Myocardial hypertrophy of the left ventricle of the heart - Causes, Symptoms and Treatment .MF .
Causes of myocardial hypertrophy
Treatment and lifestyle
Complications and prognosis
left ventricle - a chamber of the heart, which is a cavity that receives arterial blood from the left atrium through the mitral valve and pushes it into the aorta through the aortic valveto further promote blood through the vessels of the body.The thickness of the muscular wall of the left ventricle at the apex is about 14 mm in the septum between the right and left ventricles - 4 mm, lateral and posterior portions - 11 mm.Function ventricular muscle cells is to relax in the diastolic phase and take the blood and then to decline in systole and expel blood into the aorta, and the more blood goes into the ventricle and stronger stretch its walls, the stronger the muscle contraction.
If more blood enters the ventricle or walls have to overcome greater resistance to ejection of blood into the aorta than usual, developing ventricular volume overload or pressure respectively.This occurs gradually c
left ventricular hypertrophy is classified as follows:
1. concentric and eccentric .
concentric hypertrophy develops in ventricular pressure overload, such as aortic stenosis or hypertension, and is characterized by a uniform thickening of its walls with a possible decrease in the ventricular cavity.Muscle mass is built up ventricle to push blood into the narrowed valve or spastic vessels in hypertension.
Heart in cross section.Reduction of the left ventricular cavity.
Eccentric type of hypertrophy develops in volume overload, such as failure of the mitral, aortic valves, as well as alimentary - constitutional obesity (foodborne) and is characterized by the expansion chamber ventricular wall thickening, or maintaining their normal thickness, the total increase in this type ofthe mass of the left ventricle.The left ventricle is not thickened so much as the blood fills and inflates as a ball filled with water.
This separation is important to understand the doctor and the patient, since the value of the first type of cardiac output may remain unchanged, while the second is reduced, that is, when the second type of heart copes with bad blood ejection into the aorta.
2. with obstruction of the outflow tract without obstruction and asymmetric types .
outflow tract obstruction means muscular wall thickening and its protrusion into the lumen of the ventricle, ventricular cavity with the restriction at the exit site of aorta, leading to subaortic stenosis and further exacerbating the systemic circulation.Thus ventricular cavity may be divided into two parts like an hourglass.Obstruction is not developing at the uniform, diffuse hypertrophy concentric type.Asymmetric hypertrophy is characterized by thickening of the interventricular septum, and can be either with obstruction, and without it.
3. By degree of thickening of the muscle wall - up to 21 mm, from 21 to 25 mm, 25 mm.
The figure shows a thickening of the heart muscle compared with normal myocardium.
Danger hypertrophy that violated the processes of relaxation and contraction of the myocardium, which leads to violations of intracardiac blood flow and, therefore, a violation of the blood supply to other organs and systems.It is also more likely to develop coronary heart disease, acute myocardial infarction, stroke, congestive heart failure.
reasons hypertrophy of the left ventricle
Bring to that ventricle thicken and stretched, may overload its pressure and volume when the heart muscle to overcome obstruction to blood flow to expel it into the aorta or eject much larger volume of blood than occurs inOK.Causes of overload can be such diseases and conditions as:
- arterial hypertension (90% of all cases of hypertrophy associated with high blood pressure for a long time, as the steadily developing a spasm of blood vessels and increased vascular resistance)
- heart defects congenital and acquired- aortic stenosis, aortic and mitral valves, coarctation (area restriction)
aorta - atherosclerosis of the aorta and the deposition of calcium in the aortic valve and the aortic wall
- endocrine diseases - diseases of the thyroid gland (hyperthyroidism), adrenal gland (pheochromocytoma), diabetesdiabetes
- obesity, foodborne or due to hormonal disorders
- frequent (daily) use of alcohol, tobacco
- professional sport - athletes from developing myocardial hypertrophy in response to a constant load on the skeletal muscles and the heart muscle.Hypertrophy in this group of people is not dangerous in the event, if not disturbed blood flow in the aorta and the systemic circulation.
Risk factors for the development of hypertrophy are:
- family history of heart disease
- floor (usually male)
- age (older than 50 - years)
- high salt intake
- disorders of cholesterol metabolism
Symptomshypertrophy of the left ventricle of the heart
clinical picture of left ventricular hypertrophy is characterized by the absence of a strictly specific symptoms and the sum of the manifestations of the underlying disease that led to it, and the manifestations of heart failure, arrhythmias, myocardial ischemia and other effects of hypertrophy.In most cases, the payment period and the absence of symptoms can last for years, until the patient is scheduled to be held or ultrasound of the heart do not notice the appearance of complaints from the heart.
hypertrophy can be suspected in the case, if you experience the following symptoms:
- long-existing high blood pressure for many years, especially poorly to medical correction and the high numbers of blood pressure (more than 180/110 mm Hg)
- a common occurrenceweakness, fatigue, shortness of breath when performing those loads that previously were well tolerated
- there feeling disruptions of the heart or overt cardiac arrhythmias, most commonly atrial fibrillation, ventricular tachycardia
- swelling in the legs, arms, face, usually occurring at the end ofday and going in the morning
- episodes of cardiac asthma, breathlessness and dry cough in the supine position, often at night
- cyanosis (blue) fingertips, nose,
mouth - pain attacks in the heart or in the chest with a load or at rest (angina)
- frequent dizziness or loss of consciousness
At the slightest deterioration of the health and appearance of heart complaints should consult a doctor for further diagnosis and treatment.
diagnosis of myocardial hypertrophy disease
can assume during the inspection and survey of the patient, especially if history is an indication of heart disease, hypertension, or endocrine disorders.For a more complete diagnosis the doctor will prescribe appropriate methods of examination.These include:
- laboratory methods - blood tests and biochemical blood research on hormones, urine.
- chest X-ray - may be determined by a significant increase in the shadow of the heart, increase the shadow of the aorta with aortic valve regurgitation, aortic configuration of the heart with aortic stenosis - heart underline waist arc displacement of the left ventricle to the left.
- ECG - in most cases on the electrocardiogram revealed an increase in R-wave amplitude in the left, and the wave S in the right precordial leads, the deepening of Q wave in left leads, shifting electrical axis of heart (EOS) to the left, the displacement of ST segment below the contour lines can be observed signsblockade of the left bundle branch block.
- Echo - CG (echocardiography, ultrasound of the heart) accurately visualize the heart and its internal structures to see on the screen.In hypertrophy determined by the thickening of the apical, septal myocardial zones, front or back of its walls;there may be areas of reduced myocardial contractility (hypokinesia).Measured pressure in the chambers of the heart and large vessels, calculated pressure gradient between the ventricle and the aorta, cardiac ejection fraction (normally 55-60%), stroke volume and ventricular cavity dimensions (BWW CSR).In addition, visualized heart defects, if any, were the cause of hypertrophy.
- stress testing and stress - Echo - CG - held ECG and ultrasound of the heart after the exercise (treadmill test, bicycle ergometry).Needed to obtain information about the heart muscle endurance and exercise tolerance.
- ECG monitoring is indicated for registering possible violations of rhythm, if they have not been registered previously in the standard cardiogram, and the patient complained of disruption of the heart.
- can be assigned on the testimony of invasive methods of research, such as coronary angiography to assess the patency of the coronary arteries in a patient with ischemic heart disease.
- MRI of the heart for accurate visualization of intracardiac structures.
Treatment of hypertrophy of the left ventricular hypertrophy
Treatment is primarily directed to the treatment of the underlying disease that led to its development.This includes blood pressure correction, medical and surgical treatment of heart diseases, diseases of the endocrine therapy, the fight against obesity, alcoholism.
main groups of drugs aimed directly at preventing further cardiac geometry are:
- ACE inhibitors (Hart (ramipril), fozikard (fosinopril) prestarium (perindopril), etc.) have oranoprotektivnymi properties, that is, not only to protect organs- target, stricken with hypertension (brain, kidneys, blood vessels), but also prevent further remodeling (rebuilding) the myocardium.
- beta - blockers (nebilet (nebivalol), Inderal (propranolol), rekardium (carvedilol), etc.) reduce the heart rate, reducing the need muscle for oxygen and reducing hypoxic cells, resulting in further hardening and replacement zones sclerosis hypertrophied muscle slows down.Also prevent the progression of angina by reducing the frequency of pain attacks and heart dyspnea.
- calcium channel blockers (Norvasc (amlodipine), verapamil, diltiazem) reduce calcium in heart muscle cells, preventing the buildup of intracellular structures, leading to hypertrophy.Also, reduce the heart rate, reducing myocardial oxygen demand.
- a combination of drugs - Prestancia (amlodipine + perindopril) noliprel (perindopril + indapamide) and others.
In addition to these drugs, depending on the underlying and concomitant cardiac pathology can be assigned:
- antiarrhythmics - Cordarone, amiodarone
- Diuretics - furosemide, Lasix, indapamide
- nitrates - Nitromintum, nitrosprey, izoket, kardiket, monocinque
- anticoagulants and antiplatelet drugs - aspirin, clopidogrel, Plavix, chimes
- cardiac glycosides - strofantin, digoxin
- antioxidants - mexidol aktovegin, coenzyme Q10
- vitamins and drugs that improve cardiac nutrition - thiamine, riboflavin, niacin, magnerot, Pananginum
Surgical treatment is used to correct heart defects, implantation of an artificial pacemaker (pacemaker or cardioverter - defibrillator) with frequent paroxysms of ventricular tachycardia.Surgical correction is applied directly hypertrophy in severe obstruction of the outflow tract and is to conduct operations Morrow - excision of the hypertrophic heart muscle in the walls.This can be both an operation on damaged heart valves.
Lifestyle with left ventricular hypertrophy
Lifestyle hypertrophy is not much different from the key recommendations for other heart diseases.It is necessary to observe the principles of a healthy lifestyle, including the deletion of, or at least limit the number of cigarettes smoked.
following components can be distinguished lifestyle:
- mode.It is more than a walk in the fresh air and to develop adequate work and rest with sufficient sleep duration necessary for the recovery of the body.
- diet.Food is desirable to cook boiled, steam or baked form, limiting the preparation of fried dishes.Of the products resolved lean meats, poultry and fish, dairy products, fresh fruits and vegetables, juices, jellies, fruit drinks, fruit drinks, cereals, vegetable fats.Limited abundant fluid intake, salt, confectionery, fresh bread, animal fats.Excludes alcohol, spicy, fatty, fried, spicy food, smoked.Eating should be at least four times a day in small portions.
- physical activity.Limited significant exercise, especially when expressed outflow tract obstruction, with high functional class CHD or at later stages of heart failure.
- komploentnost (adherence to treatment).It is recommended to regularly take prescribed medications and promptly attending physician in order to prevent the development of complications.
Employability hypertrophy (an operating contingent of individuals) is determined by the underlying disease and the presence / absence of complications and comorbidities.For example, in severe heart attacks, strokes, severe heart failure expert commission decision can be made on the availability permanent disability (disability), with worsening hypertension observed temporary netrudosposbnost, recorded on sick leave, and with stable hypertension and lack of ability to work complications completely preserved.
complications of left ventricular hypertrophy
In severe hypertrophy may develop complications such as acute heart failure, sudden cardiac death, fatal arrhythmias (ventricular fibrillation).With the progression of hypertrophy gradually develop chronic heart failure and myocardial ischemia, which can lead to acute myocardial infarction.Arrhythmias, such as atrial fibrillation can lead to thromboembolic complications - stroke, pulmonary embolism.
presence of myocardial hypertrophy with defects or high blood pressure significantly increases the risk of chronic circulatory failure, coronary artery disease and myocardial infarction.According to some studies, five-year survival of patients with hypertension, hypertrophy is no more than 90%, while with decreasing hypertrophy and less than 81%.However, provided that the regular intake drugs to hypertrophy regression, the risk of complications is reduced and prognosis is favorable.At the same time, heart defects, for example, the prognosis is determined by the degree of circulatory disorders caused by the defect, depending on the stage of heart failure, as in the later stages of its poor prognosis.
therapists Sazykina OJ