Overload of the right heart. Ventricular systolic overload. Classification of heart failure Systolic overload of the left ventricle treatment
Left ventricular hypertrophy (LVH) is a concept that reflects thickening of the walls of the left ventricle with or without expansion of the left ventricular (LV) cavity. This condition can occur for various reasons, but in most cases indicate pathology of the heart muscle, sometimes quite serious. The danger of LVH is that sooner or later it develops, since the myocardium cannot always work with the same load that it experiences with LVH.
According to statistics, LVH is more common in elderly patients (over 60 years of age), but with some heart diseases it is observed in adulthood, childhood, and even during the neonatal period.
Causes of left ventricular hypertrophy
1. “Sports heart”
The formation of hypertrophy of the walls of the left ventricle of the heart is a variant of the norm only in one case - in a person who has been involved in sports for a long time and professionally. Due to the fact that the chamber of the left ventricle does the main job of expelling a volume of blood sufficient for the entire body, it has to experience more load than other chambers. When a person trains for a long time and intensely, his skeletal muscles require more blood flow, and as muscle mass increases, the amount of increase in blood flow in the muscles becomes constant. In other words, if at the beginning of training the heart only periodically experiences an increasing load, then after some time the load on the heart muscle becomes constant. Therefore, the LV myocardium increases its mass, and the LV walls become thicker and more powerful.
example of a sports heart
Despite the fact that, in principle, the “athletic heart” is an indicator of good training and endurance of an athlete, it is very important not to miss the moment when physiological LVH can turn into pathological LVH. In this regard, athletes are monitored by sports medicine doctors who clearly know in which sports LVH is acceptable and in which it should not occur. Thus, LVH is especially developed in athletes involved in cyclic sports (running, swimming, rowing, cross-country skiing, walking, biathlon, etc.). LVH develops moderately in athletes with developed strength qualities (wrestling, boxing, etc.). In people involved in team sports, LVH normally develops very little or does not develop at all.
2. Arterial hypertension
In patients with high numbers, a long-term and persistent spasm of the peripheral arteries is formed. In this regard, the left ventricle has to push blood with greater force than at normal blood pressure. This mechanism is caused by an increase in total peripheral vascular resistance (TPVR), and when it occurs, the heart is overloaded with pressure. After a few years, the LV wall thickens, which leads to rapid wear and tear of the heart muscle - CHF begins.
3. Coronary heart disease
Eccentric hypertrophy left ventricle (asymmetric) involves not only a thickening and increase in the mass of the LV wall, but also an expansion of the cavity. This type is more common with heart defects, with myocardial ischemia.
Depending on how thick the LV wall is, moderate and severe hypertrophy are distinguished.
In addition, hypertrophy is distinguished with and without obstruction of the LV outflow tract. In the first type, hypertrophy also affects the interventricular septum, as a result of which the LV zone closer to the aortic root acquires a pronounced narrowing. With the second type, there is no overlap in the transition zone of the LV to the aorta. The second option is more favorable.
Is left ventricular hypertrophy clinically evident?
If we talk about symptoms and any specific signs of LVH, then it is necessary to clarify the extent to which the thickening of the muscular wall of the heart has reached. Thus, in the initial stages, LVH may not manifest itself at all, and the main symptoms will be noted from the underlying heart disease, for example, headache with high blood pressure, chest pain with ischemia, etc.
As myocardial mass increases, other complaints appear. Due to the fact that thickened areas of the cardiac muscle of the left ventricle compress the coronary arteries, and the thickened myocardium requires more oxygen, type chest pain occurs (burning, squeezing).
Due to gradual decompensation and a decrease in myocardial reserves, pain develops, which is manifested by attacks, swelling on the face and lower extremities, as well as a decrease in tolerance to habitual physical activity.
When the heart muscle hypertrophies, disturbances in the conduction system may also occur, which can lead to heart rhythm disturbances. More often than others, with LVH, atrial and ventricular extrasystole occurs, as well as atrial fibrillation-flutter, which is manifested by a feeling of fading and cardiac arrest and interruptions in cardiac function of varying intensity.
If any of the described symptoms appear, even if they are mild and rarely bother you, you still need to consult a doctor to find out the causes of this condition. After all, the earlier LVH is diagnosed, the higher the success of treatment and the lower the risk of complications.
How to confirm the diagnosis?
In order to suspect left ventricular hypertrophy, it is quite enough to perform a standard electrocardiogram. The main criteria for left ventricular hypertrophy on the ECG are disturbances in repolarization processes (sometimes up to ischemia) in the chest leads, oblique or oblique elevation of the ST segment in leads V5, V6, there may be depression of the ST segment in leads III and aVF, as well as a negative T wave) . In addition, voltage signs are easily determined on the ECG - an increase in the amplitude of the R wave in the left precordial leads - I, aVL, V5 and V6.
If the patient shows signs of myocardial hypertrophy and LV overload on the ECG, the doctor prescribes further examination. The gold standard is, or echocardioscopy. On EchoCS, the doctor will see the degree of hypertrophy, the condition of the LV cavity, and also identify the possible cause of LVH. The normal thickness of the LV wall is less than 10 mm for women and less than 11 mm for men.
LVH on echocardiography
Often, changes in the size of the heart can be judged by performing a conventional chest x-ray in two projections. By assessing some parameters (heart waist, cardiac arches, etc.), the radiologist may also suspect changes in the configuration of the heart chambers and their sizes.
Video: ECG signs of hypertrophy of the left ventricle and other chambers of the heart
Is it possible to cure left ventricular hypertrophy permanently?
Therapy for LV hypertrophy comes down to eliminating the causative factors. Thus, in the case of heart defects, the only radical treatment method is surgical correction of the defect.
In most situations (hypertension, ischemia, cardiomyodystrophy, etc.), it is necessary to treat left ventricular hypertrophy with the help of constant intake, which not only influence the mechanisms of development of the underlying disease, but also protect the heart muscle from remodeling, that is, they have a cardioprotective effect.
Drugs such as enalapril, quadripril, lisinopril normalize blood pressure. In the process of many years of large-scale studies, it has been reliably proven that this group of drugs () within six months from the start of therapy leads to normalization of LV wall thickness.
Medicines from the group (bisoprolol, carvedilol, nebivalol, metoprolol) not only reduce the heart rate and “relax” the heart muscle, but also reduce pre- and afterload on the heart.
Drugs, or nitrates, have the ability to perfectly dilate blood vessels (vasodilating effect), which also significantly reduces the load on the heart muscle.
In the case of concomitant heart pathology and the development of CHF, the use of diuretics (indapamide, hypothiazide, diuver, etc.) is indicated. When taken, the circulating blood volume (CBV) decreases, resulting in a decrease in volume overload of the heart.
Any treatment, be it taking one of the drugs (for hypertension - monotherapy), or several (for ischemia, atherosclerosis, CHF - complex therapy), is prescribed only by a doctor. Self-medication, as well as self-diagnosis, can cause irreparable harm to health.
Speaking about curing LVH forever, it should be noted that pathological processes in the heart muscle are reversible only when treatment is prescribed on time, in the early stages of the disease, and The medications are taken continuously, and in some cases for life.
Why is LVH dangerous?
In cases where minor LV hypertrophy is diagnosed in the early stages, and the underlying disease is treatable, complete cure of hypertrophy has every chance of success. However, in case of severe heart pathology (extensive heart attacks, widespread cardiosclerosis, heart defects) complications may develop. Such patients may experience heart attacks and strokes. Long-term hypertrophy leads to severe CHF, with swelling throughout the body up to anasarca, with complete intolerance to ordinary household stress. Patients with severe CHF cannot move around the house normally due to severe shortness of breath; they cannot tie their shoelaces or prepare food. In the later stages of CHF, the patient is unable to leave the house.
Prevention of adverse consequences is regular medical monitoring with ultrasound of the heart every six months, as well as constant use of medications.
Forecast
The prognosis of LVH is determined by the disease that led to it. Thus, with arterial hypertension, successfully corrected with the help of antihypertensive drugs, the prognosis is favorable, CHF develops slowly, and the person lives for decades without affecting his quality of life. In older people with myocardial ischemia, as well as with previous heart attacks, no one can predict the development of CHF. It can develop both slowly and quite quickly, leading to the patient’s disability and loss of ability to work.
Video: left ventricular hypertrophy, program “About the Most Important Thing”
Video: cardiac hypertrophy, program “Live Healthy!”
Last article updated: April, 2019
is a pathological condition in which one of the chambers of the heart, the left ventricle, expands or stretches (dilates).
Causes
There are several reasons for the development of this condition, but they can be roughly divided into two groups. The first is associated with changes in the myocardium of the left ventricle itself, and the second is due to the fact that a healthy, normal left ventricle experiences overload, but first things first.
Left ventricular overload
The left ventricle is a chamber that, decreasing and increasing in volume, provides the pumping function of the heart.
This chamber receives blood from the left atrium and pumps it into the aorta, the largest artery in the body, from which blood is redistributed to all organs.
If the aorta or (more often) the aortic valve is narrowed, then the left ventricle experiences overload and begins to stretch and dilate. A similar situation occurs with some heart defects, in which too much blood enters the left ventricle.
Of the defects leading to dilatation of the left ventricle, the most common is aortic stenosis.
Pathological conditions in the walls (myocardium) of the left ventricle
Dilatation of the left ventricle can occur completely without cause, in which case this condition is called dilated cardiomyopathy. Such a diagnosis is valid only if other causes of dilatation are excluded; they will be discussed further.
Other causes of dilatation are: previous inflammation of the heart - myocarditis; cardiac ischemia; hypertonic disease . With these diseases, the wall of the left ventricle becomes weaker, loses its elasticity and, as a result, begins to stretch.
How to diagnose left ventricular dilatation?
Complaints are not diagnostic criteria, since with slight dilatation they may not exist at all, at least for the time being. If, due to dilatation, the pumping function of the heart begins to decrease, then signs of heart failure appear: weakness, poor exercise tolerance, shortness of breath, swelling of the legs, etc. However, there is no such complaint that could accurately indicate the presence of ventricular dilatation, that is, the complaints are nonspecific .
ECG in some cases, it may allow one to suspect changes in the left ventricle, but this method also does not allow dilation itself to be detected.
Ultrasound of the heart- This is the main method for identifying left ventricular dilatation; moreover, ultrasound can identify heart defects, and sometimes a previous myocardial infarction, and, accordingly, the cause of dilatation.
During cardiac ultrasound, the diameter of the left ventricle is measured in two-dimensional space, more precisely, the end-diastolic size, denoted in the conclusion by the abbreviation “EDV”.
Normally, the ESD of the left ventricle, in the average person, should not exceed 56 mm. But this indicator is not absolute. So, for example, a basketball player is 2 meters tall and weighs 110 kg. EDR = 56-58 mm is normal, while in a woman 155 cm tall and weighing 45 kg, EDR = 54-55 mm can be considered as dilatation of the left ventricle.
Treatment
Of course, left ventricular dilatation is a pathological condition that requires treatment. Therapy is selected depending on the causes of dilatation: elimination of the defect, treatment of arterial hypertension, coronary heart disease.
Unfortunately, it is not always possible to eliminate dilatation of the left ventricle, since it may be based on irreversible changes in the heart muscle: myocardial fibrosis, scarring and sclerotic changes in the myocardium. In such cases, the main goal of treatment is to prevent further progression of left ventricular distension.
It should be noted that in some cases treatment is reduced to metabolic therapy (trimetazidine, mildronate, corvitin, etc.), in other cases more serious treatment is required.
Why is left ventricular dilatation dangerous?
We have already mentioned that dilatation of the left ventricle is fraught with the development of heart failure. In addition, in the altered left ventricle, prerequisites are created for the development of certain arrhythmias, including life-threatening ones.
Also, following the expansion of the ventricle, expansion of the valve ring often occurs and, as a consequence, deformation of the mitral valve. This leads to the development of heart disease - mitral regurgitation, which significantly worsens the clinical situation.
It is very important to identify and begin treatment for left ventricular dilatation in a timely manner, and although this is not a guarantee of success, complete healing is not always possible, but this allows you to stabilize the situation, improving the quality of life and its duration.
Content
LVH is a specific lesion of the heart, in which it increases in size and becomes more susceptible to any changes. Hypertrophy mainly affects the myocardium, the strongest muscle of the heart wall, making contractions difficult, as a result of which the risk of developing other diseases increases.
What is left ventricular hypertrophy of the heart?
Cardiac hypertrophy, or, in other words, hypertrophic cardiomyopathy, is a thickening of the wall of the left ventricle of the heart, which leads to malfunction of the aortic valve. The problem is common among patients with hypertension, as well as athletes, people leading a sedentary lifestyle, addicted to alcohol and those who have inherited a tendency to pathology.
Myocardial hypertension of the left ventricles of the heart belongs to class 9 on the ICD 10 scale, along with other diseases of the circulatory system. This pathology is mainly a syndrome of other heart diseases, of which it exhibits indirect signs. In order to prevent possible problems in the future, it is necessary to intensively treat the hypertrophied organ in a timely manner, immediately after pathologies are detected.
Degrees of left ventricular hypertrophy
Depending on the signs of LVH and the size of the deformed muscle tissue, several stages of the development of the disease can be distinguished:
Moderate left ventricular hypertrophy (LVH) occurs as a consequence of hypertension or other heart disease. This seemingly insignificant increase signals an overload of the heart and that the risk of myocardial diseases (heart attack, stroke) for the patient increases. It often occurs without any symptoms and is detected only by ECG analysis. If the left ventricle is enlarged, it is necessary to be treated with the help of specialists, preferably in an inpatient setting.
Severe LVH is characterized by dystrophic changes in which the mitral valve is located close to the surface of the septum and interferes with blood flow, causing excessive muscle tension and stress on the left ventricle.
Enlargement of the left ventricle of the heart - causes
The causes of hypertrophy of the left ventricle of the heart can be varied, including both chronic and acquired diseases of different parts of the body:
- hypertension;
- obesity: the development of the disease is very dangerous in young children who are overweight;
- ischemia;
- diabetes;
- arrhythmia, atherosclerosis;
- frequent excessive physical activity;
- alcoholism, smoking;
- high blood pressure;
- lung diseases;
- aortic stenosis;
- disturbances in the functioning of the mitral valve;
- stress, psychological illness, nervous exhaustion.
The development of the body in a child can occur with disruption of the processes of myocardial repolarization and, as a result, an increase in the walls of the ventricle. If such a situation arises, it must be prevented, and then monitored on a regular basis throughout adulthood and prevent progression. Constant exercise can naturally lead to heart enlargement, while work associated with heavy lifting is a potential threat of systolic overload, so you should normalize your physical activity and monitor your health.
Another indirect cause is sleep disturbance, in which a person stops breathing for a short period of time. It can be observed in women during menopause or in older people and entails consequences such as expansion of the diameter of the heart vessels, growth of the septum and walls of the heart, increased blood pressure, and arrhythmia.
Signs of left ventricular hypertrophy
Symptoms of cardiomyopathy are not always obvious, and people are often unaware that there is a problem. If the fetus does not develop properly during pregnancy, there may be a congenital defect and hypertrophy of the left side of the heart. Such cases must be observed from birth and complications should not be allowed. But if there are periodic interruptions in the heart's function and a person feels any of these signs, the walls of the ventricle may be abnormal. The symptoms of this problem are:
- labored breathing;
- weakness, fatigue;
- chest pain;
- low heart rate;
- swelling of the face in the afternoon;
- disturbed sleep: insomnia or excessive sleepiness;
- headache.
Types of left ventricular hypertrophy
The types of left ventricular hypertrophy vary depending on the structure of changes in the heart muscles. It happens: concentric and eccentric LVH, ventricular dilatation. They are distinguished based on echocardiographic indicators (cardiogram) and the thickness of the organ walls. Each type of LVH is not an independent disease, but occurs as a consequence of other pathologies in the human body.
Eccentric hypertrophy
Eccentric myocardial hypertrophy is characterized by an increase in the heart and the volume of its chambers in parallel with the thickening of the muscles of the left ventricle. It is provoked by a sharp growth of cardiomyocytes, their transverse size does not change. Also, eccentric LVH threatens to slow the pulse and cause breathing complications. Appears with heart defects or after a heart attack.
Concentric hypertrophy of the left ventricular myocardium
Concentric hypertension occurs due to hyperfunction of myocardiocytes due to pressure load. The size of the cavity does not change, sometimes it even becomes smaller. The size of the walls of the left ventricle, the total mass of the myocardium and the heart increase. Concentric hypertrophy occurs with hypertension, arterial hypertension; causes a decrease in coronary reserve.
Left ventricular dilatation
Dilatation is an expansion of the left ventricle of the heart and occurs when the myocardium changes or the healthy ventricle is overloaded. If the arc of the heart is lengthened, this can also be an initial symptom of LVH. Sometimes aortic stenosis leads to dilation, when the narrowed valve cannot perform its pumping function. Past illnesses are often the cause of heart enlargement; in rare cases, it can occur on its own, as a congenital pathology.
What is the danger of left ventricular hypertrophy?
If the left ventricle is hypertrophied, this is not a disease, but it can provoke many of them in the future, including fatal heart attacks, strokes, angina pectoris and other heart ailments. Often, organ enlargement occurs due to an active lifestyle, among athletes, when the heart works harder than in the average body. Such changes may not pose a threat, but in each individual case, qualified consultation and medical advice is necessary.
Diagnosis of cardiomyopathy
Diagnosis of left ventricular hypertrophy occurs in several ways: by identifying signs of the disease on an ECG, examining the heart using ultrasound or using a magnetic resonance imaging scanner. If you experience any heart problems or symptoms of illness, you should contact a cardiologist, and if you have already suffered some kind of defect and suspect complications, you need a cardiac surgeon and, possibly, a treatment system.
Left ventricular hypertrophy on ECG
ECG is a common diagnostic method that helps to find out the thickness of the heart muscle and voltage characteristics. However, it can be difficult to identify LVH on an ECG without the participation of other methods: an erroneous diagnosis of hypertrophy may be made, since on the ECG the signs that are characteristic of it can be observed in a healthy person. Therefore, if they are found in you, this may be due to increased body weight or its special constitution. Then it is worth conducting another echocardiographic examination.
LVH on ultrasound
Ultrasound examination helps to more likely judge individual factors and causes of hypertrophy. The advantage of ultrasound is that this method allows not only to diagnose, but also to determine the characteristics of the course of hypertrophy and the general condition of the heart muscle. Indicators of cardiac echocardiography reveal changes in the left ventricle such as:
- ventricular wall thickness;
- ratio of myocardial mass to body mass;
- coefficient of asymmetry of seals;
- direction and speed of blood flow.
MRI of the heart
Magnetic resonance imaging helps to clearly calculate the area and degree of enlargement of the ventricle, atrium or other compartment of the heart, and to understand how strong the degenerative changes are. MRI of the myocardium shows all the anatomical features and configuration of the heart, as if “stratifying” it, which gives the doctor complete visualization of the organ and detailed information about the condition of each department.
How to treat left ventricular hypertrophy of the heart
Many people are susceptible to cardiac hypertrophy. If the problem is severe, medical or surgical treatment of left ventricular hypertrophy is performed. In this case, depending on the extent of the damage, treatment can be aimed at preventing the progression of the disease or at returning the myocardium to its normal size. But it happens that this condition is reversible; if the disease cannot be cured completely, then regression can be achieved by correcting such things as:
- Lifestyle;
- food type;
- hormonal balance;
- excess weight;
- amount of physical activity.
Treatment of left ventricular hypertrophy with medication
Medicines for left ventricular hypertrophy of the heart can have an effective result if taken under the supervision of a doctor. It is impossible to completely eliminate the symptoms of hypertension, but taking antihypertensive drugs for this disease and following a diet will help fight the causes and prevent deterioration of health. To treat LVH, the following medications are prescribed:
Verapamil is an angiarrhythmic drug from the group of calcium channel blockers. Reduces myocardial contractility, reduces heart rate. Can be used by both adults and children, doses are set individually.
Beta blockers - reduce the pressure and volume load in the heart cavity, help to even out the rhythm and reduce the risk of defects.
Sartans - effectively reduce the overall load on the heart and remodel the myocardium.
Myocardial hypertension of the left heart belongs to class 9 on the ICD-10 scale, along with other diseases of the circulatory system. Preference should be given exclusively to drugs whose quality has been tested and proven clinically; experimental drugs may not only not have the expected effect, but also negatively affect overall health.
Cardiomyopathy surgical treatment
Surgery for left ventricular hypertrophy may be necessary to remove the hypertrophied portion of the muscle in late and advanced stages of the disease. To do this, a transplant of the entire heart or its individual parts is performed. If the cause of LVMH is damage to a valve or septum, transplantation of these specific organs is first attempted, which is simpler than whole-heart surgery. In the case of such an intervention, the patient will have to be under the supervision of a cardiologist for the rest of his life and take medications to prevent coronary thrombosis.
Traditional treatment of left ventricular hypertrophy
Treatment of hypertrophy of the left ventricle of the heart with folk remedies cannot help in the later stages of lesions, but it can be effective with minor increases, to prevent their development, and reduce the risk of more serious consequences. You will not be able to completely cure the disease, but traditional medicine can relieve discomfort, chest pain, weakness and fainting. The following means are known:
Herbal infusions as an auxiliary therapy during the main treatment (blueberry, motherwort, blasphemous hawthorn, horsetail, cornflower flowers, adonis)
Infused milk: boil and pour into a thermos overnight, or put in the oven until it turns brown.
Lily of the valley in the form of drops of tincture or gruel. For the tincture, pour vodka or alcohol into the lily of the valley, leave in a dark place for 2 weeks, take 10 drops 3 times a day for 2 months. Gruel: pour boiling water over lily of the valley flowers, leave for 10 minutes. Then drain the water, chop the plant and take a tablespoon 2 times a day. Recommended in combination with drops.
Garlic honey: mix crushed garlic with honey in a 1:1 ratio, leave for a week in a dark place, take 1 tablespoon 3 times a day before meals.
Dry red wine infused with dried rosemary. Pour wine over the leaves, leave for about a month in a dark place, strain and take before eating.
Cranberries, mashed with sugar: a teaspoon 4 times a day.
Diet for left ventricular hypertrophy of the heart
To adjust your diet for cardiomyopathy, follow these tips:
- give up salt;
- eat often, about 6 times a day, but in small portions;
- stop smoking, drink less alcohol;
- choose foods that are lower in fat and cholesterol;
- limit the amount of animal fats;
- Fermented milk, dairy products, fresh vegetables and fruits are healthy;
- eat less flour and sweets;
- if you are overweight, follow a diet to lose weight and reduce the load on your heart.
Video: left ventricular myocardial hypertrophy
Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.
Found an error in the text? Select it, press Ctrl + Enter and we will fix everything!When evaluating an electrocardiogram or performing an ultrasound of the heart, left ventricular hypertrophy is often detected. This is a condition characterized by an increase in the volume of muscle fibers. 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:
- 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.
Find out your risk level for heart attack or stroke
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.
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 persistently high blood 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 the blood from the two sections of the ventricles mixes and, when entering the organs and tissues, does not deliver the required amount of oxygen (in this case, both cardiac sections begin to function in an enhanced mode, trying to restore normal nutrition to the body, and this represents an additional burden).
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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 left ventricular myocardium in children occurs with 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.
However, 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.
Rice. 91. Graphics of the electrocardiogram in the left precordial leads with diastolic overload of the left ventricle.
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:
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;
Rice. 92. Electrocardiogram of Natasha P., 1 year 1 month. Diagnosis: endomyocardial fibroelastosis. Left ventricular overload of obstructive type.
b) “adaptive” hypertrophy develops in a similar way to that described above, but has a milder course due to the presence of abducens tracts.
the functioning of the latter depends on the discharge of stenotic resistance. In this regard, it practically does not reach the degree of hypertrophy observed in the first 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.
teas),
signs of blockade of the left posterior branch of the atrioventricular bundle (His) (in 1/2 observations).
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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, the following drugs are actively recommended:
- 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.
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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 separate 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 refers to left ventricular 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%.
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Cardiac hypertrophy - what is it?