Myocardial hypertrophy: types, causes, symptoms, diagnosis and treatment
In medicine, the term "myocardial hypertrophy" refers to a pathological process, the development of which is accompanied by an increase in size. The weight of the whole body also becomes larger, its shape changes. With hypertrophy of the left ventricular myocardium, the size increases on the left side, the right side - on the other. Rarely, but it happens that both departments are involved in the pathological process. Despite the high risk of death, the prognosis for this disease can be favorable. As a rule, this is due to the timeliness of treatment to the doctor.
From the moment of the appearance of the newborn baby, the baby’s heart is exposed to certain stresses. Over time, their intensity increases. Nature intended that the heart must withstand numerous loads.The indicator of the strength of the body depends on the state of the myocardium.
If the heart is subjected to significant stress, it needs more blood. This increases the frequency of contractions of the body. If the influence of a negative factor (stress) is permanent, the heart begins to work faster. This is necessary in order to timely pump blood and deliver it to all organs and systems. If the heart is not able to work in a similar rhythm, the elastic properties of the myocardium are lost, gradually it increases in size.
Over time, pathology progresses. The danger of the disease lies in the fact that many people live for years with myocardial hypertrophy and do not even know about it, writing off the warning signs for other existing ailments or overwork. In this case, the lack of treatment can be fatal.
Pathology occurs when the heart is regularly exposed to high loads. The latter often accompany arterial hypertension or hypertension.
In addition, the following diseases and conditions often cause myocardial hypertrophy:
- Heart defects of congenital nature. These include: aortic stenosis, one ventricle, impaired communication between departments, pulmonary hypoplasia, or artesia.
- Heart defects acquired character. The body is subjected to high loads during the narrowing of the aortic valve and mitral insufficiency.
- Cardiac ischemia.
- High intensity exercise. For this reason, myocardial hypertrophy often develops in athletes.
- Fabry disease.
- Inactive lifestyle.
- Frequent episodes of obstructive sleep apnea.
- Tobacco smoking.
- Excessive use of alcoholic beverages.
Sometimes an increase in the size of the right or left ventricle of the heart occurs in completely healthy people. Athletes are at risk, as they regularly subject the body to high-intensity loads. In such cases, it is customary to talk about physiological myocardial hypertrophy. When increasing one or both departments in size, it is necessary to reduce the intensity of the loads. When this condition is met, in most cases the ailment does not turn into a pathological form, but it also increases the risk of developing other diseases of the cardiovascular system.
Hypertrophy may be asymmetric or concentric. In the first case, the shape and size of the upper, middle or lower part of the left ventricle of the heart changes. Often, the partition separating the departments is involved in the pathological process. This type of myocardial hypertrophy is diagnosed in 50% of cases. The thickness of the muscle tissue in certain areas can reach 6 cm.
Concentric hypertrophy is much less common. It is characterized by a decrease in the size of the cavities, impaired heart rhythm and diastolic function of the organ. In most cases, concentric myocardial left ventricular hypertrophy is diagnosed, less often - right. This is due to the fact that the work of the latter is largely dependent on the functioning of the lungs.
The involvement of both departments in the pathological process is extremely rare.
Myocardial hypertrophy is a cunning disease. This is due to the fact that most people do not even suspect the presence of the disease and live with it for years. As a rule, the disease is detected at random during the examination, appointed for a completely different reason.
As the pathological myocardial hypertrophy progresses, the first warning signs begin to appear. As a rule, they occur already at a late stage, when the work of the heart is significantly impaired.
In order to prevent the disease from becoming severe, it is necessary to consult a doctor if even mild symptoms are present. These include:
- rapid onset of fatigue;
- muscle weakness;
- darkening of the eyes.
As the pathology develops, the following signs of myocardial hypertrophy appear:
- Swelling of the face in the evening.
- Dry cough.
- Heart rhythm disorders.
- Constant drowsiness or, on the contrary, insomnia.
- Increased fatigue.
- Frequent episodes of headache.
- Blood pressure jumps.
- Symptoms of angina.
- Pain in the chest.
- Muscle weakness.
Often the development of myocardial hypertrophy is accompanied by attacks of cardiac asthma. The pathological condition arises due to the fact that the muscle can no longer pump a large amount of blood, against the background of which stagnant liquid connective tissue is formed.
Degrees of severity
The disease develops gradually, passing through several stages.
The degree of myocardial hypertrophy:
- Compensation. This is the initial stage of development of the pathological process, in which both the left and right ventricles function normally. In this regard, the patient does not feel any warning signs. In such cases, the disease is detected by chance during diagnostic procedures prescribed for another reason.
- Subcompensation. At this stage, the general condition of the person may also remain the same. Persons with other pathologies of the heart may experience the first symptoms: shortness of breath, weakness, fatigue, darkening of the eyes.
- Decompensation. Changes in the myocardium are pronounced, in connection with which the symptoms of the disease appear very clearly.
At an early stage, the disease in most cases can be treated with conservative methods. When the form is started, the doctor decides the question of the appropriateness of the surgical intervention.
When the first warning signs of myocardial hypertrophy appear, it is necessary to consult a cardiologist.In the process of receiving the doctor conducts a primary diagnosis, including the following activities:
- Interview. The specialist needs to provide information on what symptoms bother the person, how long they appeared and what degree of manifestation they have. It is also important to inform the cardiologist about the presence of other diseases, since hypertrophy is a symptom of many ailments. In addition, you must inform the doctor about what ailments afflicted with immediate family.
- Examination of the patient. The specialist evaluates the patient's condition and roughly determines the severity of the pathological process during auscultation, percussion and palpation. Using these methods, the doctor can identify the boundaries of the heart and assess the changes in his work.
For making an accurate diagnosis, a comprehensive examination is appointed. The main method of instrumental diagnosis of the disease is electrocardiography. When myocardial hypertrophy on the ECG revealed the following changes:
- Deformation of the R wave. In this case, it is customary to speak of the pathology of the atria.
- The electrical axis is deflected left or right.It depends on which ventricle is enlarged. The horizontal position of the axis also often indicates the presence of pathology on the left side, but in this case the R tooth should be increased in the 5th and 6th chest leads.
- Changed the degree of electrical conductivity of the heart.
By decision of the doctor, additional methods of instrumental diagnostics are also prescribed. These include:
- Ultrasound. In the course of the study, it is possible to identify various heart defects, areas with reduced contractility, thickening of the interventricular septum and myocardium.
- Echocardiography. Highly informative diagnostic method, which allows to assess the size of the heart, as well as analyze the pressure gradient between the ventricles and blood vessels. In the process of conducting echocardiography, it is possible to fix the reverse flow of the liquid connective tissue.
- Load tests. Means carrying out bicycle ergonometry. While receiving the load on the treadmill from the patient using an ECG, ultrasound and echocardiography, all the necessary indicators are recorded.
In some cases, it is advisable to conduct radiographic studies, coronary angiography and MRI of the heart.Based on the results obtained, the doctor makes the most effective treatment regimen.
All drugs are prescribed to eliminate the root causes of the disease, to improve the general well-being of the patient, to increase the patient’s life expectancy, as well as to prevent various complications that may be dangerous not only for health, but also for human life.
In the vast majority of cases, left ventricular hypertrophy is diagnosed. In such situations, the following medications are prescribed:
- Beta-blockers. Examples of drugs: "Atenolol", "Nadolol", "Sotalol", "Propranolol". Such tools help to achieve visible improvements in at least one third of patients. The mechanism of action of drugs is the following: penetrating into the body, the active components reduce the heart's need for oxygen. If the patient is in a state of psycho-emotional or physical stress, the substances help reduce the degree of sympathoadrenal system effects. As a result, the patient's quality of life is significantly improved by eliminating unpleasant symptoms.Most often, cardiologists prescribe "Propranolol." At the initial stage of treatment of myocardial hypertrophy, the drug must be taken three times a day at a dosage of 20 mg. The latter should gradually increase. If at the most effective dosage (up to 240 mg) adverse reactions occur in a patient, the drug must be replaced. For persons suffering from chronic heart failure of a chronic nature, the approach is always individual. The minus of these drugs: they do not affect the life expectancy of the patient, that is, they can not increase it.
- Calcium channel blockers. Against the background of receiving these funds, the contractile function is normalized, due to which the progression of hypertrophy is stopped. In addition, the cardiac muscle's need for oxygen decreases. As a result, the patient's well-being improves significantly, his body becomes more enduring. As a rule, doctors prescribe "Verapamil". According to statistics, treatment with this drug is effective in most patients. It is necessary to take the drug three times a day at a dosage of 20-40 mg. With good portability, it is gradually increased to a maximum of 240 mg.
- Additional funds.These include: antiarrhythmic drugs (for example, Disopyramide), anticoagulants, antihypertensive drugs, vitamins and microelements.
The functioning of the right ventricle is largely dependent on the work of the lungs. If its hypertrophy is revealed, which happens in rare cases, drugs are prescribed to treat the underlying disease of the respiratory system. What means it is advisable to take, the doctor decides on the basis of the results of diagnosis and individual health of the patient.
When stopping the development of myocardial hypertrophy, improving the quality and longevity of the patient, without the risk of complications, the result of drug therapy is considered successful.
With the ineffectiveness of conservative methods, surgical intervention is indicated. As a rule, it is performed using one of the main methods: myoseptectomy or transplantation of a donor organ. In the first case, resection of hypertrophied tissues is performed.
Often, surgical treatment is accompanied by the implementation of coronary artery stenting, angioplasty,dissection of adhesions and valve prosthetics (in cases when their insufficiency was diagnosed).
Features of day mode and nutrition
Drug therapy and surgery are important steps towards getting rid of the disease. But the effectiveness of such methods is minimal, if the patient does not change the mode of the day and does not make adjustments to the diet.
On the background of hypertrophy, myocardial elasticity decreases. In order to restore it, you must adhere to the following rules of nutrition:
- All dishes should be boiled, baked or steamed.
- It is necessary to include in the diet of meat, but only low-fat varieties.
- During each meal, you need to eat any product from the following list: nuts, cereals, fruits, vegetable oil, vegetables, kefir, jelly, fruit drinks.
- Confectionery and fresh bread should be excluded from the diet.
- It is strictly forbidden to consume alcoholic beverages.
- The amount of water should be reduced.
- Per day you need to eat 4-6 times. At the same time, the size of one portion should not exceed 200 g.
For persons with myocardial hypertrophy, proper rest is shown.But this does not mean that the lifestyle should be inactive. All patients are shown moderate exercise.
Possible complications and prognosis
The disease at the initial stage of development is not dangerous for life. At this stage, the heart muscle is functioning normally. If the pathology is in the stage of decompensation, stagnation is formed in the bloodstream. Against this background, heart failure or myocardial infarction may develop.
When hypertrophy of the left ventricle arrhythmic manifestations may occur. Ischemic disease often develops. The most serious complication is sudden cardiac arrest.
With the defeat of the right ventricle in the venous bed, blood stasis forms. Against the background of this pathological process, edemas appear, fluid accumulates in the chest and abdominal cavity. In advanced cases, ascites occurs.
The prognosis directly depends on the severity of the underlying disease. In addition, the body's response to medication or surgery is important. At the initial stage of the development of pathology, the prognosis is usually favorable.If the disease is identified already at the stage of decompensation, the disease often ends with the death of the patient. This is due to the fact that in severe cases the course of pathology in most cases is accompanied by life-threatening complications.
Myocardial hypertrophy is a pathological process characterized by an increase in the size of the heart muscle. A similar condition develops in the presence of large loads to which the body is subjected.
At the initial stages of development, the disease may not manifest in any way, since the work of the heart is not significantly impaired. In such cases, the disease is usually detected randomly. When running form the quality of life of the patient is significantly deteriorating.
Treatment of the disease involves taking medication, changing lifestyle and adjusting the diet. With the ineffectiveness of conservative methods, surgical intervention is indicated.