is located below the isoline, the T wave V5,V6 is negative (similar changes in the ST segment and T wave are usually observed in leads I, aVL);
the activation time of the left ventricle in leads V5, V6 is increased and exceeds 0.04 s.

Right ventricular systolic overload

ECG signs of systolic overload of the right ventricle:

high R V1,V2 (R V1 ≥ S V1), a high late R wave is often observed in lead aVR;
the ST segment V1,V2 is located below the isoline, the T wave is negative (similar changes in the ST segment and T wave are often observed in leads II, III, aVF);
deviation of the electrical axis of the heart to the right;
the activation time of the left ventricle in leads V1, V2 is increased and exceeds 0.03 s.

Diastolic overload of the left ventricle

ECG signs of left ventricular diastolic overload:

q V5,V6 > 2 mm, but less than a quarter of the R wave V5,V6 and less than 0.03 s;
high R V5,V6 > R V4 with deep S V1,V2;
the ST segment V5,V6 is located on the isoline or slightly higher, the T wave V5,V6 is positive (often high and pointed).

Diastolic overload of the right ventricle

A sign of diastolic overload of the right ventricle on the ECG is the appearance in leads V1, V2 of complete or incomplete blockade of the right bundle branch:

The ECG looks like rsR’ or rSR’;
The electrical axis of the heart is usually deviated to the right.

Right ventricular hypertrophy: causes, diagnosis and treatment

Our heart consists of four parts, and if at least one of them begins to work incorrectly, then our body is at risk. Right ventricular hypertrophy can cause new diseases of the main organ in the body.

Specialists can identify this defect by making a diagnosis and interviewing the patient. This diagnosis can be heard by both parents of young children and older people. I would like to tell you why it is so important to seek help from a cardiologist in a timely manner.

Description of cardiac hypertrophy

Ventricular hypertrophy (also known as right ventricular myocardial hypertrophy or right ventricular hypertrophy) is a heart condition in which the right ventricle undergoes a change in size as a result of an increase in muscle tissue (heart fibers), and this in turn leads to overload of the heart.

Enlargement of the heart ventricle occurs in people of different ages, but most of it is diagnosed in children. It is worth noting that cardiac hypertrophy can be observed in newborns, because they have increased heart work in the first days of life and specifically on the right side of the heart.

But most often, ventricular hypertrophy is pathological and may indicate the existence of a congenital heart defect.

As you know, the human heart has four chambers and the two right parts of the heart regulate the functioning of the pulmonary circulation, also called the pulmonary circulation. And the two left parts are responsible for the work of the large circle, or systemic one. In a normal heart condition, blood pressure in the right side is lower.

If a person develops congenital heart defects or some kind of malfunction of the heart, then this rule is violated, which leads to overload of the right ventricle of the heart, since it receives more blood flow than expected, and then to its hypertrophy.

Enlargement of the right side of the heart is observed in people of all ages. Most often, this pathology is diagnosed in children. This is due to the fact that in the first years of life the child’s body grows rapidly, and accordingly, his heart is subjected to increased stress.

When the disease is acute, this indicates the presence of congenital heart disease. This diagnosis can be made on an ECG. Hypertrophy of the right ventricle of the heart can also be acquired. Often such changes are associated with an unhealthy lifestyle, poor nutrition, and constant stress.

The right ventricle enlarges, since it is the one responsible for the large flow of blood, that is, it is subjected to greater load and, under certain circumstances, fails faster. Some signs directly indicate that the heart muscle is overloaded and exhausted, unable to cope with the amount of work that the body has assigned to it.

Often the person himself overloads the heart without even thinking about it. The occurrence of hypertrophy can lead to problems in the functioning of the heart. Because of this, arrhythmia occurs, that is, the heartbeat is not even, but chaotic, the heart beats sometimes faster, sometimes slower, regardless of human activity.

If changes begin in one place, they will entail changes in other organs. So, when the ventricle enlarges, the structure of the arteries changes. They change in size and adapt to the new rhythm of life.

The arteries harden and do not allow certain substances to pass through. Over time, these substances accumulate and form obstructions to the passage of blood. This is how stagnation occurs, which leads to the formation of blood clots.

A little physiology

It is known that the human heart has four chambers: it consists of two atria and two ventricles. Normally, all cavities are isolated from each other. The heart is a muscular pump that operates in a certain sequence, thanks to the conduction system of the heart and myocardial contractility. The work cycle looks like this:

the left ventricle releases oxygen-rich blood into organs and tissues - into the systemic circulation;
the blood, having passed through increasingly smaller arteries, enters the capillary network, where gas exchange occurs and changes color to dark, enters small veins, then into large ones, which flow into the right atrium;
from the right atrium, which serves as a venous “cistern”, it flows during diastole (relaxation) into the right ventricle;
the right ventricle, during contraction, forcefully throws venous blood into the pulmonary artery into the pulmonary circulation, which is located in the lungs to saturate it with oxygen;
scarlet, oxygenated blood collects in the pulmonary veins, and then through the pulmonary veins enters the left atrium;
From the left atrium, blood is ejected into the left, strongest ventricle, and now it is ready to repeat the entire path - the blood circulation circles are closed.

Many are perplexed: why is the pulmonary artery called an artery, although venous blood flows in it, and, conversely, the pulmonary veins are called veins, but contain bright scarlet arterial blood? The answer is very simple: the nomenclature is based not on the color and composition of the blood, but on the nature of the arrangement of the vessels: all vessels flowing into the atria are veins, and all flowing from the ventricles are arteries.

We told this so that there is a clear understanding that the heart muscle does not work as a single whole: the left ventricle supplies oxygen to the whole body, and the right one sends blood to the lungs.

Main types of pathology

The disease itself is divided into several types, which are distinguished by the course of the pathology, signs and symptoms.

It is observed when the mass of the right side of the heart is several times larger than the left side.

It is observed when the processes occurring in the right part of the heart muscle slow down and lag behind the processes on the left part. They should not exhibit asynchronous operation.

There is nothing to worry about when this disease is detected. Timely and correct treatment will help get rid of the problem. During diagnosis, a slight increase in the right region is observed.

At the initial stages there are no symptoms. This is why timely diagnosis is difficult. In order to avoid a latent form of the disease, it is necessary to perform an ECG once a year. To identify the first stages of pathology in babies, intrauterine CTG and ECG are prescribed after the first year of life.

Right ventricular hypertrophy - causes

The causes of right ventricular myocardial hypertrophy are acquired or congenital. In the first case, restructuring of the heart muscle is usually a consequence of diseases of the respiratory system:

obstructive bronchitis;
bronchial asthma;
pneumosclerosis;
emphysema;
polycystic disease;
tuberculosis;
sarcoidosis;
bronchiectasis;
pneumoconiosis.

In addition, a primary change in chest volume is possible with various deviations. These include:

violation of the structure of the musculoskeletal system (scoliosis, ankylosing spondylitis);
decreased neuromuscular transmission (poliomyelitis);
pathology of the pleura and diaphragm associated with injury or surgery;
severe obesity (Pickwick syndrome).

Primary damage to the pulmonary vessels, which leads to hypertrophy, can develop as a result of:

primary pulmonary hypertension;
thromboembolic foci in this area;
arterial atherosclerosis;
space-occupying formations in the mediastinum.

An increase in the mass of the right ventricle occurs in various diseases of the respiratory and circulatory systems.

Right ventricular hypertrophy in infants is associated with congenital heart defects:

Tetralogy of Fallot, which leads to impaired emptying of the right ventricle, resulting in hypertension.
Violation of the integrity of the interventricular septum. At the same time, the pressure in the right and left parts of the heart is equalized. This leads to decreased oxygenation (oxygen saturation) of the blood, as well as hypertrophy.
Stenosis of the pulmonary valves, which impedes the movement of blood from the heart to the vessels of the pulmonary circulation.
Pulmonary hypertension associated with increased vascular resistance.

With congenital defects, hypertrophy appears at an early age.

Various bronchopulmonary diseases can become catalysts for the growth of cardiomycytes, which leads to the progression of pathology:

fibrosis;
emphysema;
chronic obstructive bronchitis;
bronchial asthma;
pneumoconiosis;
sarcoidosis;
pneumonia.

There are also causes of right ventricular hypertrophy that are not associated with cardiovascular or pulmonary diseases:

pathological increase in body weight (obesity);
systematic and prolonged stress that develops into neuroses.

Another factor that provokes the development of right ventricular hypertrophy may be excessive involvement in aerobic physical activity.

Depending on the ratio of sizes and mass of the right and left ventricles, three forms of the course of RVH syndrome are distinguished: moderate, moderate and sharp (acute). With a moderate form of RVH, the size of the right ventricle slightly prevails in size over the left, and their weight is almost the same.

With a moderate form of RVH, an excess of the size and mass of both ventricles is noted; with a pronounced form, the difference in these parameters is significant. The absence of therapeutic measures in the acute form of right gastric hypertrophy can lead to the death of the patient.

RPG syndrome is also classified according to the type of occurrence:

physiological (congenital), when right ventricular hypertrophy in a child is diagnosed from the first days of life. The pathology manifests itself as a consequence of congenital heart disease (congenital heart defects) and is often diagnosed immediately after birth by extensive cyanosis (bluish discoloration of the skin) of the face or the entire body.
pathological (acquired) - right ventricular enlargement syndrome occurs as a consequence of bronchopulmonary illnesses or physical overload.

Features of the disease in children

As the child grows, the load on his heart increases. If there is any obstruction to the flow of blood through the vessels of the pulmonary (respiratory) circulation, an increase in the muscle mass of the right ventricle occurs. According to disappointing statistics, this disease is much more common in children, which is due to the congenital nature of the pathology.

With long-term hypertrophy, secondary damage to the pulmonary vessels occurs. They become stiffer and less elastic, which further aggravates the course of the disease.

Physiological hypertrophy of the right sections can occur in the first days of a baby’s life, since during this period a sharp restructuring of the circulatory system occurs. However, more often the causes of this pathological condition in infants are as follows:

heart septal defect;
violation of the outflow of blood from the cavity of the right ventricle;
increased load on these parts of the heart during fetal development;
pulmonary artery stenosis.

In this case, symptoms of the disease may not appear immediately, but after some time. This is due to the fact that at first, cardiac dysfunction is compensated by various protective mechanisms. With the development of a decompensated state, the first signs appear, but the child’s condition can be quite serious.

If there is a suspicion of a change in the structure of the myocardium, it is necessary to perform an ultrasound of the heart in the maternity hospital. In children, right ventricular hypertrophy occurs much more often than in adults.

Physiological hypertrophy occurs in children in the first days of life, pathological hypertrophy occurs with various congenital heart defects (transposition of the great vessels, tetralogy of Fallot, ventricular septal defect and patent ductus arteriosus with high pulmonary hypertension, etc.), primary pulmonary hypertension, with congenital diseases of the lungs and lungs. blood vessels (Wilson-Mikiti syndrome, lobar emphysema, etc.), chronic carditis, etc.

Finally, children often have acute overloads of the right ventricle during burn disease, acute pneumonia and other conditions, often simulating right ventricular myocardial hypertrophy. Diagnosis of right ventricular hypertrophy by ECG in some cases is fraught with difficulties.

First of all, this concerns the differentiation of physiological and pathological hypertrophy in children in the first days of life. Difficulties also arise when diagnosing the initial stages of right ventricular hypertrophy in young children, in whom the EDS of the right ventricular myocardium may predominate for a long time even without it.

Significant difficulties are caused by identifying signs of right ventricular hypertrophy on the ECG with clear symptoms of left ventricular myocardial hypertrophy. Electrocardiographic changes in right ventricular hypertrophy are associated with the fact that the EMF vector of the right ventricle becomes predominant and changes the orientation of the total EMF to the right and forward, exceeding its normal age-related potentials.

In this case, right ventricular hypertrophy is judged by the deviation of the EMF vector forward (leads V3R, V1, V2) and to the right (leads from the limbs). The combination of these signs makes the diagnosis most likely.

Hypertrophy in newborns

Most often, this syndrome occurs in newborns as a consequence of problems with the development and functionality of the heart. This condition develops in the first days of life, when the load on this organ is especially great (especially on its right half.

Hypertrophy of the right ventricle of the heart also develops with a defect in the septum that separates the ventricles. At the same time, the blood mixes and becomes insufficiently saturated with oxygen. The heart, trying to restore normal blood flow, increases the load on the right ventricle.

Hypertrophy is also possible due to tetralogy of Fallot, a narrowing of the pulmonary valve. If you detect any symptoms that indicate abnormal heart function, you should immediately show the child to a specialist.

Symptoms of RPG

In its acquired form, this syndrome is characterized by the absence of specific symptoms by which right gastric hypertrophy can be determined.

Signs of right ventricular hypertrophy are similar to the manifestations of many other ailments and at the initial stage of development of the pathology they practically do not manifest themselves, beginning to really bother the patient only with a significant increase in the size and mass of the right ventricular myocardium. These signs include:

prolonged pain in the right sternum of a sharp, stabbing nature;
dyspnea;
dizziness, accompanied by loss of orientation in space and fainting (in some cases);
heart rhythm disturbance;
swelling of the lower extremities, which becomes more pronounced towards the end of the day.

The main clinical signs of RPH include an increase in heart rate (tachycardia) and a sharp decrease in blood pressure. The clinical picture of right ventricular hypertrophy may also be accompanied by “cor pulmonale,” the cause of which is pulmonary embolism.

Acute cor pulmonale is characterized by acute right ventricular failure, severe shortness of breath, decreased blood pressure, and tachycardia. Most often, acute right ventricular failure is fatal.

The chronic form of cor pulmonale has the same clinical picture as acute cor pulmonale until the process of decompensation occurs. In severe forms of chronic right ventricular failure, chronic obstructive pulmonary disease occurs.

Diagnostic methods

An accurate diagnosis can be made only after carrying out the entire range of diagnostic measures. Only after this can treatment begin. Diagnostics is as follows:

Medical examination. Without it, no examination can be started.

As a rule, it is a thorough medical examination that can suggest that a person is developing hypertrophy. Usually, a cardiologist with experience in working with and diagnosing such patients can easily hear pathological murmurs in the heart area by simple auscultation.

Cardiography. Right ventricular hypertrophy on the ECG is noticeable by numerous specific changes. However, on the ECG, the doctor sees only a rhythm disturbance, but not an increase in the size of the ventricle. Accordingly, the latter can cause numerous disruptions in heart rhythm.

A thorough analysis of the anamnesis and collection of complaints may suggest the development of this hypertrophy.

Echocardiography is a study of the heart using ultrasound.

This type of diagnosis helps the specialist determine the thickness of the ventricular wall and other parameters of the myocardium. In addition, echocardiography can accurately determine the pressure in the ventricle, which, in turn, makes it possible to diagnose the disease.

Examination of the heart using a cardiovisor.

Determination of unfavorable hereditary predisposition to the disease.

Those who smoke, regularly drink alcohol, or do not monitor the intensity of physical activity should be periodically checked by a doctor.

With RPG, pathological changes are recorded not only in the myocardium. Over time, they are characterized by spreading to the pulmonary arteries and blood vessels, which causes the development of other ailments:

aortic sclerosis;
hypertension of the pulmonary circulation;
Eisenmenger syndrome (excess of pressure in the pulmonary artery over the aortic).

Timely diagnosis of prostate cancer allows not only to prevent the development of these pathologies, but also to significantly facilitate the fight against the syndrome as a whole. The presence of right gastric hypertrophy can be confirmed or refuted only thanks to cardiac examination devices:

electrocardiography;
echocardiography (ultrasound examination of the structure of the heart muscle).

An electrocardiogram as a method for diagnosing RPG is less indicative. Hypertrophy of the right ventricle on the ECG is expressed only in changes in the waves of the cardiogram, which can only indicate the fact of a change in the size of the ventricle; the severity of the pathology cannot be determined in this way.

RVH syndrome is “displayed” on electrocardiography only in moderate and acute forms of the course. An echocardiogram has much greater diagnostic value. This research method allows you to determine not only the presence of an enlargement of the right gastric region, but also its exact dimensions, as well as diagnose defects in the structure of heart tissue.

Echocardiography as a method for diagnosing RVH is often combined with Doppler ultrasound, which allows further examination of the direction and speed of blood flow. This method of research makes it possible to determine right gastric hypertrophy even in a moderate form of the course, thanks to which it is possible to prevent the progression of the growth of cardiomycytes in the heart muscle.

ECG and signs of pathology

On the ECG, right ventricular hypertrophy is well defined. Every functional diagnostics doctor, cardiologist and therapist knows the ECG signs of right ventricular hypertrophy, we will analyze the main ones:

In leads V1 V2 III aVF, the height of the R wave increases;
S-T shift slightly below the isoline, negative or double-humped T in V1 V2 III aVF;
Pravogramma (EOS is deviated to the right).

These are the main signs of enlargement of the right ventricle, by which pathology can be suspected. Right ventricular hypertrophy on the ECG for people over 30 years of age has the following diagnostic criteria:

EOS deviation to the right is more than +110 degrees;
High R waves in V1 (more than 7 mm), S waves in V1 less than 2 mm, R/S ratio in V1 greater than one;
The S wave in V5 and V6 is greater than or equal to 2 mm;
qR type complexes in V1.

If two or more of these criteria are present on the ECG, right ventricular hypertrophy may be indicated. Doctors also remember the confirmatory signs of right ventricular hypertrophy, these include:

changes in the S-T segment and T wave according to the “overload” type in leads V1-V3,
enlargement of the right atrium.

The principle of electrocardiography

As for the features of electrocardiography for diseases of the cardiovascular system, there are quite a lot of them. To begin with, it is necessary to focus on the fact that such an examination is carried out in the most comfortable position for the patient.

It is important to know! During the examination, the patient should be in a relaxed state and breathe calmly and evenly, since the result of electrocardiography depends on this. To determine ECG signs of right ventricular hypertrophy, 12 leads are used, 6 pieces are connected to the chest, and the remaining 6 pieces are connected to the patient’s extremities.

Sometimes the technique of conducting electrocardiography at home is used, in this case only 6 branches are used. When carrying out such diagnostics, it is important to understand that several factors influence its result:

Patient's condition.
Patient's breathing is correct.
Number of leads used.
Correct connection of each branch.

Even if one electrode is connected incorrectly, the electrocardiogram information may be unreliable or incomplete. When conducting such an examination, the main emphasis is on heart rhythm, characteristics of the T and ST waves, cardiac conduction intervals, the electrical axis of the heart and QRS characteristics.

Difficulties in diagnosing right ventricular hypertrophy

ECG is a universal, widely available and very popular method. But diagnosing right ventricular hypertrophy only through an cardiogram has some disadvantages. First of all, already pronounced hypertrophy is visible on the cardiogram; with slight hypertrophy, changes on the ECG will be insignificant or will not appear at all.

In addition, one should refrain from diagnosing right ventricular hypertrophy by ECG if the following conditions occur:

right bundle branch block,
WPW syndrome
confirmed posterior myocardial infarction,
in children, the above ECG signs may be normal,
shift of the transition zone to the right,
the R wave has a high amplitude in V1 V2, but the R / S ratio in V5 or V6 is greater than one,
dextroposition (the heart is located mirror image, in the right half of the chest),
hypertrophic cardiomyopathy: the presence of high R waves in V1 is possible, with the R / S ratio greater than one.

When diagnosing right ventricular hypertrophy, the width of the QRS complex should be less than 0.12 s. Therefore, accurate diagnosis by ECG is impossible in RBBB and Wolff-Parkinson-White syndrome.

Treatment

The main goal of treatment is to normalize the heart to its normal size. The following stages of treatment are provided, aimed primarily at eliminating the cause of hypertrophy:

drug treatment (elimination of stenosis, normalization of the lungs, treatment of heart defects);
adjusting the patient’s diet and lifestyle.

In addition to the main intake of diuretics, beta-blockers and calcium channel antagonists, drugs are also prescribed to normalize lung function and eliminate pulmonary valve stenosis. In some cases, most of the medications will have to be taken throughout your life.

Therapy is carried out under regular supervision of a specialist. During treatment, the functioning of the heart and its contraction frequency are systematically checked. In the absence of positive dynamics of treatment, the patient is recommended to undergo surgical intervention.

In case of progression of hypertrophy and development of heart disease, surgical intervention is prescribed. The operation involves implantation of an artificial valve. The operation is also performed during the first year of life in children who have been diagnosed with hypertrophy.

If the source of cardiac hypertrophy is identified, treatment is aimed at eliminating the underlying disease. Self-medication in such cases is unacceptable. Overweight people and those who are periodically exposed to physical activity are recommended to be observed by a cardiologist.

Only after making a diagnosis can the doctor decide on the treatment strategy for ventricular hyperfunction. Therapy is aimed at eliminating the disease that provoked hypertrophy. There are such methods of treating pathology:

Etiotropic: used for congenital heart abnormalities. Treatment using this method is aimed at weakening the factor that provokes hypertrophy.
Pathogenetic: used if right ventricular hypertrophy is acquired. It is aimed at activating the immune system, thereby neutralizing the factor that provokes the underlying disease.

In case of congenital heart defects, the patient is indicated for cardiac surgery in the first year of life - replacement of the abnormal valve with a full-fledged synthetic analogue. If the cause of changes in ventricular parameters is lung disease, the patient is prescribed:

bronchodilators (Broncholitin): eliminate bronchospasm;
mucaltic agents (Bromhexine): thin mucus and promote its release from the lungs;
analeptics: stimulate the functioning of the respiratory system and circulatory system.

If a patient has problems with blood pressure, the doctor prescribes Eufillin. This drug is used for hypertension in the pulmonary circulation, as well as for cardiac asthma and vasospasm. However, treatment with Eufillin is prohibited for heart failure, arrhythmia and coronary blood flow disorders.

For minor hypertrophy, the doctor prescribes Nifedipine, a calcium channel blocker drug. With progressive hyperfunction, drugs of the nitrate group are prescribed:

Nitrosorbide.
Nitroglycerine.

All medications should be taken according to the regimen prescribed by your doctor. Independently replacing medications and changing their dosage is unacceptable! Traditional methods There is no cure for the pathology.

All people with right ventricular hypertrophy should be seen by a cardiologist at least once a year and undergo all tests prescribed by the doctor. Such patients are advised to follow a healthy lifestyle: control body weight, quit drinking alcohol and smoking.

Drug treatment

Regular use of diuretics;
Anticoagulants;
Magnesium and potassium preparations;

Depending on the cause of the pathology, the following medications are prescribed:

In some cases, it may be necessary to take some of the medications described above throughout your life. If no positive dynamics or any improvements are noted, the patient may undergo surgery. Therapy is recommended to be carried out under the systematic supervision of a medical specialist.

During treatment, the work of the heart is systematically recorded and the heart rate is checked. If the enlargement of the ventricle is associated with another disease, treatment is aimed at eliminating the root cause.

Treatment with folk remedies

Quite often, the treatment of this disease combines drug therapy with folk remedies. It is worth considering that traditional medicine acts as an auxiliary therapy and should only be used in combination with the main treatment.

The main recipes of traditional medicine are infusions and various decoctions. Garlic supports myocardial function very well. It is necessary to chop the garlic and add honey to it (in equal proportions), place the container in some dark place for 7 days, shake the mixture periodically.

Take this medicine one tablespoon three times a day thirty minutes before meals. There are no restrictions on the use of this medicinal mixture; it can be taken all year round. St. John's wort infusion has a very good effect in the treatment of right ventricular hypertrophy.

To prepare it, you will need 100 grams of St. John's wort, which needs to be poured with two liters of water and boiled for ten minutes in a closed container over low heat. Then leave and let the herb brew for about an hour. Afterwards, strain the infusion and add two hundred grams of honey, stir and bottle.

Drink an infusion of St. John's wort herb, one-third of a glass three times a day, thirty minutes before meals. The medicine should be stored in the refrigerator. Do not forget that traditional medicine alone cannot cure hypertrophy; it can only act as an auxiliary therapy.

Before starting treatment with folk remedies, be sure to consult with your doctor; you may have any contraindications to certain types of herbs. Therefore, it is better to start treatment with folk remedies by consulting a doctor.

Traditional methods of treating right ventricular hypertrophy, due to their low effectiveness, are little used. Their use is possible only as sedatives and sedatives, as well as strengthening the heart muscle. A popular plant is lily of the valley. The following recipes are known:

Take fresh lily of the valley flowers and pour 96% alcohol. It should be left for 2 weeks, after which it is filtered and taken 20 drops three times a day.
Pour 300 ml of boiling water over a large spoon of lily of the valley flowers and leave for 1 hour. Then strain and take two large spoons every two hours.
A mixture of motherwort and lily of the valley is effective. An infusion of these plants is prepared and taken 3 or 4 times a day.
Mix the stinging nettle plant and honey in different proportions. Leave in a dark room for up to 14 days, then heat in a water bath until liquid and strain. The infusion is stored in the refrigerator. Take 4-5 times a day.

Complications of the disease

In the later stages of the development of this disease, signs of the so-called cor pulmonale appear. The main symptoms of cor pulmonale are:

the appearance of severe and sudden pain in the chest area;
a sharp decrease in pressure (up to the development of signs of a collaptoid state);
swelling of the neck veins;
a progressive increase in the size of the liver (this process is accompanied by pain in the right hypochondrium);
severe psychomotor agitation;
the appearance of a sharp and pathological pulsation.

In the case of pulmonary embolism, a person quickly, literally within a few minutes, develops signs of shock with severe pulmonary edema. With pulmonary edema, a massive release of transudate into the lung tissue from the capillary area appears.

Severe shortness of breath develops at rest, and the person feels tightness in the chest. Later, suffocation and cyanosis occur, followed by a cough. Sudden death can occur in one third of all cases of pulmonary embolism.

With compensated cor pulmonale, as the main consequence of right ventricular hypertrophy, the symptoms of the underlying disorder are not pronounced. Some patients may notice a slight pulsation in the upper abdomen.

But in the stage of decompensation, signs of left ventricular failure gradually develop. The manifestation of such decompensation is severe shortness of breath, which does not subside even at rest. It intensifies if a person changes body position, especially lying down.

Other symptoms indicate that a person is developing so-called congestive heart failure.

Prevention

Prevention of right ventricular hypertrophy comes down to fulfilling the following several requirements. Firstly, it is a prevention of the development of phlebothrombosis of the legs:

diagnosis of this pathology at the earliest stages and its immediate treatment;
preventive examination by a specialist;
after surgery, if phlebothrombosis is diagnosed, the patient is recommended to actively move;
following all doctor's recommendations.

For chronic lung diseases you should:

protect yourself from hypothermia and drafts;
do not smoke, including not being a participant in passive smoking;
treat the disease at the earliest stages;
lead an active lifestyle with adequate moderate exercise;
take oxygen cocktails.

For prevention purposes, it is also recommended to periodically do an electrocardiogram, give up bad habits and adhere to a therapeutic diet. You should regularly check with a cardiologist, undergo examinations, follow all recommendations and take appropriate medications.

Source: “skalpil.ru; iserdce.ru; prososud.ru; upheart.org; asosudy.ru; vashflebolog.ru; zabserdce.ru; ritmserdca.ru; heal-cardio.ru; zdorovguru.ru; sosudiveny.ru; mysymptoms.ru; serdechno.ru; kakfb.ru; healthruguru.ru"

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Right ventricular hypertrophy: causes, symptoms, treatment

Right ventricular hypertrophy (RVH) is a condition in which there is an increase in the thickness of the walls and mass of the myocardium of one of the parts of the heart, namely the right ventricle. Venous blood from large venous trunks enters the right atrium, and from there into the right ventricle. They are separated from each other by a tricuspid valve. When the right ventricle contracts, venous blood enters the pulmonary artery and is enriched with oxygen in the lungs. It then enters the left side of the heart. In various pathological conditions, the right ventricle expands (dilatation) and the mass of its walls increases (hypertrophy).

It is important to know the symptoms of right ventricular hypertrophy and the causes of the disease in order to consult a doctor in time to prescribe adequate treatment.

Mechanisms of development of prostate cancer:

thickening of cardiac muscle fibers;
increased blood pressure in the cavity of the right ventricle;
lack of oxygen (hypoxia);
metabolic and structural changes in the myocardium;
changes in the anatomy of the ventricles of the heart.

Reasons for development

Symptoms

hemoptysis;
heart rhythm disturbances;

heaviness in the right hypochondrium;

Diagnostics

Methods for diagnosing BPH:

Treatment

Complete rest and sleep.

Which doctor should I contact?

Help the children

Helpful information

Contact the specialists

Phone number for appointments with medical specialists in Moscow:

The information is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Editorial office address: Moscow, 3rd Frunzenskaya st., 26

Right ventricular overload

Hello! I am 23 years old. Height is 164 cm, weight ranges from 58 to 60 kg. Over the past 8 years I have not gained weight or lost any weight. I have been taking OK “Yaryna” as prescribed by a gynecologist for 6 years (there are no contraindications to use). I drink alcohol very rarely (on very big holidays, a maximum of a couple of times a year), I don’t use drugs, I smoke. In early childhood (about 6 years old) there was inflammation of the heart due to some kind of infectious disease (unfortunately, I don’t remember which one). I have a sedentary lifestyle, sometimes a week I go for long walks (from 3 to 5 hours), sometimes I do various exercises at home (stretching, dancing, diaphragmatic breathing). My blood pressure has been stable at 90/60 all my life, but over the last 2 years it has become 110/70, and subjectively I don’t feel it.

REALLY NEED YOUR HELP! The doctors at the clinic shrug their shoulders.

For about a year and a half, no more than two years, I have been worried about tachycardia. At first, the pulse was from 90 to 110. Then I took drugs such as: “Teravit antistress” (1 tablet, 1 rub. per day, 60 days), “Magnicum” (1 tablet, 2 rub. per day). days, 60 days), “Thiotriazolin” (1 volume, 3 times a day, 30 days). After taking these drugs, the pulse decreased: during the day from 85 to 100, when I fall asleep or wake up from 60 to 72.

The problem is that the tachycardia remains, but its cause has not been identified.

dP = 0.109 sec, PQ = 0.132 sec, dQ = 0.020 sec, QRS = 0.059 sec, dR = 0.039 sec, QT = 0.317 sec, QTc = 0.406 sec, aQRS = 84.

Sinus tachycardia. Vertical position of the heart axis. Increased load on the right atrium.

Aorta: not narrowed, not dilated.

Leve is over-excited: no worse.

The empty space of the left hole is not widened.

AO = 2.95 (H up to 3.7 cm). LP = 3.12 (H up to 3.7 cm). CDR = 4.57 (H = 5.5 cm). CSR = 2.99 (H up to 3.7 cm). EDV = 96 ml. CSR = 35 ml. SV = 61 ml.

Myocardial velocity of the left ventricle: satisfactory, 64% (% H up to 55%).

Zones of hypokinesia were identified in the area of the IVS.

Interstitial septum: not thickened. TMShP = 0.73 (H up to 1.1 cm).

The posterior wall of the left shunt: not thickened. TZSLSH = 0.73 (H up to 1.1 cm).

Aortic valve: stools are not narrowed, AC opening = 1.8 cm.

Mitral valve: antiphase; the chairs are slightly narrower.

Right little one: no extensions.

There is no sign of legen hypertension.

Doppler echocardiography: no pathological flows were detected in the empty heart.

Signs of insufficiency: mitral, aortic, tricuspid, pulmonary valve - none.

Signs of stenosis: mitral, aortic, tricuspid, pulmonary valve - none.

Comment: insignificant reverse current through the CLA, TC.

EchoCG signs of moderate compaction of the MV leaflets. Systolic deflection of the anterior valve leaflet is 0.4 cm. Hypokinesis of the IVS. The cavities of the heart are not dilated. LV myocardial contractility is satisfactory.

At appointments with rheumatologists and cardiologists: there were no heart murmurs, some noted harsh breathing.

RESULTS OF GENERAL BLOOD ANALYSIS (reference values in parentheses):

Hemoglobin().

Color index - 0.93 (0.85-1.05).

Band neutrophils - 2 (1-6).

Segmented neutrophils - 46 (47-72).

Analysis No. 2 (exactly a month after the first, a couple of days after the cold):

Hemoglobin().

Hematocrit - 36 (35-54).

The average erythrocyte volume is 88.2 (76-96).

The average hemoglobin concentration in an erythrocyte is 33.1 (32.0-36.0).

Platelets().

The width of the distribution of erythrocytes is 13 (12.0-15.0).

The width of platelet distribution is 14 (10.0-20.0).

The average platelet volume was 11.5 (6.0-13.0).

Neutrophil granulocytes - 48.6% (47-72).

Lymphocytes - 39.7 (19-37).

RESULTS OF BIOCHEMICAL BLOOD ANALYSIS (reference values in parentheses):

Haptoglobin - 0.89 (0.3-2.0).

Alkaline phosphatase - 30.6 (0-270).

Total bilirubin - 10.1 (0.5-20.5).

Total protein - 66.8 (60-83).

Cholesterol - 4.57 (2.99-6.24).

Triglycerides - 2.64 (0.4-1.6).

Atherogenic coefficient - 1.85.

Creatinine - 50.7 (53-115).

Uric acid - 151.1 ().

Cholinesterase)

C-reactive protein is negative.

Antistreptolysin O - negative.

Seromucoid - 0.19 units.

Thymol test - 0.58 units.

Problems with the thyroid gland were suspected.

RESULTS OF ULTRASOUND OF THE THYROID GLAND: Located in a typical location, symmetrical. The contour is smooth and clear. Echogenicity is normal. The structure is homogeneous, fine-grained. No focal formations were identified. Right lobe 5.5 cc. cm. Left lobe 5.0 cc. see Isthmus 2 mm. Lymph nodes are not identified.

RESULTS OF ANALYSIS FOR THYROID HORMONES:

TSH = 3.48 µIU/ml (normal: 0.27-4.2).

T4 St. = 1.08 ng/dL (normal: 0.93-1.7).

Thyroid AMC = 0.44 R (R 1.1 - positive. Positivity coefficient R is the optical density of the sample / critical optical density).

Then they suspected that I had something with the gastrointestinal tract (as if some organ was enlarged (liver, in my opinion), it was lifting the diaphragm, and that’s why I had tachycardia).

RESULTS OF ULTRASOUND OF THE ABDOMINAL ORGANS:

LIVER: not enlarged, the contour is smooth, the structure is homogeneous, echogenicity is not changed, sound conductivity (-), vascular pattern (-), intrahepatic ducts are not dilated.

GALLBLADDER: normal position, correct shape, moderately enlarged size, wall: echogenicity is not changed, does not contain stones. The common bile duct is not dilated.

PANCREAS: not enlarged, the contour is smooth, the structure is homogeneous, the echogenicity is not changed. The pancreatic duct is normal.

SPLEN: not enlarged.

VESSELS OF THE PORTAL SYSTEM: normal.

KIDNEYS: RIGHT: position - lowered, normal dimensions, smooth contour, central complex: normal echogenicity, not dilated, not deformed, does not contain stones. LEFT: normal position, normal dimensions, smooth contour, central complex: normal echogenicity, not dilated, not deformed, does not contain stones.

CONCLUSION: ULTRASOUND SIGNS of moderately pronounced “congestive” gallbladder, nephroptosis on the right.

Just in case, I was examined by a neurologist. I won’t reprint absolutely everything from the surveys (there’s a lot there), just the conclusions.

REG signs of vasospasm of the percapillary blood vessels, mostly on the left, moderate venous congestion on both sides.

RESULTS OF DUPLEX SCAN OF THE EXTRACRANIAL DIVISION OF THE BRACHIOCEPHAL VESSELS (doplegraphy of the vessels of the head and neck):

Considering the presence of a characteristic asymmetry of peak blood flow velocities and the index of peripheral resistance in the ICA and MCA, the identified echographic picture can be interpreted as manifestations of a migraine pattern. Option for the development of left VA without the formation of blood flow deficiency at the intracranial level.

EEG + EchoEG RESULTS:

The EEG reveals moderate changes in bioelectrical activity of an irritative nature with signs of irritation of the posterior brainstem structures against the background of a sharp decrease in the overall level of bioelectrical activity (increased tone of the activating system).

actually tachycardia, I almost always feel a heartbeat, the temperature has been elevated for the last 1.5-2 years (37.1-37.4), shortness of breath has begun to appear more quickly, the hands/legs do not get cold, do not sweat, the vision in the left eye has decreased slightly, sometimes to or after eating, discomfort in the right side, back pain due to seochondrosis.

Doctor! I beg you to help! Where to look for the cause of my tachycardia.

Many thanks in advance for your answer and help! Thank you!

In the context of this issue central å, as a matter of fact, this is the case with Ë5- In other words This is how it works.

Òàêèå èçìåíåíèÿ ñåãìåíòà RS-T è çóáöà Ã íåñêîëüêî ÷àùå íàáëþäàþòñÿ ïðè îñòðîé ñèñòîëè÷åñêîé ïåðåãðóçêå æåëóäî÷êîâ, êîãäà âîçíèêàåò ïðåïÿòñòâèå íà ïóòè èçãíàíèÿ êðîâè â âèäå ñóæå íèÿ âûõîäíîãî îòâåðñòèÿ èëè ïîâûøåíèÿ äàâëåíèÿ â áîëüøîì èëè ìàëîì êðóãå êðîâîîáðàùåíèÿ. Íàïðèìåð, ïåðåãðóçêà ëåâîãî æåëóäî÷êà ìîæåò ðàçâèòüñÿ âñëåäñòâèå ðåçêîãî ïîâûøåíèÿ àðòå ðèàëüíîãî äàâëåíèÿ, ãèïåðòîíè÷åñêîãî êðèçà, ïðè ôèçè÷åñêîì ïåðåíàïðÿæåíèè è ò. ä. Â ýòèõ ñëó÷àÿõ íà ÝÊÃ ìîæåò ïîÿâèòüñÿ äåïðåññèÿ ñåãìåíòà RS -Òâ white glaucoma (V , 6). On the other hand, the meaning of the world is different from that of the world. that's it. By way of example, in this case, in the face of the Russian Federation sòàvëåí ía ðèñ. 7.19. NA ESSAY (Rhyme 7.19, a) FEATURE: VALUE Rëååâûõ ãlðóäíûõ îòåäåíèÿõ (V s 6) èàì ïëèòäû Ë Ë ê îâïðàâûõ îòåäåíèÿõ (V j 2) elek QR in version V 6), with reference to the îòåêòðè÷îêîêîêîèñè V ñåðäöà vâëåâîèèðð. CONCLUSIONS OF THIS FRAMEWORK kokov RS-T, syllables 7).

Yes, the same as in Russia size 220/130 mm. sys., sys. RS -Òè This is the case with the most important countries in the world. p. 7.19, b), in other words This is a facade of the world. ×åðåç äåíü íîðìàëçàöèè ÀÄ (Fig. 7Ë9, a) the case of the Russian Federation, and the European Union ê èñõîäíîé.

Ïåðåãðóçêà ïðàâîãî æåëóäî÷êà ìîæåò ðàçâèòüñÿ ïðè îñòðîì ïîâûøåíèè äàâëåíèÿ â ìàëîì êðóãå êðîâîîáðàùåíèÿ, íàïðèìåð, ó áîëüíûõ ñ òðîìáîýìáîëèåé ëåãî÷íîé àðòåðèè, îòåêîì ëåãêèõ, ïðè àñòìàòè÷åñêîì ñòàòóñå ó áîëüíûõ áðîíõèàëüíîé àñòìîé è ò. ä. Â ýòèõ ñëó÷àÿõ íà ÝÊÃ â ïðàâûõ ãðóäíûõ îòâåäåíèÿõ (V 12) ìîæíî îáíàðóæèòü ïðåõîäÿùåå ñìåùåíèå ñåãìåíòà RS -Òè ñãëàæåííîñòü èëè èíâåðñèþ Ã, áûñòðî èñ÷åçàþùèå ïîñëå íîðìàëèçàöèè ñîñòî ÿíèÿ áîëüíîãî.

In this case, this is the case with the äèía ÝÊÃ ïðåäññòàëåí íà ðèñ. 7.5. Yes, this is the same as the other one îé, sòðàäàþùåé áðîíèàëüíîîàñîîé (Fig. 7.5, a), ïîìèìî ïðèçíà êîâ ïåðãðó The term "pulmonale" (P - pulmonale) RS -Òè îòðèöàòåëüíûå çóáöû Òü Formation V t - V r Introduction to the economic system vase to the world (Fig. 7.5, c)

This is what we are talking about, this is what we are talking about about the whole world. Referring to the Russian Federation, the Russian Federation, the Russian Federation this is the case with the façade of the fauna y, y y y y ov y ov y o y o y y o y y y o y y y by y y by y y y o y y o y y y by y y y by , with the WPW and with the other information about the world of the world This is how the world is different from the other countries. FEATURES OF THE SYSTEM RS-Tz êëèíè÷åñêè ìè è èíñòðóìåíòàëüíûìè ïðèçíàêàìè ïîâûøåíèÿ äàâëåíèÿ â áîëü øîì èëè ìàëîì êðóãå êðîâîîáðàùåíèÿ.

Trávïüçîàâøñü îáùm ïëàíîîà ÝÊÃ (see chapter 4), sysññ This is the case with the EU, and with the help of the Russian Federation. 7.20-7.24. In other words, this is the same as the other one. the most important aspects of the Russian Federation, Meaning of the world R è S:

The same, the same, is the following: ÷Con

è, â-tòðåtüèõ, èçìåðåíèå èítåðâàëà vâíóòðåíåãî îòêîîíåíèÿ îîòåäåí èÿõ V , è V 6 .

In this case, we are talking about this topic. this is the case in the region 4, and in the second phase kèk êkðèòåðèåâ gãèïåðîôèè, ïðèâääííûõ âäàí íîé ãëàâå. More information about this topic.

CHRONIC PULMONARY HEART

Enlargement of the right ventricle with the development of heart failure resulting from disease of the lungs or their blood vessels. Chronic cor pulmonale develops with emphysema, pneumosclerosis, pneumoconiosis and a number of other chronic lung diseases. In its origin, the main significance is the increase in pressure in the pulmonary artery to 100/70 mm Hg. Art. instead of 25/15 mm is normal.

In most cases, the clinical picture is dominated by the symptoms of the underlying pulmonary disease and associated respiratory failure: shortness of breath, cyanosis, cough, etc. Manifestations of chronic cor pulmonale consist of signs of pulmonary hypertension, hypertrophy and dilatation of the right ventricle and circulatory disorders in the systemic circle. Clinically, to recognize pulmonary hypertension, as well as assess its severity, the emphasis of the second tone on the pulmonary artery, radiological signs of expansion of its main trunks, electrocardiographic signs of overload of the right atrium and ventricle (deviation of the electrical axis of the heart to the right, the appearance of high sharp teeth PI]_I)I are important ). In severe cases of pulmonary hypertension, there is a diastolic murmur in the pulmonary artery. Instrumental research methods (electrokymography, rheography, etc.) help indirectly assess the degree of pulmonary hypertension. When examining a patient, you can palpate to determine the pulsation of the hypertrophied right ventricle in the epigastric region, which should be distinguished from the pulsation of the liver and abdominal aorta. For the diagnosis of chronic pulmonary heart disease, it is especially important to identify signs of circulatory disorders in a large circle in the form of liver enlargement, swelling of the neck veins, edema in the legs, ascites, congestive kidney with proteinuria. At the onset of the disease, signs of heart failure may be mildly expressed and periodically disappear.

Treatment of patients with chronic cor pulmonale consists of reducing respiratory failure, reducing pulmonary hypertension and treating chronic heart failure (see).

Prevention of chronic pulmonary heart disease consists of timely active treatment of the underlying disease with a focus on restoring bronchial patency. Early detection and treatment of pulmonary hypertension with the use of diuretics, chloracyzine, euphyllia, and oxygen therapy is important.

Right ventricular hypertrophy

Hypertrophy is referred to as a syndrome that can serve as an impetus for the formation of other heart pathologies. In this condition, the mass of the right ventricle increases, and the muscle fibers thicken.

It is from the right ventricle that the pulmonary circulation starts, then the blood is enriched with oxygen. Right ventricular hypertrophy is a rare disease. Often, children and newborns are the first to suffer from this disease. Also, people most often affected by this disorder are those who are overweight, practice excessive strength training, and abuse nicotine and alcohol.

Right ventricular hypertrophy is a pathological condition that may indicate heart disease.

Depending on the size of the ventricle, this condition is classified as: moderate, moderate and severe. Moderate hypertrophy is recorded with enlargement of the right ventricle. Moreover, its mass is identical to the mass of the left ventricle. With moderate hypertrophy, moderate excitation and an increase in the size of the ventricle are noted. A pronounced condition is characterized by a pronounced enlargement of the ventricle.

Treatment of right ventricular hypertrophy is aimed at taking medications, as well as adjusting nutrition and lifestyle.

Symptoms

Symptoms of right ventricular hypertrophy are not very informative in the initial stage of the disease. Among the recorded conditions, swelling of the lower extremities, systematic fainting, dizziness, difficulty breathing, pain and heaviness in the chest, shortness of breath are noted.

Diagnostics

Symptoms of right ventricular hypertrophy do not always allow one to fully identify the disease. To accurately identify the disease, a number of additional studies may be prescribed.

Initial examination. Listening with a stethoscope can help identify heart murmurs.
An electrocardiogram allows you to diagnose the disease.
An ultrasound will help determine the size of the ventricle and the pressure in the heart chambers.

Causes

The causes of right ventricular hypertrophy are directly related to concomitant diseases. First of all, this disease can be provoked by disturbances in the normal functioning of the heart (including various congenital pathologies).

Other causes of right ventricular hypertrophy are also noted:

High blood pressure;
Cardiomyopathy;
Bronchial asthma, pneumonia, bronchitis;
Systematic stress state;
Increase in body weight;
If there is a defect in the septum between the ventricles, blood from the two sections mixes. Organ systems and tissues receive deoxygenated blood and excessive load on the right ventricle occurs.
Pulmonary hypertension, which is accompanied by fainting and shortness of breath. In this condition, there is an increase in pressure in the pulmonary artery area.
This symptom develops with Tetralogy of Fallot, a congenital pathology that promotes outflow from the right ventricle. A child born with this syndrome is characterized by bluish skin. This defect is observed throughout the year from the birth of the child.
This condition can occur as a result of pulmonary valve stenosis and impaired blood flow from the right atrium.

Treatment

Treatment, the goal of which is to reduce the size of the heart to normal, consists of two stages: medication and correction of nutrition, as well as the patient’s lifestyle.

Patients are recommended to introduce a large amount of plant-based foods, fermented milk products, grains, and lean meat into their diet. It is necessary to avoid salt, fried and fatty foods. It will not be superfluous to give up all sorts of bad habits.

If hypertrophy provokes the development of heart disease, surgery may be prescribed.

Surgery involves implantation of an artificial valve.

Drug treatment of right ventricular hypertrophy consists of taking the following groups of drugs:

Regular use of diuretics;
Beta-adrenergic blockers (medicines of this pharmacological group are incompatible with alcoholic beverages and smoking);
Calcium channel antagonists;
Anticoagulants;
Magnesium and potassium preparations;
The use of cardiac glycosides is permissible in a minimal dosage;
Medicines that help lower blood pressure.

Concomitant prescriptions are possible to normalize lung function and eliminate pulmonary valve stenosis.

In some cases, it may be necessary to take some of the medications described above throughout your life. If no positive dynamics or any improvements are noted, the patient may undergo surgery.

If the enlargement of the ventricle is associated with another disease, treatment is aimed at eliminating the root cause.

Patients should remember the dangers of self-medication and not try to select medications on their own. People suffering from excess body weight, as well as those who are systematically exposed to physical activity, are recommended to be regularly examined by a cardiologist.

Right ventricular hypertrophy

Right ventricular hypertrophy is a pathological condition in which the right ventricle increases in size, which leads to the development of serious ailments and overload of the heart.

Depending on the degree of enlargement in the right side of the organ, the disease can be: mild, moderate, or severe in severity.

In addition, there are other types: physiological - observed in newborn children; pathological - observed in case of burn injury or pneumonia, various pulmonary ailments, genetic imperfections, and is formed due to sudden overloads of the body.

Causes

Changes in the size of the right ventricle are associated with the accelerated growth of specialized cardiac cells - cardiomyocytes.

An increase in size may occur as a result of congenital heart disease, mitral stenosis.

The most common sufferers are children, who are characterized by various health problems, and adults who have abnormalities in the pulmonary organs or valve defects, complicated by changes in the functioning of the cardiovascular system.

There are many configurations depending on the severity. Basically, the flaw is formed due to:

pulmonary hypertension, which causes an increase in pressure in the corresponding artery, causing shortness of breath, dizziness and fainting;
tetralogy of Fallot, observed in newborns, diagnosed during the first months of the baby’s life. The defect is considered congenital and causes a violation of blood flow;
valve stenosis, during which disruptions in the outflow of blood into the artery occur;
ventricular septal defect, which causes oxygen deficiency and increases the work of all departments, including the right stomach.

The evolution of the defect can be caused by diseases such as pulmonary fibrosis and emphysema, prolonged bronchitis and pneumonia, pneumosclerosis, and bronchial asthma.

Symptoms

In the presence of such a syndrome, in the early stages the manifestations are mild, but in the later stages the following signs appear:

sensations of severe chest pain, a feeling of heaviness, difficulty breathing;
arrhythmia or irregular heartbeat, a feeling of “fluttering” in the chest;
fainting, sudden attacks of dizziness;
swelling in the legs.

This symptomatology is also called “pulmonary heart”, which can be acute or chronic.

Clinical manifestations of acute cor pulmonale are characterized by:

insufficiency;
severe shortness of breath;
tachycardia;
a sharp decrease in pressure.

Very often the acute form leads to death.

The chronic form is difficult to distinguish from the acute form until decompensation occurs. A severe degree of chronic deficiency ends in the clinic of obstruction.

Diagnostics

Symptoms do not always allow one to identify the disease. For an accurate diagnosis, the cardiologist prescribes a series of studies: an initial examination is carried out, and murmurs in the cardiac region are listened to using a stethoscope.

A diagnosis can be made by performing an electrocardiogram and ultrasound, which determines the size of the organ, as well as other defects.

Treatment

If the syndrome is present, therapy is aimed at normalizing pulmonary function, eliminating valve stenosis, and curing defects.

In addition, they carry out symptomatic physiatry aimed at supporting the functioning of the myocardium, additionally nourishing it, and normalizing pulse and blood pressure. In certain cases, surgical intervention is indicated, especially for children with such pathology. It is almost impossible to recover completely.

Prevention

Prevention measures boil down to taking measures that help prevent the progression of phlebothrombosis in the legs. To do this, it is necessary to diagnose the pathology in the early stages of its evolution and immediately begin physiatry, conduct regular examinations in the hospital to exclude an increased risk of the disease. During the postoperative period, a patient diagnosed with “phlebothrombosis of the extremities” must lead an active life to prevent the process of blood stagnation, while bandaging the operated leg with an elastic bandage. It is important to follow the entire protocol prescribed by the attending physician. It is necessary to protect yourself from hypothermia and not to be exposed to drafts, not to smoke, to avoid consuming smoke, even passive smoke, not to prolong any ailments that have arisen, but to receive timely treatment in the early stages of their manifestation.

Reasons for development

The main reason for the development of prostate cancer is excessive load on it. It appears when blood pressure increases in the pulmonary circulation (pulmonary artery and its branches, pulmonary capillaries, pulmonary veins), as well as when blood is discharged into the right ventricle in some congenital heart defects.

In children, the development of RVH is associated primarily with congenital heart defects. RVH develops with a significant ventricular septal defect. This is a congenital heart defect in which blood from the left ventricle, during its contractions, is partially ejected not into the aorta, but through a hole in the interventricular septum into the right ventricle. As a result, it is forced to pump significantly larger volumes of blood than it should. At the same time, thickening of its walls develops. Other congenital heart defects that lead to the development of RVH are atrial septal defect, pulmonary valve insufficiency, tetralogy of Fallot, and other conditions that cause overload of the right ventricle with blood volume or pressure in the pulmonary artery system.

In adults, the main cause of prostate cancer is the so-called cor pulmonale. Cor pulmonale occurs when diseases interfere with normal breathing. As a result, the pressure in the pulmonary artery increases, the right ventricle experiences overload and enlarges. Causes of pulmonary hypertension and cor pulmonale:

lung diseases (bronchial asthma, chronic bronchitis, emphysema, bronchiectasis, tuberculosis and others);
diseases of the chest (curvature of the spine, poliomyelitis and others);
diseases of the pulmonary vessels (thrombosis and embolism, arteritis, compression of blood vessels by a mediastinal tumor and others).

RVH in adults sometimes occurs as a result of mitral valve stenosis. With this disease, the function of the left ventricle is impaired, then the pressure in the pulmonary vessels increases and the right ventricle is secondarily affected. Tricuspid valve insufficiency also leads to the development of RVH. With this defect, part of the blood from the right ventricle, when it contracts, does not enter the pulmonary artery, but back into the right atrium, and again into the right ventricle. It is forced to pump a large volume of blood and as a result it increases.

Symptoms

GPH itself does not cause any complaints. Only its causes (pulmonary hypertension) and complications (heart failure) are clinically manifested.

Signs of pulmonary hypertension:

shortness of breath with little physical exertion and at rest, dry cough;
weakness, apathy, dizziness and fainting;
rapid heartbeat, swelling of the neck veins;
hemoptysis;
heart rhythm disturbances;
anginal pain associated with oxygen starvation of the myocardium (pressing, squeezing pain behind the sternum during exercise, often accompanied by cold sweat, which goes away after taking nitroglycerin).

Signs of heart failure caused by decreased contractility of an enlarged right ventricle:

heaviness in the right hypochondrium;
the appearance of dilated veins on the skin of the abdomen;
swelling of the legs and anterior abdominal wall.

Congenital heart defects in children may be accompanied by cyanosis (blue discoloration) of the skin, shortness of breath and rapid heartbeat, heart rhythm disturbances, and retarded growth and development.

Diagnostics

Methods for diagnosing BPH:

electrocardiography: does not always detect RVH, especially at an early stage;
echocardiography, or ultrasound examination of the heart: the most informative method;
Chest X-ray: may provide additional diagnostic information for cor pulmonale.

Treatment

GPH itself cannot be treated. The diseases that caused it are being treated. Non-drug treatment methods include:

Avoid heavy physical activity and sports, especially with severe prostate cancer.
Complete rest and sleep.
Prevention of influenza, ARVI, exacerbations of chronic lung diseases.
High altitude conditions are not recommended.

Pulmonary hypertension and chronic cor pulmonale often require chronic use of calcium antagonists (nifedipine), prostaglandins and inhaled nitric oxide.

Heart defects in children and adults are corrected through surgery.

Circulatory failure is treated according to appropriate protocols.

Which doctor should I contact?

If an electrocardiogram or other heart study reveals right ventricular hypertrophy, consult a physician or cardiologist. After additional examination, the doctor will prescribe treatment for the reasons that caused this condition. It is likely that you will need to consult a cardiac surgeon, an orthopedist (for spinal curvature), and a pulmonologist (for cor pulmonale).

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