Overload of the right atrium ECG what. What is left ventricular overload? Why does the load increase?

In these cases, the ECG shows signs characteristic of hypertrophy of the right or left atrium (see sections 7.1 and 7-2), which disappear after the cessation of hemodynamic overload of the atria.

For example, when patients develop attacks of bronchial asthma, pulmonary edema, pulmonary embolism, lobar pneumonia, etc., when, due to increased pressure in the pulmonary artery, the load on the right side of the heart increases, the appearance of high-amplitude with a pointed apex can sometimes be observed on the ECG teeth R in leads II, III, aVF (P - pulmonale) and an increase in the first positive (right atrial) phase of the wave R in lead V f. After the patient's condition normalizes, these ECG changes decrease or disappear.

Rice. 7.5. ECG dynamics in a patient with bronchial asthma.

a - initial, b - during status asthmaticus, c - after relief

status Explanation in the text

In Fig. Figure 7.5 shows the dynamics of the ECG in a patient with bronchial asthma. On the ECG recorded during severe status asthmaticus (Fig. 7.5, b), the amplitudes of the teeth are noticeably increased R in leads II, III, aVF and V. 3 days after the relief of status asthmaticus, these signs of acute overload of the right atrium decreased significantly (Fig. 7.5, c), and the ECG returned to the original one (Fig. 7.5, a).

Overload of the left atrium can develop with a sharp increase in blood pressure (hypertensive crisis), an attack of angina or pulmonary edema and other conditions. In this case, an increase in the amplitude and duration of the second negative (left atrial) wave phase can be observed on the ECG R in lead V(less often V 2) or even the formation of a negative wave P W [ . In leads I, II, aVL, V *, bifurcation and an increase in the amplitude of the teeth sometimes appear R(P-mitrale).

In Fig. Figure 7.6 shows the dynamics of the ECG of a patient with coronary heart disease, recorded during dosage physical activity on a bicycle ergometer. At the height of the load, the patient developed an attack of angina pectoris, severe shortness of breath, and a decrease in blood pressure, which indicated a significant drop in the contractility of the left ventricular myocardium against the background of acute coronary insufficiency. On the ECG (Fig. 7.6, b), in addition to signs of myocardial ischemia (see Chapter 8), the formation of negative waves was observed R lead V, deepening of the second negative (left atrial) phase of the Ruz wave and an increase in the amplitude and duration of the wave Rv leads I, aVL and V5, which indicated acute overload of the left atrium. After 36 minutes, the ECG was completely normalized (Fig. 7.6, c).

Rice. 7.6. ECG dynamics in a patient with coronary heart disease during a test with dosed physical activity on a bicycle ergometer. a - initial ECG, b - at the height of maximum physical activity, c - 30 minutes after stopping the bicycle ergometer test Explanation in the text

Left atrial overload

Overload of the left atrium is indicated in cases when a wide double-humped P wave appears after an acute situation - a hypertensive crisis, an attack of cardiac asthma or pulmonary edema, myocardial infarction, etc. Then, as the patient’s condition improves, the ECG gradually normalizes.

It is possible to clearly distinguish between an ECG during hypertrophy and overload of the left atrium only with dynamic electrocardiographic observation. Anamnesis, physical examination data, X-ray examination, etc. help in making a differential diagnosis.

Often they talk about overload of the left atrium in cases where characteristic changes in the P wave are observed in patients with chronic ischemic heart disease, hypertension, kidney disease with symptomatic hypertension, etc.

In these cases, although the compensatory development of atrial hypertrophy cannot be completely excluded, the term “left atrial overload” is more acceptable.

“Guide to electrocardiography”, V.N. Orlov

This information is for your information only; please consult your doctor for treatment.

ECG. Left atrial hypertrophy

With left atrial hypertrophy, the electrical axis of the P wave often deviates to the left (or takes a horizontal position): P I > P II > P III.

Characteristic signs of a pathological P wave with left atrial hypertrophy in various leads:

the P V1 wave is negative or biphasic with a sharp predominance of the second negative phase, the width of which is increased - this is the most characteristic sign of left atrial hypertrophy.

The atrial ECG complex with hypertrophy of the left atrium is called “P-mitrale” and most often it is observed in patients with mitral stenosis, aortic heart defects, hypertension, cardiosclerosis, congenital heart defects with overload of the left parts.

Left atrial overload

Left atrial hypertrophy - main features and methods of diagnosis

Hypertrophy of one of the chambers of the heart is an alarming sign that indicates the presence of a disease. It is a pathological enlargement of the heart muscle - the myocardium. Most often, the left half is subject to this deviation.

Many people face such a problem as left atrial hypertrophy. How does this condition occur and what treatment does it require?

Normal sizes

Arterial blood passes through the left atrium and left ventricle, which is why they are called the arterial heart. By the same principle, the right atrium and right ventricle are called the venous heart.

Through the pulmonary veins, that is, the veins that come from the lungs, oxygenated blood enters the left atrium. From there it goes into the left ventricle, and then disperses throughout the body, providing oxygen to all its organs and systems. Then, through the superior vena cava, venous blood enters the right atrium, and from it into the right ventricle, which sends it to the lungs.

has a wall thickness in the central part of the order of 1.5-2 mm;
has a cavity volume of cm3.

Reasons for the increase

Hypertrophy of this chamber develops in cases where it experiences increased load for a long time. As a result, the left atrium myocardium enlarges. This is necessary so that he can cope with his work.

Signs on ECG

With left atrial hypertrophy, characteristic changes in the shape of the P wave appear on the electrocardiogram. As a result of the enlargement of this part of the heart muscle, the vector of its excitation increases, and the excitation lasts longer.

As a result, on the ECG, the second (right) part of the P wave, reflecting the nature of excitation of the left atrium, is increased in amplitude, as a result it becomes larger than the first part, which remains unchanged. Also, the second part is increased in width, which consequently exceeds 0.10 seconds.

Establishing diagnosis

Using an ECG, a cardiologist can make a diagnosis and prescribe further examinations and treatment. At the same time, he will definitely compare the results of the study with the patient’s complaints. Hypertrophy of the right atrium myocardium leads to problems such as:

Diseases of which this may be a symptom

Diseases that cause increased stress on this part of the heart include:

With hypertension, which usually develops in adulthood and old age, the arterial heart experiences great resistance when pumping blood throughout the body. The result is hypertrophy. From high pressure As a rule, those who live with constant elevated level stress and often experiences strong emotional distress.

Valve insufficiency is a deviation in which it stops working normally. In this case, the valves that ensure normal blood flow cannot close completely, as a result, blood circulation is impaired.

For example, with mitral valve insufficiency, part of the blood from the left ventricle flows back into the atrium, while normally all of it should go into the aorta and further disperse throughout the body.

Stenosis is a pathological narrowing of the openings through which blood flows from one chamber to another. The result of both of these deviations is the same - increased load on the left atrium.

Cardiomyopathy is a myocardial disease in which the heart muscle changes structurally and functionally in the absence of hypertension, pathologies of the arteries and valves. This is a serious disease in which two thirds of patients die within five years, but it is quite rare.

via ultrasound;

The doctor listens to tones (short, sharp sounds that accompany the work of the myocardium) and murmurs (long sounds). The appearance of the latter is a consequence of any problems and serves as an indication for an ECG.

In turn, changes in the electrocardiogram are an indication for an ultrasound examination - EchoCG. This is a very simple and quite informative diagnostic method that will allow you to accurately determine the wall thickness of each chamber.

Therapy tactics

Obesity treatment

regular physical activity:

In most cases, changing your diet and exercising helps bring your weight back to normal. If this does not happen, then there is some problem in the body that causes obesity. She might, for example, hormonal disorder. In this case, it will be necessary to diagnose the disease and treat it.

Elimination of hypertension

Relief from valve stenosis or insufficiency

Valve defects can only be eliminated surgically. However, this is not always done - most patients with these pathologies are prescribed maintenance therapy, which allows them to relieve the load on the heart muscle.

This may include:

cardiac glycosides;
beta blockers;
anticoagulants;
antiplatelet agents;
ACE inhibitors;
diuretics.

Left atrium changes

Left atrium enlargement

When the left atrium enlarges (dilatation or hypertrophy), the shape of the P wave also changes. Usually, depolarization of the right atrium occurs first, then the left. Thus, with an increase in the left atrium, the total time of atrial depolarization lengthens, which is manifested by a pathologically wide P wave lasting at least 0.12 s (at least three small divisions). With enlargement of the left atrium, the amplitude (height) of the P wave may be normal or increased.

Some patients, especially those with coronary artery disease (CAD), may have wide P waves without noticeable enlargement of the left atrium, which is likely due to a delay in impulse conduction through the normal-sized atrium. For this reason, the term “left atrial overload” is more often used to describe pathologically wide P waves.

P waves characteristic of left atrium overload

The P wave is sometimes double-humped or jagged (Fig. 6-4, A). Its second peak corresponds to delayed depolarization of the left atrium. Double-humped P waves are usually better visible in the limb leads (Figure 6-5).

The old term “P-mitrale” is sometimes used to describe wide P waves because these changes were first identified in patients with mitral valve disease due to rheumatic heart disease.

In patients with left atrium overload, a biphasic P wave is sometimes observed in lead V 1 (Fig. 6-6, 6-4, B).

It has a small initial positive and a wide negative phase. The duration of the negative phase is more than 0.04 s, the depth is at least 1 mm. A pronounced negative phase corresponds to delayed excitation of the enlarged left atrium. Anatomically, the LA is located posteriorly, opposite the esophagus, and the PP is located in front, behind the sternum. In lead V 1, the initial positive phase of the P wave reflects the depolarization of the RA, and the deep negative phase is a consequence of the fact that when the LA is depolarized, the electrical potentials are directed posteriorly (from the positive pole of lead V 1).

Sometimes, when the LA is overloaded, a wide, often double-humped P wave is observed in leads I and II and a biphasic P wave in lead V1. In other cases, only wide, jagged P waves are visible.

Sometimes a biphasic P wave in lead V 1 is the only sign of LA overload on the electrocardiogram.

Clinical causes of left atrial overload:

Heart valve defects, especially aortic stenosis, aortic regurgitation, mitral regurgitation and mitral stenosis. In mitral stenosis, an obstruction of blood flow through the valve from the left atrium to the left ventricle causes an increase in pressure in the pulmonary vessels and right ventricle. For this reason, the ECG manifestation of severe mitral stenosis is a combination of LA overload (or AF) and signs of RV hypertrophy (see Fig. 23-1).
Arterial hypertension, which leads to the development of LV hypertrophy and LA overload.
Cardiomyopathies.

Signs of LA and RA overload are shown schematically in Fig. 6-6. In patients with enlargement of both atria, a combination of these signs is possible (for example, tall and wide P waves).

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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 the heart muscle. various parts 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, 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.”

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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Left atrial hypertrophy: causes, symptoms, diagnosis

The left atrium receives oxygenated blood from the pulmonary veins. When the atrium contracts, blood enters the cavity of the left ventricle, from where it is released into the aorta. The left atrium and left ventricle are separated by the mitral valve. In some diseases, the left atrium is overloaded, resulting in an increase in the thickness of its walls (hypertrophy) and an increase in the size of its cavity (dilatation). Left atrial hypertrophy (LAH) is most often first detected by electrocardiography (“P-mitrale”). However, electrocardiographic criteria for this condition are rather arbitrary. Therefore, the patient’s HLP is not always reflected in the electrocardiographic report. Sometimes overdiagnosis of HLP occurs, that is, there are some signs of it on the electrocardiogram, but in fact the dimensions of the left atrium are within normal limits.

Causes

The main cause of HLP is mitral stenosis. This is a valvular heart defect in which there is a narrowing of the opening between the left atrium and the left ventricle. As a result, the left atrium experiences greater strain, moving blood through the narrowed opening into the left ventricle. Like any working muscle, as a result it hypertrophies. The main cause of mitral stenosis is rheumatism.

In more rare cases, HLP occurs with mitral regurgitation. With this valvular heart disease, the opening between the left atrium and the ventricle widens. During ventricular contraction, some of the blood does not enter the aorta, but back into the left atrium. As a result, its volume is overloaded, and it hypertrophies.

Aortic heart defects and some congenital defects can lead to the development of HLP. It can accompany hypertension and cardiosclerosis.

Symptoms

Left atrial hypertrophy itself often has no effect on the patient’s well-being. In other cases, a manifestation of this condition may be atrial extrasystoles, manifested, in particular, by a feeling of interruptions in the work of the heart.

In advanced cases of the disease, when the left atrium can no longer cope with its load, the pressure in the pulmonary venous system increases. Phenomena of heart failure occur in the pulmonary circulation. Its symptoms are shortness of breath with little exertion and while lying down, especially at night. A symptom of blood stagnation in the pulmonary circulation may be hemoptysis, characteristic of mitral stenosis. Patients have reduced exercise tolerance.

The diseases that cause HLP can also cause other symptoms (increased blood pressure, chest pain, swelling of the legs, and others). They are not directly related to the SLP.

Complications

The GLP gradually transforms into dilatation of its cavity with expansion of the volume. This leads to the development of stagnation in the pulmonary circulation and pulmonary hypertension. Pulmonary hypertension can lead to dysfunction of the right side of the heart. In turn, this causes the development of circulatory failure in a large circle. Swelling, heaviness in the right hypochondrium, and abdominal enlargement appear. In advanced cases, severe heart failure develops.

Diagnostics

The diagnosis of HLP can be suggested by electrocardiography and chest radiography. Echocardiography will help clarify its presence and evaluate the enlargement of the left atrium quantitatively, and in many cases determine the cause of the disease. To diagnose atrial arrhythmias caused by this condition, 24-hour electrocardiogram monitoring is performed.

Treatment

When HLP appears, heavy physical activity is contraindicated. It is necessary to give up smoking and drinking alcohol, as well as strong tea, coffee, and tonic drinks. Dietary restrictions on salt and saturated fat are recommended. It will not be superfluous to eat foods rich in potassium (dried apricots, bananas, baked potatoes). You can also use folk remedies to maintain myocardial metabolism: the fruits of hawthorn, rowan, viburnum, honey.

Walking in the fresh air helps improve the functional state of the myocardium. To reduce anxiety and stress, your doctor may recommend taking herbal sedatives.

GLP has no specific treatment. Treatment is carried out for the disease that was its cause.

For heart defects, surgical treatment is possible.

Hypertension and coronary heart disease are treated according to appropriate standards.

Treatment for pulmonary hypertension includes medications and inhaled nitric oxide.

In cases of severe heart failure, heart transplantation may be indicated.

Left atrial hypertrophy: symptoms, treatment and prevention

A heart pathology that is very common today is left atrial hypertrophy. It usually occurs due to heavy load to this part of the heart.

Hypertrophy can affect any of us at any age. A person needs to clearly understand what he is faced with, how to behave and what needs to be done. We invite you to familiarize yourself with the material that will allow you to protect yourself from this disease and allow you to find out which treatment will be more effective.

Left atrial hypertrophy - description of the disease

Left atrial hypertrophy is a disease in which the left ventricle of the heart thickens, causing the surface to lose its elasticity. If the compaction of the heart septum occurs unevenly, disturbances in the functioning of the aortic and mitral valves of the heart may additionally occur.

Today, the criterion for hypertrophy is myocardial thickening of 1.5 cm or more. This disease is currently the main cause of early death among young athletes. Thickening of the heart muscle occurs quite often. The disease can be observed in young and older people. This is a rather serious disease, as it can result in myocardial infarction or stroke, as well as death.

Left ventricular hypertrophy tends to progress. And the signs are not always expressed clearly, but contribute to the aggravation of the disease. Today, with timely, correct medical care, even in the most advanced stages, the prognosis is quite favorable.

Left atrial hypertrophy (LAH) is most often first detected by electrocardiography (“P-mitrale”). However, electrocardiographic criteria for this condition are rather arbitrary. Therefore, the patient’s HLP is not always reflected in the electrocardiographic report. Sometimes overdiagnosis of HLP occurs, that is, there are some signs of it on the electrocardiogram, but in fact the dimensions of the left atrium are within normal limits.

What functions do the atria perform?

The human heart consists of two halves: right and left. They are separated by a special septum into the atrium and ventricle. And between them there are valves. The right half of the heart muscle performs the contraction function. The right atrium has a thinner wall and, together with the ventricle, resembles a vein.

Blood flow flows through this part, as it is located between the vena cava and the pulmonary artery. Therefore, this atrium, together with the ventricle, belongs to the venous system.

The left side of the heart also consists of the atrium and ventricle. They have a thicker wall, but tend to stretch like an artery. Their location is between the pulmonary vein, through which arterial blood passes. In view of this fact, the left atrium and ventricle are compared to an artery and are considered part of the arterial system.

Based on this, it turns out that the heart performs two functions: it contracts and stretches. Contraction is performed by the right half of the heart, and stretching is performed by the left. The atria of each part are connected to the ventricle by certain openings in which valves are located.

The valve on the left side has two leaflets, so it is called bicuspid, and the right one is called tricuspid. When blood from the atria circulates to the ventricles, the valves open, but in one direction. As a result of contraction of the myocardium (heart muscle), pressure occurs and blood naturally circulates through the circulatory system.

When does left atrial hypertrophy occur?

Heart pathologies develop gradually if they are not congenital. Anomalies can affect both atria, in which case the patient's condition will be regarded as extremely serious. But in most cases, the disease develops in one part of the heart muscle.

The right atrium may be damaged as a result of previous illnesses respiratory system or vessels. Changes in this part of the heart are noticeable on an ECG.

Left atrial hypertrophy is much more common. The increase itself is not a disease, it is a syndrome indicating the presence of a pathological process. The reasons why hypertrophy occurs are as follows:

obesity at an early age;
heart defects of various etiologies;
mitral stenosis;
arterial hypertension;
mitral valve insufficiency;
kidney diseases;
prolonged stress;
psycho-emotional instability;
respiratory system infections;
high blood pressure;
diabetes;
atherosclerosis;
work involving heavy physical labor;
muscular dystrophy;
alcohol abuse;
smoking;
no load;
hereditary factor.

Mitral stenosis refers to an acquired heart defect in which the opening between the atrium and the ventricle narrows. This pathology can develop with mitral valve insufficiency. With mitral valve insufficiency (MVR), regurgitation occurs (reverse return of blood from the left ventricle to the atrium) because the valve is not able to block this process.

Although sport is known to improve human health, too intense exercise can lead to the opposite. Therefore, often people who exercise unrestrictedly can provoke the development of hypertrophy, as pressure increases and thickening of the left atrium occurs. Those who wish to improve their health through exercise should be aware of what happens when they over-exercise. Consult your doctor about exercising.

Causes of left atrial hypertrophy

Left atrial hypertrophy is very often associated with genetic defects and is therefore inherited. Important causes of this pathology also include obesity and high blood pressure.

This is one of the main reasons for left atrium enlargement in young people. According to recent data, obesity is increasing at an alarming rate in children, making them prone to this heart disease.

The mitral valve allows blood to circulate from the left atrium to the left ventricle. To be precise, it regulates blood flow between these two chambers of the heart. The mitral valve opens when the left atrium is filled with a predetermined amount of blood, and it closes after the required volume of blood has been pumped into the left ventricle.

There are two types of dysfunction of this system - stenosis and mitral valve insufficiency. In regurgitation, the mitral valve does not work properly and does not close, even after all the blood has been moved to the left ventricle.

The failure of the mitral valve to close tightly causes blood to flow in the opposite direction - from the left ventricle to the left atrium. This phenomenon can lead to inflammation of the left atrium. Mitral valve stenosis is a narrowing of the opening between two chambers of the heart.

In such cases, the left atrium has to work harder to pump the required volume of blood into the left ventricle. This excessive load causes hypertrophy of the left atrium.

Typically characterized by unnatural thickening of the ventricles of the heart. This condition places excessive stress on the heart, as it requires greater efforts to supply sufficient blood to various parts of the body.

This overload of the lower chambers of the heart can cause abnormal enlargement of the left atrium. Hypertrophic cardiomyopathy is an inherited disease.

We have already talked about the detrimental effects of mitral valve stenosis. In addition, aortic valve stenosis can also lead to left atrium enlargement.

The aorta is connected to the left ventricle, and if the opening in the aorta is narrowed, the heart muscle has to make more effort to push out the required amount of blood.

The abnormal narrowing causes the valve to malfunction, thereby reducing the amount of blood leaving the heart. In this case, the left atrium also suffers.

High blood pressure.

Blood pressure regulates the normal flow of blood through the vessels and maintains them in normal condition. Various factors lead to an increase in blood pressure, resulting in increased workload on the heart. Therefore, people with high blood pressure are more susceptible to hypertrophic changes in the heart muscle.

Pulmonary diseases. Any infection or disease of the respiratory system that significantly reduces the functionality of the lungs can also lead to left atrial hypertrophy.

Stress. An increase in workload leads to an increase in pressure and negatively affects the heart, which leads to changes in the left atrium.

Symptoms

Symptoms will depend on the degree of enlargement of the left atrium. If the increase is significant, the person will most likely immediately experience side effects. On the other hand, small changes in the size of the left atrium can be asymptomatic and go unnoticed for a long time. Most often, with left ventricular hypertrophy, the following symptoms appear.

Chest pain.
Increased fatigue.
Difficulty breathing.
Abnormal heartbeat.

People with this pathology find it difficult to perform physical exercise activities such as running, swimming and cycling. When overexerted, attacks of shortness of breath are possible.

With the formation of hypertrophic changes, the left atrium gradually enlarges. Clinical symptoms may not appear for quite a long time. Early symptoms are nonspecific - increased weakness, fatigue, shortness of breath, and a feeling of interruptions in the functioning of the heart.

Somewhat later, chest pain appears. They, as a rule, already attract the attention of the patient. Patients note a progressive decrease in tolerance to physical activities such as running, swimming, cycling and even brisk walking.

In addition, clinical symptoms vary depending on the underlying disease that caused hypertrophy of this part of the heart. For example:

with mitral valve stenosis, patients are bothered by swelling lower limbs, a feeling of interruptions in the work of the heart, often a cough, which is accompanied by hemoptysis;
with mitral valve insufficiency, complaints of shortness of breath, increased general weakness and fatigue, and episodes of rapid heartbeat are more typical;
with aortic valve insufficiency, patients are usually pale and complain of shortness of breath and pain during exercise.

It should be remembered that there is a possibility of a combination of several causes, as well as the action of a number of aggravating factors (lifestyle, occupational hazards, and so on), which can modify the course of the disease and make the clinical picture extremely variable.

Left atrial hypertrophy will manifest itself depending on the severity of the pathology. A significant role is played by the extent to which the septum and myocardium have thickened, as well as their uniformity and symmetry. The patient may not always suspect the presence of such a pathology, because the symptoms are similar to other diseases. Among the most common manifestations of hypertrophy are:

frequent pain affecting the left side of the sternum;
dyspnea;
atrial fibrillation;
changes in blood pressure;
angina pectoris;
disturbance of night sleep;
insomnia;
drowsiness;
headache;
rapid fatigue during physical activity;
weakness.

In addition to these manifestations, there may be fainting. But such a symptom occurs very rarely. Fainting occurs due to sudden cardiac arrest due to a lack of oxygen, which must enter the body in a certain amount. At the first stage of the disease, shortness of breath is observed only during exertion, and in a situation of rest it manifests itself even in an advanced state.

Such signs should not be ignored. They can be a warning sign of serious heart disease that progresses without proper treatment. Sometimes this can be fatal, as pulmonary edema, myocardial infarction and other life-threatening phenomena can occur.

However, the insidiousness of this pathology lies in the fact that in the first stages it does not manifest itself in any way.

A person may not be aware of heart problems, because at first the thickening of the walls does not create strong barriers to blood circulation.

Stages of development of damage to the left ventricle and atria

The first stage of hypertrophy is called emergency.

The load on the heart muscle is greater than its capacity. The absorption of oxygen and glucose from the blood by cells increases compensatoryly, and the content of potassium and creatine phosphate decreases. The processes of protein and energy formation are activated, muscle fibers rapidly increase in volume.

The second stage is characterized by sustained hypertrophy.

During this period, the tension in the muscle cells is equal in strength to the pressure on them. Metabolism is normalized, the heart can adequately respond to increased load over a long period of time.

At the third stage, reserve capabilities are depleted.

If the load continues to increase, then muscle growth is not supported by the development of the vascular network. Ischemic and dystrophic processes develop in the myocardium, and functioning cells are replaced by connective tissue. The heart cannot pump out blood normally. The consequence of this is the progression of heart failure.

ECG - Left atrial hypertrophy

With hypertrophy of the left atrium, the EMF it creates increases, while the excitation of the right atrium occurs normally.

The top picture shows the formation of a normal P wave:

excitation of the right atrium begins slightly earlier and ends earlier (blue curve);
excitation of the left atrium begins somewhat later and ends later (red curve);
the total vector of the EMF of excitation of both atria draws a positive smoothed P wave, the leading edge of which forms the beginning of excitation of the right atrium, and the rear edge forms the end of excitation of the left atrium.

With hypertrophy of the left atrium, the vector of its excitation increases, which leads to an increase in the amplitude and duration of the second part of the P wave (lower figure), due to excitation of the left atrium. As a result, a double-humped wide P wave is formed in which the second peak of the wave exceeds the first in amplitude:

with hypertrophy of the left atrium, the P wave is wide, double-humped (as a rule);
the width of the P wave exceeds 0.1-0.12 s (5-6 cells);
the height of the P wave is slightly increased;
the P wave may be serrated at the apex (the distance between serrations exceeds 0.02 s or 1 cell).

With left atrial hypertrophy, the electrical axis of the P wave often deviates to the left (or takes a horizontal position): PI>PII>PIII. Characteristic signs of a pathological P wave with left atrial hypertrophy in various leads:

a wide double-humped P wave is usually recorded in leads: I, II, aVL, V5, V6;
in lead aVR, the P wave is wide, double-humped, negative;
the PV1 wave is negative or biphasic with a sharp predominance of the second negative phase, the width of which is increased - this is the most characteristic sign of left atrial hypertrophy.

With left atrial hypertrophy, the Macruse index (the ratio of the duration of the P wave to the duration of the PQ segment) is often greater than the upper permissible limit - 1.6. At the same time, the activation time of the left atrium increases, exceeding 0.06 s (3 cells) in leads I, aVL, V5, V6.

Electrocardiographic signs of left atrial hypertrophy can be caused by both hypertrophy itself and its dilatation, as well as their combination.

The atrial ECG complex with left atrial hypertrophy is called “P-mitrale” and most often it is observed in patients with mitral stenosis, aortic heart defects, hypertension, cardiosclerosis, congenital heart defects with overload of the left parts.

Overload of the left atrium is indicated if a wide double-humped P wave appears after an acute situation: a hypertensive crisis, an attack of cardiac asthma, pulmonary edema, myocardial infarction, etc. But with subsequent normalization of the patient’s condition, the ECG changes disappear. It is possible to clearly differentiate between hypertrophy of the left atrium and its overload only on the basis of dynamic ECG observation.

Additional diagnostic tests

In addition to the ECG, hypertrophy can be detected:

when listening with a stethoscope (auscultation);
via ultrasound;
with chest x-ray.

Most often, suspicion of pathological changes in the heart muscle primarily arises during listening, which is carried out by a therapist, when a patient comes to him about pain and discomfort in the chest. The doctor listens to tones (short, sharp sounds that accompany the work of the myocardium) and murmurs (long sounds).

The appearance of the latter is a consequence of any problems and serves as an indication for an ECG. In turn, changes in the electrocardiogram are an indication for an ultrasound examination - EchoCG. This is a very simple and quite informative diagnostic method that will allow you to accurately determine the wall thickness of each chamber.

A chest x-ray can also determine the size of the heart and each of its parts. However, the main research method in cardiology, which is indicated for changes in the ECG, is still ultrasound.

Which diagnostic method is better - ultrasound or electrocardiography

These are completely different methods: ultrasound evaluates morphological changes, anatomical structures, chamber occupancy, and electrocardiography evaluates the functional nature of the disorders. However, it should be noted that there may be signs on the electrocardiogram that do not justify themselves on echocardiography.

The treatment of each patient is absolutely individual, so diagnostic methods can only be prescribed by an experienced attending physician.

All diagnostic procedures are carried out in city clinics as planned and absolutely free of charge if you have a compulsory medical insurance policy. As already mentioned, it is first necessary to determine the cause that caused this condition.

For mitral and aortic heart defects, there is no conservative specific treatment method. For mitral stenosis, the necessary treatment is commissurotomy, especially with pulmonary edema and the appearance of bloody sputum. For mitral insufficiency, an effective method of treatment is surgery, installation of artificial valves, and their prosthetics.

For aortic insufficiency, in addition to artificial valve implantation, therapy with cardiac glycosides, preferably digoxin, strophanthin or corglycon, is prescribed, since they have the least effect on heart rate. For aortic stenosis, diuretics and aldosterone antagonists (veroshpiron, aldactone) are used, which allow correction of chronic heart failure. Etiotropic therapy (rheumatism, bacterial endocarditis, syphilis) is always prescribed.

For arterial hypertension, antihypertensive drugs are used, such as ACE inhibitors (Capoten, Ranitek), beta blockers (Concor, Obsidian, Visken), calcium antagonists (Corinfar, Norvasc), diuretics (hypothiazide), angiotensin-2 blockers (Cozaar, Lozap) . These are the first choice drugs - the most effective medicines.

In severe cases, the combined use of 3-4 drugs from different groups is necessary, for example: beta-blocker + diuretic + ACE inhibitor. It is not recommended to combine ACE inhibitors and angiotensin-2 blockers. All drugs are presented for informational purposes; the appropriateness of their prescription can only be determined by an experienced cardiologist. Treatment can slow the progression of the disease, but not eliminate it.

How to treat pathology

Treatment of this pathology depends on the patient's condition. Hypertrophy is a symptom of some disease. Therefore, it needs to be eliminated. If the thickening of the walls is a consequence of a congenital defect, then in such a situation surgical intervention is required. This usually affects children who were born with heart abnormalities. After the operation, a course of treatment is carried out.

For acquired heart defects, surgical operations are also performed. If hypertrophy is associated with hypertension, then the patient is prescribed drugs that stabilize the condition by lowering the pressure. Older people with hypertension should take antihypertensive medications regularly.

Treatment will not have any effect if a person is obese and does not want to change his lifestyle. Therefore, if this pathology is associated with poor nutrition, it is necessary to take doctors’ recommendations seriously. If a person cannot create his own diet, you can visit a nutritionist. It is necessary to avoid foods rich in fat and carbonated drinks.

Lifestyle changes will include stopping smoking cigarettes and drinking alcohol. To keep your heart healthy, it is recommended to engage in walking and swimming. This is especially important for those who work in an office. Lack of exercise has a detrimental effect on the functioning of the heart.

Those who provoke hypertrophy through excessive sports training need to reduce the load. Patients with this diagnosis are required to regularly visit a cardiologist and undergo the necessary follow-up examinations.

The goal of treating left atrial hypertrophy is to normalize the functioning of the heart muscle. First, it is necessary to identify the nature of the origin and characteristics of the disease. For this purpose, the necessary diagnostic examinations are carried out. A blood test is taken, blood pressure is checked regularly, an electrocardiogram, echocardiogram and ultrasound are done.

Based on the data obtained, a diagnosis is made and treatment is determined. General measures include limiting the amount of physical activity to a moderate amount and completely stopping sports. Everyday loads are not limiting.

The basis of therapy is drugs with ionotropic negative effects. These include calcium antagonists (one of them is Verapamil) or β-blockers. These drugs are prescribed in doses that are optimal for a person and should be taken for life. For severe rhythm disturbances, antiarrhythmic drugs are prescribed.

If patients develop dilatation of the cavities and systolic dysfunction, heart failure therapy is carried out according to general rules. ACE inhibitors, diuretics, ongiotensin receptor antagonists, cardiac glycosides, spironolactone, and β-blockers are used. Large doses of saluretics and ACEs can lead to an increase in the obstruction gradient.

Treatment with surgical methods is indicated when the clinical effect of drug therapy is ineffective in patients with asymmetric hypertrophy of the interventricular septum and subaortic pressure gradient at rest. And also with severe obstruction and existing significant clinical manifestations.

The classic operation is transortic septal myectomy according to Morrow. Another method of operation according to L. Bockeria and K. Borisov is excision of the area of the enlarged interventricular septum from the right atrium. An alternative is septal transcatheter alcohol ablation.

These methods involve reducing obstruction by reducing the compaction of the interventricular septum. In surgical practice, dual-chamber pacing with a shortened atrioventricular delay is also used.

Drug treatment

For left ventricular (atrial) hypertrophy, antihypertensive therapy is prescribed, the following groups of medications are used:

angiotensin converting enzyme inhibitors (Enalapril);
angiotensin receptor blockers (Cozaar);
diuretics (Torasemide);
beta blockers (Bisoprolol) and calcium antagonists (Diltiazem).

If the thickness of the walls of the right chambers of the heart is increased, then treatment is aimed at relieving spasm of the bronchial tract. For this purpose, various bronchodilators and expectorants are used to reduce the viscosity of sputum. In addition, regardless of the location of hypertrophy, medications are used to strengthen the heart muscle, antioxidants, and vitamins.

Heart transplant as the only option at a late stage

Artificial heart In the event that myocardial hypertrophy is not diagnosed in time, the patient has not received adequate treatment, or the heart has ceased to properly perform its functions, then transplantation is the last resort. This operation is carried out under the following conditions:

Age up to 65 years.
Without surgery, life expectancy is less than a year.
Shortness of breath and palpitations, severe weakness occur when walking less than 20 - 50 meters or with the slightest exertion.
There is no persistent pulmonary hypertension.
The patient does not drink alcohol, drugs, or smoke.

Therapy tactics

In order to eliminate hypertrophy, it is necessary to cure the problem in the body that caused it.

Getting rid of obesity is a small problem. The main condition is the will of the patient, who must change his habits and lifestyle. In order to normalize weight, you need to:

change your diet: give up high-calorie foods and foods with a high glycemic index, such as fatty foods and sweets;
regular physical activity.

As a result, the number of calories expended will be less than the number consumed. The body will be forced to burn fat, and the extra pounds will begin to disappear. In most cases, changing your diet and exercising helps bring your weight back to normal.

If this does not happen, then there is some problem in the body that causes obesity. She may have, for example, a hormonal disorder. In this case, it will be necessary to diagnose the disease and treat it.

Hypertension is treated with antihypertensive drugs. They can be prescribed by a therapist or cardiologist. Regular physical activity also helps normalize blood pressure. It is also important to get rid of stress and reduce the level of emotional experiences.

If hypertension is a consequence of any disease - for example, kidney disease - it must be treated.

Relief from valve stenosis or insufficiency.

cardiac glycosides;
beta blockers;
anticoagulants;
antiplatelet agents;
ACE inhibitors;
anti-inflammatory drugs;
antirheumatic drugs;
diuretics.

If hypertrophy was diagnosed at an early stage and all necessary examinations were carried out, the prognosis is usually favorable. If the diagnosis was made correctly and treatment was prescribed correctly, the harm from this deviation can be avoided or reduced to a minimum.

Eliminating the cause of pathological enlargement of the myocardium may require a lot of time and effort, but the result is worth it - because if successful, the patient will be able to live a full life without fear for the condition of such an important organ as the heart.

Traditional medicine methods

For left atrial hypertrophy, the traditional treatment regimen can be combined with folk remedies. Before using this or that product, you should first consult with your doctor. otherwise the condition may worsen sharply, which will entail Negative consequences. And self-medication in some cases can lead to death.

Lily of the valley tincture will help eliminate the symptoms of hypertrophy.

Pour 1 tbsp. l. flower ml vodka or alcohol. Place the tincture in the refrigerator. After 2 weeks, take drops 3 times a day.

You can make an infusion from lily of the valley. To do this you will need to pour 1-1.5 tbsp. l. dry herbs 200 ml boiling water. Cool the finished infusion and strain. Take the product in small portions throughout the day.

Rosemary-based tincture will help reduce signs of atrial hypertrophy.

To prepare the recipe, you need to pour 100 g of rosemary into 1 liter of red wine. Then place the contents in a cool and dark place above. The medicine should be taken 50 ml 3-4 times a day. The course of treatment is 1 month. After which you need to take a week's break and start treatment again.

Pour 100 g of St. John's wort into 300 ml of water. Place the container on the stove and bring the broth to a boil. Cool the finished product and strain through a sieve. Take 100 ml 3 times a day.

If left atrial hypertrophy was caused by excess weight, then a diet is prescribed as an additional treatment.

The menu must include fresh vegetables and fruits. Doctors recommend using:

Nutrition should be balanced and healthy. A healthy diet should include beneficial microelements, which are found in:

raisins,
nuts,
bananas,
rice,
oatmeal,
avocado,
bran,
Lean meats are allowed.

Seafood and dairy products are considered healthy. Therapeutic diet excludes animal fats, smoked, fried, spicy and salty foods. The consumption of sweets should be kept to a minimum. During treatment you should stop smoking and drinking alcohol. Caffeinated and carbonated drinks are also prohibited.

Diet

Treatment of left atrial hypertrophy will be complete and effective if the patient completely gives up bad habits, including drinking alcohol. It will be necessary to adhere to a daily routine and a specific diet.

The diet should contain: fruits and vegetables in fresh, seafood, dairy products, lean meat. It is completely necessary to exclude fatty meat and animal fats, sweets, fried, smoked and salted foods. It is recommended to remove salt from the table altogether or reduce it to a minimum.
It is recommended to eat more fruits containing float: watermelons, Brussels sprouts, asparagus and legumes. Nuts, seeds and oily fish should be consumed no more than two or three times a week.
The body needs potassium, so you should eat raisins, baked potatoes, bananas, seaweed and dried apricots.
Microelements are important components of a healthy diet. Products containing important substances: yoghurts, avocados, bran, rice, rolled oats.

Prevention

The procedure for preventing this disease is very well known to everyone. First thing - healthy image life. Thanks to normal sleep, proper nutrition, constant moderate physical activity, they can easily prevent the occurrence of heart pathologies.

A prerequisite is moderate stress on the body. Don’t think that the heart of a bodybuilder who lifts heavy weights is always healthy. This is where the secret lies, since a person puts extreme stress on the body, which significantly increases the pressure in the entire circulatory system. This becomes the cause of non-pathological hypertrophy. For this reason, you should try not to overload yourself.

Movement is life, especially if this procedure is carried out in the form of a game. It is also about health prevention. It is recommended to regularly walk outside, ride a bike, or do light jogging. People who do this every day have 10 times fewer heart problems.

Well, and, of course, for prevention you need to try to be less nervous. It's better to laugh and be happy. This is what doctors recommend. It is also necessary to promptly treat diseases that can create complications and spread to the cardiovascular system.

We all know that prevention is much better than cure. And a condition such as left heart hypertrophy can also be prevented. The main recommendation for prevention is to maintain a healthy lifestyle. Should be paid Special attention to the points listed below.

Active, mobile lifestyle. At the same time, it is important to dose physical activity and avoid excessive stress. As preventive measures Physical activities such as swimming, cycling and walking are great.
Balanced diet. Regular meals of moderate amounts, a diet rich in fresh vegetables and fruits, vitamins, polyunsaturated fatty acids- this is exactly what is needed to maintain the normal functioning of our heart.
Compliance with the work and rest regime, healthy sleep. Eight hours of sleep is considered optimal, but each of us knows our needs and how much time we need to sleep. It is important to wake up feeling good.
Avoid stress. This point is quite difficult to fulfill in conditions modern world, but you should definitely strive for it. Calmness is very important to keep your heart healthy.
Timely treatment of other diseases. At the very beginning of this article, it was said that enlargement of the left atrium, as a rule, is a manifestation of other diseases. Usually these are chronic, neglected processes. Timely detection and treatment of diseases is perhaps the most effective preventive measure.

Important! If the pathological process is formed, then preventive measures alone will no longer have a sufficient effect. Compliance with them is, of course, important in order not to aggravate the process and increase the effectiveness of treatment measures. But how can this pathology be treated?

Once again we come back to the fact that the left atrium is usually enlarged due to a number of other diseases. Therefore, the key to successful treatment is adequate therapy of the underlying disease. Let's give a few examples.

If the cause of hypertrophic changes is a heart defect, then only surgical treatment.
If the cause is hypertension, which leads to the formation of a hypertensive heart, then selection of adequate antihypertensive therapy is necessary.

It should be remembered that each case is individual and the doctor selects therapy based on the severity of the process, the general condition of the patient, as well as the presence of concomitant diseases.

Prognosis for recovery

How effective the treatment will be depends on how quickly the pathology was identified, the state of the cardiovascular system and the body as a whole, and how severely the heart and left atrium were affected. Timely diagnosis and correct treatment allow you to get rid of a dangerous symptom and return to your normal life without fear for your health.

It is important to remember that the reasons that led to hypertrophy could cause damage not only to the atrium, but also to the vessels, aorta or ventricle. These points must be taken into account during examination and therapy. Left atrial hypertrophy is a dangerous symptom, which, in addition to serious consequences, can also cause life-threatening complications.

A missed moment, ineffective treatment, or incorrectly identified causes can lead to disability or death.

But timely diagnosis and proper treatment, even for congenital defects, gives a good prognosis for recovery. After drug treatment and surgical intervention, a person can return to his normal life without limiting himself due to illness.

The prognosis for recovery is favorable; the main thing is not to delay seeing a doctor. When the first signs appear, you should immediately go to the clinic. Mild malaise and barely noticeable pain cannot be an accident; this is the body signaling the occurrence of problems in the functioning of the cardiovascular system. The sooner they are identified, the faster the recovery will be.

Each organism is individual and the approach to treatment should also be based on the results of tests and studies, as well as on the general condition of the patient. It is also important to take into account that the symptoms of pathology are different for everyone and there are also many reasons for the occurrence of hypertrophy.

Most often, the left half is subject to this deviation.

Many people face such a problem as left atrial hypertrophy. How does this condition occur and what treatment does it require?

Normal sizes

has a wall thickness in the central part of the order of 1.5-2 mm;
has a cavity volume of cm3.

Reasons for the increase

Signs on ECG

Establishing diagnosis

Diseases of which this may be a symptom

Diseases that cause increased stress on this part of the heart include:

With hypertension, which usually develops in adulthood and old age, the arterial heart experiences great resistance when pumping blood throughout the body. The result is hypertrophy. High blood pressure typically affects those who live with constant high levels of stress and often experience strong emotional distress.

Valve insufficiency is a deviation in which it stops working normally. In this case, the valves that ensure normal blood flow cannot close completely, as a result, blood circulation is impaired.

Stenosis is a pathological narrowing of the openings through which blood flows from one chamber to another. The result of both of these deviations is the same - increased load on the left atrium.

Cardiomyopathy is a myocardial disease in which the heart muscle changes structurally and functionally in the absence of hypertension, pathologies of the arteries and valves. This is a serious disease in which two thirds of patients die within five years, but it is quite rare.

Additional diagnostic tests

In addition to the ECG, hypertrophy can be detected:

when listening with a stethoscope (auscultation);
via ultrasound;
with chest x-ray.

A chest x-ray can also determine the size of the heart and each of its parts. However, the main research method in cardiology, which is indicated for changes in the ECG, is still ultrasound.

Therapy tactics

Obesity treatment

regular physical activity:

In most cases, changing your diet and exercising helps bring your weight back to normal. If this does not happen, then there is some problem in the body that causes obesity. She may have, for example, a hormonal disorder. In this case, it will be necessary to diagnose the disease and treat it.

Elimination of hypertension

If hypertension is a consequence of any disease - for example, kidney disease - it must be treated.

Relief from valve stenosis or insufficiency

This may include:

cardiac glycosides;
beta blockers;
anticoagulants;
antiplatelet agents;
ACE inhibitors;
diuretics.

Atrial overload

An increase in the electrical activity of the atria may be due not only to their hypertrophy, but also to transient hyperfunction. The latter occurs in some acute clinical situations leading to a short-term but significant increase in the load on the atria. In these cases, the ECG shows signs characteristic of hypertrophy of the right or left atrium (see sections 7.1 and 7-2), which disappear after the cessation of hemodynamic overload of the atria.

Rice. 7.5. ECG dynamics in a patient with bronchial asthma.

a - initial, b - during status asthmaticus, c - after relief

status Explanation in the text

In Fig. Figure 7.6 shows the dynamics of the ECG of a patient with coronary heart disease, recorded during dosed physical activity on a bicycle ergometer. At the height of the load, the patient developed an attack of angina pectoris, severe shortness of breath, and a decrease in blood pressure, which indicated a significant drop in the contractility of the left ventricular myocardium against the background of acute coronary insufficiency. On the ECG (Fig. 7.6, b), in addition to signs of myocardial ischemia (see Chapter 8), the formation of negative waves was observed R lead V, deepening of the second negative (left atrial) phase of the Ruz wave and an increase in the amplitude and duration of the wave Rv leads I, aVL and V5, which indicated acute overload of the left atrium. After 36 minutes, the ECG was completely normalized (Fig. 7.6, c).

ECG. Left atrial hypertrophy

With left atrial hypertrophy, the electrical axis of the P wave often deviates to the left (or takes a horizontal position): P I > P II > P III.

the P V1 wave is negative or biphasic with a sharp predominance of the second negative phase, the width of which is increased - this is the most characteristic sign of left atrial hypertrophy.

Left atrial overload

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.

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.

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

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.

Treatment and prognosis

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.”

Causes of left atrium enlargement

There are many causes of the disease. Some people have a hereditary tendency to cardiovascular disease. Enlargement of the cardiac cavity occurs in overweight individuals, as well as in those who suffer from cardiac pathologies. Atrial hypertrophy can occur in a sedentary person. Heart diseases pose a threat to health: each of them requires timely treatment.

An enlarged left atrium is associated with the degree of obesity: the disease is often diagnosed in obese people, regardless of age. A predisposing factor to atrial hypertrophy is high blood pressure, or hypertension. Increased pressure occurs due to strong physical and psycho-emotional stress. If you often experience such stress, cardiovascular diseases may develop, in which hypertrophy of the left atrium occurs.

The load on the heart is increased, and blood flow in the heart muscle is impaired. Left atrial hypertrophy occurs because the blood vessels of the heart narrow. Thus, the organ does not receive enough oxygen. A predisposing factor is mitral valve stenosis: with this pathology, the load on the left atrium increases. The cause of mitral valve stenosis is a violation of blood circulation in the vessels, as a result of which blood stagnates in organs and tissues.

Predisposing pathologies

Enlargement of the left atrium is caused by aortic valve stenosis. The function of the valve is that it helps redirect blood from the left ventricle to the aorta. With aortic valve stenosis, the heart does not give enough blood, so the load on its muscles increases, and the functioning of the left atrium is disrupted. The mitral and aortic valves can narrow, causing pathologies. If the valves do not work properly, the heart experiences stress, and subsequently the left atrium enlarges.

Hypertrophy of the heart muscle occurs against the background of myocardial pathologies. In humans, inflammatory diseases are observed that disrupt the activity of the heart, in particular its contractility. Blood pressure increases with kidney and liver pathologies. Atrial hypertrophy appears due to infectious diseases associated with respiratory tract. With such ailments, the functioning of the lungs and the functioning of the left atrium are disrupted.

As mentioned above, hypertrophy develops in people with a hereditary predisposition. The cardiac ventricles may be thickened due to congenital characteristics. Against the background of this problem, the left atrium enlarges. The external chambers of the heart work actively, as they must provide blood supply to the organs: this leads to the fact that the heart muscle grows.

Clinical picture

Let's look at the symptoms of the disease, which manifest themselves in different ways. In some patients the symptoms are mild, in others they are stronger. If the heart muscle is not too enlarged, there may be no symptoms. Accordingly, the person will not suspect the disease. If the heart tissue is significantly affected, many unpleasant symptoms appear. Physical activity increases the heart rate: with atrial hypertrophy, a person will experience shortness of breath. Chest pain is possible. People with such symptoms are often tired, and everyday activities can cause them psychological discomfort. If atrial hypertrophy develops, a person has difficulty breathing. With such an illness, it is important to avoid physical and psycho-emotional stress.

Depending on the cause of hypertrophy, symptoms may vary. If a person has mitral stenosis, hemoptysis occurs with shortness of breath, and some people develop a cough.

With mitral stenosis, there is swelling of the extremities. The functioning of the heart is also impaired, weakness, shortness of breath occur, and the pulse becomes rapid. With mitral valve insufficiency, the skin turns pale and severe shortness of breath appears. With physical activity the pain becomes intense. If alarming symptoms are detected, you should contact a cardiologist; a specialist will prescribe mandatory diagnostic measures.

Diagnostics

Cardiovascular pathologies require complex, professional treatment. Therapy on early stages will improve the prognosis of the disease. Treatment is different in each case. The doctor prescribes medications depending on the type of pathology. Atrial hypertrophy is detected by auscultation. During this examination, the doctor analyzes the sounds coming from the heart. If pathology is suspected, you need to listen to sounds using an otoscope.

It is important to analyze noises and tones. If the doctor hears a noise, he draws conclusions about disturbances in the functioning of the heart valves. Accordingly, a person may develop pathology. Left atrial hypertrophy is detected by ultrasound. Echocardiography allows you to analyze the functioning of the heart and valve apparatus. Reflected ultrasound signals make it possible to obtain images, on the basis of which the cause of hypertrophy will be identified.

During the diagnostic process, the doctor determines the size of the heart chambers and the thickness of the heart walls. It is important to analyze the movement of blood into the ventricles and atria so that an effective examination can be carried out. Heart defects, cardiovascular disease and left atrial hypertrophy can be detected by X-ray examination. The doctor also evaluates the condition of the lungs. Thanks to modern examination methods, it is possible to determine the size of the heart chambers.

An electrocardiogram is effective in detecting cardiovascular disease. With the help of such diagnostics, contractility disorders can be identified. The above examination methods are highly informative. But to get an accurate clinical picture, you need to analyze all the data. Only comprehensive diagnostics will reveal pathology. To identify the disease, examination data using an ECG is used. It is worth noting once again that an enlarged left atrium is not an independent disease; treatment involves therapy for the underlying disease. It is important to determine the true cause of atrial hypertrophy. If necessary, the doctor carries out differential diagnosis.

How is the treatment carried out?

If the underlying pathology is treated correctly, the prognosis for hypertrophy will be favorable. If the increase occurs as a result of a pathology associated with the respiratory tract, the doctor prescribes treatment taking into account the symptoms. If necessary, antiviral medications are prescribed. In particular, they are required if hypertrophy occurs against the background of a viral infection. Antibiotics are prescribed for bacterial infections.

Atrial hypertrophy is often associated with hypertension. Based on this, you need to take appropriate medications prescribed by your doctor. If hypertrophy occurs due to mitral valve insufficiency, the cardiologist will prescribe medications to support its function. In some cases, treatment is aimed at eliminating streptococcal infection: the patient can take Bicillin for 12 months. For advanced pathologies, doctors recommend surgery.

If atrial hypertrophy occurs against the background of mitral stenosis, surgical intervention cannot be avoided. Depending on the nature of the pathology, surgery is prescribed to restore the function of the valve or replace it. Treatment of hypertrophy is individual.

What is right atrial overload?

The task of the heart muscle is to pump blood throughout the body, while simultaneously saturating all tissues and organs with oxygen. From the right atrium, it passes through a special valve and enters the right ventricle. The valve's job is to prevent blood from flowing back. Instead, she moves on.

Passing through the pulmonary circulation, it is saturated with oxygen and enters the aorta.

Overload of the right atrium develops in a situation when the amount of blood in it becomes more than acceptable. Its cavity gradually expands and the wall thickens.

Why is this happening:

Overload can be caused by excess pressure in the pulmonary artery. This occurs against the background of various diseases of the lungs and blood vessels in them, and with chest deformities. As a result, pressure in the right atrium and ventricle increases. This condition is called cor pulmonale.
Tricuspid valve insufficiency leads to the fact that blood from the right ventricle only partially goes into the aorta, some of its volume returns back. This is an acquired heart defect.
Some congenital heart defects lead to enlargement of the right atrium: atrial septal defect, Ebstein's anomaly, transposition of the great vessels, etc.

The presence of changes in the right atrium is usually noticeable on the cardiogram.

Signs of right atrium overload

Since this condition is usually a consequence of other diseases, it does not have any symptoms in itself. But at the same time, the person is concerned about the manifestations associated with the underlying disease. If we are talking about cor pulmonale, this is:

shortness of breath, which is caused by even light exertion;
shortness of breath when lying down;
night cough;
coughing up blood.

Signs of circulatory failure:

heaviness in the chest on the right side;
swelling of the limbs;
swelling of the abdominal wall;
Seemingly causeless growth of the abdomen;
dilatation of veins

If you have the listed symptoms, you need to do an electrocardiogram and an ultrasound of the heart muscle, they will show the presence of changes. Additional studies chosen by the doctor based on an analysis of the patient’s condition will help determine their cause.

The difference between the two worlds This is the same as the word, and this is the case. More information about the new system, this is the same as the one with the other Russia. In this regard, in this regard, in this regard, Forms of a foreign language (from chapters 7.1 and 7 2), which are the same this is the same as the other side of the spectrum.

Íàïðèìåð, ïðè ðàçâèòèè ó áîëüíûõ ïðèñòóïîâ áðîíõèàëüíîé àñòìû, îòåêà ëåãêèõ, òðîìáîýìáîëèè ëåãî÷íîé àðòåðèè, êðóïîç íîé ïíåâìîíèè è ò. ä., êîãäà âñëåäñòâèå óâåëè÷åíèÿ äàâëåíèÿ â ëåãî÷íîé àðòåðèè ïîâûøàåòñÿ íàãðóçêà íà ïðàâûå îòäåëû ñåðäöà, íà ÝÊÃ èíîãäà ìîæíî íàáëþäàòü ïîÿâëåíèå âûñîêîàìïëèòóäíûõ ñ çàîñòðåííîé âåðøèíîé çóáöîâ Ð in phalanx II, III, aVF (P - pulmonale) and in the middle systolic åðä-íîé) fàçû çóáöà Ð in terms of V f . Introduction to the new world of the world this is why.

Res. 7.5. DELIVERY OF EQUIPMENT ABOUT ASSURANCE.

à - èñõîäíàÿ, á - âî âðåìÿ àñòìàòè÷åñêîãî ñòàòóñà, â - ïîñëå êóïèðîâàíèÿ

ñòàòóñà Îáúÿñíåíèå â òåêñòå

That's it. 7.5 This is the case with the other side of the world. Yes, the same as in the world sà (Fig. 7.5, b), with reference to the çóá öîâ Ð in terms of II, III, aVF and V,. ×åðåç3 Formation of a foreign language (Fig. 7) .5, a), and the definition of the word (Fig. 7.5, a).

Ïåðåãðóçêà ëåâîãî ïðåäñåðäèÿ ìîæåò ðàçâèòüñÿ ïðè ðåçêîì ïîâûøåíèè àðòåðèàëüíîãî äàâëåíèÿ (ãèïåðòîíè÷åñêîì êðèçå), ïðèñòóïå ñòåíîêàðäèè èëè îòåêå ëåãêèõ è äðóãèõ ñîñòîÿíèÿõ. Ïðè ýòîì íà ÝÊÃ ìîæíî íàáëþäàòü óâåëè÷åíèå àìïëèòóäû è ïðîäîëæèòåëüíîñòè âòîðîé îòðèöàòåëüíîé (ëåâîïðåäñåðäíîÉ) ôàçû çóá öà Ð â îòâåäåíèè V(Regulation V 2) P W [ . V vols I , II , aVL , V * in other words yellowish zones Ð (Z mitrale).

That's it. 7.6 State of the art in the world format. As for the other side of the world, in this case ëlèñü Vâlðàæíàî îäø êka, ñíèæåíèå àðòåðèàëîîãî äàâêàêà, ÷òîñäåòà about the world of the world this is a form of political activity. Ná ÝÊK (Fig. 7.6, a), in addition to the idiom of the world (see Chapter 8), and the development of the formalities of the region Ðú format V, on the other side of the façade çóáöà Ðóç and óâåëè÷åíèå àmïëètóäû è ïðîäîæèòåëüíîñòè çóöà Ðâ format I , aVL and V 5 , which is in the center of the world sir. ×åðåç 36 Ðèí ÝÊÃ ïîîñòüþíîðìàëçîàëîñü (Fig. 7.6, c).

Res. 7.6. Discussion about the other side of the world áû ñ äîçèðîâàííîîé ôèçè÷åñêîîêîàðóçêîêîà “âåëîýðãîåòðå.” a - the European Union, a - the foreign language, a - the åç 30 more information about the world yes

Left atrial hypertrophy: features of the disease, causes of occurrence, treatment methods

The human heart is a unique organ that performs irreplaceable work throughout the body. Only thanks to it, all the cells of our body receive a sufficient volume of blood with all the necessary microelements. Unfortunately, for last years, heart disease ranks first in the number of deaths.

Symptoms of the disease may not be very noticeable, which makes diagnosis difficult, since a person does not turn to specialists in time. In this material, we will consider what left atrial hypertrophy is, when pathology can occur, what characteristic features and what treatment methods are used.

Left atrial hypertrophy - features of the disease

Left atrial hypertrophy

The walls of the left ventricle of the heart consist of muscles and connective tissue, the ratio between which is 4:1. The thickness of the wall at the apex is no more than 14 mm, the septum between the ventricles is 4 mm thick, the side and rear walls are 9-11 mm thick.

These are the largest parameters among other parts of the heart, which is associated with the special role of the left ventricle of the heart - it provides a large circle of blood circulation. As the walls contract, they push blood into the aorta; when the left ventricle relaxes, a new portion of blood enters it from the left atrium.

And it is characteristic that the more the walls stretch, the more they contract. With the development of hypertrophy, the septum between the ventricles may change, the walls lose elasticity, and thickening occurs either evenly or in any part of it.

Hypertrophy always disrupts the normal structure of the myocardium, that is, the increase in contractile fibers (myocytes) lags behind the growth of connective tissue. This occurs in two cases: volume overload, which causes the cavity to become larger, and pressure overload, which means a stronger muscle contraction is required to expel the blood.

Unfortunately, left ventricular hypertrophy is not uncommon among young people and its mortality rate is almost 4%. At the same time, patients have consistently high blood pressure. In general, cardiovascular problems occupy a vanguard place among other diseases, and therefore an ECG has long become mandatory during medical examinations.

A situation when a sedentary person suddenly gives himself a sharp, intense load can be dangerous. People who smoke and constantly drink alcohol are at risk. And even if the pathology does not lead to death, it can cause a stroke or myocardial infarction.

Left atrial hypertrophy is a pathological condition of the heart muscle that requires treatment of the underlying cause that caused this change. The word hypertrophy itself indicates an increase, excessive volume of a tissue or organ. Such a disorder can affect any organ in the human body.

Hypertrophy can be true or false. False hypertrophy is caused by increased proliferation of adipose tissue. True hypertrophy occurs when individual functioning elements of an organ multiply (hyperplasia). It appears due to the load on one or another organ.

We are talking about functional load, and under its influence, working hypertrophy is formed, as it is also called. Any muscle, if specifically loaded, will begin to increase. Most often, such changes affect people who engage in heavy physical labor or professional athletes.

What functions do the atria perform?

Blood flow flows through this part, as it is located between the vena cava and the pulmonary artery. Therefore, this atrium, together with the ventricle, belongs to the venous system. The left side of the heart also consists of the atrium and ventricle. They have a thicker wall, but tend to stretch like an artery.

Their location is between the pulmonary vein, through which arterial blood passes. In view of this fact, the left atrium and ventricle are compared to an artery and are considered part of the arterial system.

Based on this, it turns out that the heart performs two functions:

Contraction is performed by the right half of the heart, and stretching is performed by the left. The atria of each part are connected to the ventricle by certain openings in which valves are located. The valve on the left side has two leaflets, so it is called bicuspid, and the right one is called tricuspid.

When does atrial hypertrophy occur?

The right atrium may suffer as a result of illnesses of the respiratory system or blood vessels. Changes in this part of the heart are noticeable on an ECG. Left atrial hypertrophy is much more common. The increase itself is not a disease, it is a syndrome indicating the presence of a pathological process.

The reasons why hypertrophy occurs are as follows:

obesity at an early age;
heart defects of various etiologies;
mitral stenosis;
arterial hypertension;
mitral valve insufficiency;
kidney diseases;
prolonged stress;
psycho-emotional instability;
respiratory system infections;
high blood pressure;
diabetes;
atherosclerosis;
work involving heavy physical labor;
muscular dystrophy;
alcohol abuse;
smoking;
no load;
hereditary factor.

Therefore, often people who exercise unrestrictedly can provoke the development of hypertrophy, as pressure increases and thickening of the left atrium occurs. Those who wish to improve their health through exercise should be aware of what happens when they over-exercise. Consult your doctor about exercising.

Symptoms

Signs of left ventricular hypertrophy will depend on how dense the heart septum is, as well as on the compaction in the myocardium, on uniformity and symmetry. In rare cases, the disease can make itself felt by minor interruptions in the functioning of the heart. Therefore, a person may not be aware of the development of hypertrophy.

regular heart pain;
hard breath;
atrial fibrillation;
angina pectoris;
pressure changes;
poor sleep;
pain in the chest area;
insomnia or constant drowsiness;
frequent headache;
weakness and fatigue.

One of the rare signs of left ventricular hypertrophy may be fainting, which is caused by sudden cardiac arrest. This happens due to a lack of oxygen supply to the heart muscle and oxygen starvation of the myocardium.

This may well be a rather serious pathology: heart disease, pulmonary edema, myocardial infarction, kidney disease and other ailments. Therefore, if you identify any abnormalities in your health, you need to go to the doctor. If the opposite is true, serious complications are possible, which sometimes even result in death.

Stages of development of damage to the left ventricle and atria

The first stage of hypertrophy is called emergency.

The second stage is characterized by sustained hypertrophy.

At the third stage, reserve capabilities are depleted.

Diagnostic methods

As mentioned above, the disease develops gradually and in the initial stages may not have clinical manifestations. However, using modern methods studies, even a slight increase in the size of the left atrium can be detected. What methods can detect such changes?

Echocardiography (ultrasound examination of the heart).

The ultrasound machine receives signals reflected from the structures of the heart and produces an image that corresponds to the morphology of the organ at the moment.

In addition, the device provides digital data on the main structures of the heart, including wall thickness and the size of the left atrium cavity. Accurate digital values are given, which allow us to conclude that there are the slightest deviations from the norm.

X-ray of the chest organs.

This method is less accurate and does not make it possible to identify the early stages of the process. However, with severe hypertrophy of the left atrium, the contours of the heart change significantly, which is clearly visible on a plain X-ray.

Slow damage and enlargement of the left atrium does not allow pathology to be diagnosed based on symptoms, but there are methods by which hypertrophy can be detected at the initial stage. The first method for diagnosing disturbances in the functioning of the heart muscle and enlargement of the atrium includes auscultation.

It does not require special equipment, just a stethoscope and the professionalism of a doctor. This study is based on listening and evaluating the sounds of the heart. The appearance of murmurs and short sharp sounds indicates valve pathology, which allows for atrial hypertrophy.

The performance of the valves can be assessed and abnormalities in their operation can be detected using ultrasound diagnostics. Echocardiography and ultrasound allow you to examine the tissue of the heart muscle, assess the size and thickness of the walls of the heart.

Monitoring blood flow in parts of the heart muscle makes it possible to detect pathological changes even before hypertrophy is visible. X-ray examination is less informative, but is an indispensable diagnostic method for congenital disorders. In addition to the condition of the heart muscle, the X-ray also evaluates the potential of the lungs and their function.

Since contraction disturbances are observed quite often during hypertrophy, an electrocardiogram is one of the methods for examining the heart. One of the methods may not be a way to accurately diagnose. To establish the causes and degree of neglect of the disease, a full range of examinations are carried out.

Signs of illness on ECG

With hypertrophy of the left atrium, the EMF it creates increases, while the excitation of the right atrium occurs normally.

The top picture shows the formation of a normal P wave:

excitation of the right atrium begins slightly earlier and ends earlier (blue curve);
excitation of the left atrium begins somewhat later and ends later (red curve);
the total vector of the EMF of excitation of both atria draws a positive smoothed P wave, the leading edge of which forms the beginning of excitation of the right atrium, and the rear edge forms the end of excitation of the left atrium.

As a result, a double-humped wide P wave is formed in which the second peak of the wave exceeds the first in amplitude:

with hypertrophy of the left atrium, the P wave is wide, double-humped (as a rule);
the width of the P wave exceeds 0.1-0.12 s (5-6 cells);
the height of the P wave is slightly increased;
the P wave may be serrated at the apex (the distance between serrations exceeds 0.02 s or 1 cell).

Characteristic signs of a pathological P wave with left atrial hypertrophy in various leads:

a wide double-humped P wave is usually recorded in leads: I, II, aVL, V5, V6;
in lead aVR, the P wave is wide, double-humped, negative;
the PV1 wave is negative or biphasic with a sharp predominance of the second negative phase, the width of which is increased - this is the most characteristic sign of left atrial hypertrophy.

Electrocardiographic signs of left atrial hypertrophy can be caused by both hypertrophy itself and its dilatation, as well as their combination.

Treatment

The basis of therapy is drugs with ionotropic negative effects. These include calcium antagonists (one of them is Verapamil) or β-blockers.

These drugs are prescribed in doses that are optimal for a person and should be taken for life. For severe rhythm disturbances, antiarrhythmic drugs are prescribed. If patients develop dilatation of the cavities and systolic dysfunction, heart failure is treated according to the general rules.

ACE inhibitors, diuretics, ongiotensin receptor antagonists, cardiac glycosides, spironolactone, and β-blockers are used. Large doses of saluretics and ACEs can lead to an increase in the obstruction gradient. Treatment with surgical methods is indicated when the clinical effect of drug therapy is ineffective in patients with asymmetric hypertrophy of the interventricular septum and subaortic pressure gradient at rest.

Treatment of HLP includes a set of measures aimed at preventing the progression of the disease and eliminating symptoms of heart failure, as well as rhythm disturbances.

First of all, doctors recommend that patients with a hypertrophied left atrium change the nature of their diet and take care to normalize their weight. Patients should avoid heavy physical labor, refuse to play sports and control their psycho-emotional state.

With a hypertrophied left atrium, patients are prescribed a special diet:

limiting the consumption of fats and simple, easily digestible carbohydrates, as well as salt;
refusal of fatty foods, fried foods, smoked meats, sausages;
introducing salads from fresh vegetables, fruits, and berries into the daily diet;
limiting fluid intake to 2 liters per day;
complete cessation of smoking and drinking alcoholic beverages;
eating foods rich in potassium (baked apples, bananas, dried fruits).

Traditional medicine recipes cope well with problems of metabolism in the myocardium. Doctors often recommend to patients with hypertrophy of the heart, which is accompanied by disturbances in the rhythmic activity of the organ, tincture of rose hips, hawthorn or rowan decoctions, viburnum fruit jam with honey.

Unfortunately, modern medicine does not know how to bring the thickened walls of the heart back to normal using medications. Drug therapy involves exclusively symptomatic treatment of the manifestations of diseases that caused hypertrophy.

In order to eliminate the symptoms of the underlying disease, patients are prescribed antiarrhythmic and antihypertensive drugs, drugs that improve metabolism in the myocardium, dosage forms to thin the blood. Severe forms of HLP, complicated by cardiac and pulmonary failure at the stage of decompensation, require surgical correction of defects in the development of heart valves, and in more complex cases, heart transplantation.

Left atrial hypertrophy is one of the pathological conditions that can occur suddenly, for example, during pregnancy in women with heart defects or in young athletes after intense training. In such cases, the myocardium quickly increases in size, unable to cope with the load placed on it.

Treatment effectiveness pathological condition depends on timely early diagnosis, the degree of neglect of the underlying disease, the patient’s age, etc. That is why you should not neglect preventive examinations by a cardiologist, which will allow you to identify the disease in the initial stages of development and prescribe adequate therapy.

Therapy tactics

In order to eliminate hypertrophy, it is necessary to cure the problem in the body that caused it.

Getting rid of obesity is a small problem. The main condition is the will of the patient, who must change his habits and lifestyle. In order to normalize weight, you need to:

change your diet: give up high-calorie foods and foods with a high glycemic index, such as fatty foods and sweets;
regular physical activity

Relief from valve stenosis or insufficiency.

This may include:

cardiac glycosides;
beta blockers;
anticoagulants;
antiplatelet agents;
ACE inhibitors;
anti-inflammatory drugs;
antirheumatic drugs;
diuretics.

Drugs

In treatment, drugs with a negative ionotropic effect are used: calcium antagonists (one of them is Verapamil) or β-blockers. In some cases, ACE inhibitors, cardiac glycosides, diuretics, ongiotensin receptor antagonists, and spironolactone are used.

Cordarone (Amiodarone) or Disopyramide (Ritmilen) are prescribed as antiarrhythmic drugs indicated for severe arrhythmias. Treatment is considered successful if:

obstruction at the exit of the left ventricle decreases;
the patient's life expectancy increases;
rhythm disturbances, fainting, and angina do not develop;
heart failure does not progress;
quality of life improves.

Treatment with folk remedies

As an adjuvant to the main course of treatment, they include traditional methods treatment of left atrial hypertrophy. There are many recipes, but the most commonly used are the following:

Crushed herbs are mixed in the following proportions: 3 parts motherwort, 2 parts each wild rosemary and dried rosemary, 1 part kidney tea. Take one large spoon of the mixture and pour one and a half glasses of boiled water and boil for several minutes.

Wrap the broth in a warm cloth and leave for 4 hours. After straining, you can take 3 times half a glass minutes before meals. In addition to everything, you can additionally take a large spoonful of cranberries mashed with sugar three times after meals.

Take 100 grams of crushed St. John's wort and, pour 2 liters of water, boil under the lid for 10 minutes. Leave for an hour, strain and add 200 grams of honey. Drink less than half a glass of tincture 3 times a day 30 minutes before meals. Store in the refrigerator.

For left atrial hypertrophy, the traditional treatment regimen can be combined with folk remedies. Before using this or that remedy, you should first consult with your doctor, otherwise the condition may worsen sharply, which will entail negative consequences. And self-medication in some cases can lead to death.

Lily of the valley tincture will help eliminate the symptoms of hypertrophy. Pour 1 tbsp. l. flower ml vodka or alcohol. Place the tincture in the refrigerator. After 2 weeks, take drops 3 times a day. You can make an infusion from lily of the valley. To do this you will need to pour 1-1.5 tbsp. l. dry herbs 200 ml boiling water. Cool the finished infusion and strain. Take the product in small portions throughout the day.

Rosemary-based tincture will help reduce signs of atrial hypertrophy. To prepare the recipe, you need to pour 100 g of rosemary into 1 liter of red wine. Then place the contents in a cool and dark place above. The medicine should be taken 50 ml 3-4 times a day. The course of treatment is 1 month. After which you need to take a week's break and start treatment again.

Pour 100 g of St. John's wort into 300 ml of water. Place the container on the stove and bring the broth to a boil. Cool the finished product and strain through a sieve. Take 100 ml 3 times a day. If left atrial hypertrophy was caused by excess weight, then a diet is prescribed as an additional treatment.

The menu must include fresh vegetables and fruits. Doctors recommend eating cabbage, asparagus, watermelon and apples. Nutrition should be balanced and healthy. A healthy diet should include healthy microelements, which are found in raisins, nuts, bananas, rice, oatmeal, avocado and bran.

Therapeutic diet

The diet should contain: fresh fruits and vegetables, seafood, dairy products, lean meat. It is completely necessary to exclude fatty meat and animal fats, sweets, fried, smoked and salted foods. It is recommended to remove salt from the table altogether or reduce it to a minimum.
It is recommended to eat more fruits containing float: watermelon, Brussels sprouts, asparagus and legumes. Nuts, seeds and oily fish should be consumed no more than two or three times a week.
The body needs potassium, so you should eat raisins, baked potatoes, bananas, seaweed and dried apricots.
Microelements are important components of a healthy diet. Products containing important substances: yoghurts, avocados, bran, rice, rolled oats.

To prevent and prevent heart disease, nutrition plays an important role. Studies show that in 80% of cases, cardiovascular diseases are caused by poor diet and bad habits, and only 20% are caused by other factors.

Also, if you have heart disease, it is advisable not to gain weight. After all, the more excess weight, the higher the load on the heart and blood vessels. To lose weight, it is useful to fast on vegetables once a week. Oranges and tangerines are rich in natural sugars and minerals that improve metabolism.

During the diet, legumes will be useful - they contain a lot of vitamins and protein. Protein is also present in dairy products. It is worth giving up “fast” carbohydrates during the diet and switching to “slow” ones. They are found in cereals, nuts, seeds, dried fruits, fresh vegetables and fruits. Instead of white bread, it is better to eat whole grain or rye bread.

Sample menu for the week:

Monday.
- Breakfast: soft-boiled egg, milk oatmeal, tea.
- Lunch: baked apples.
- Lunch: vegetable soup with barley, boiled fillet with vegetables, compote.
- Afternoon snack: rosehip decoction.
- Dinner: mashed potatoes, boiled fish, kefir.
Tuesday.
- Breakfast: cottage cheese with fruit, tea.
- Lunch: yogurt.
- Lunch: vegetarian borscht, baked potatoes, beef stroganoff.
- Afternoon snack: fruit jelly.
- Dinner: pilaf (with boiled meat), baked vegetables, compote.
Wednesday.
- Breakfast: milk soup, tea with milk.
- Lunch: mousse.
- Lunch: beetroot soup, baked fish cutlets, vegetables.
- Afternoon snack: fruit jelly.
- Dinner: buckwheat, boiled veal, baked vegetables, tea.
Thursday.
- Breakfast: cottage cheese and carrot casserole, fresh juice.
- Lunch: fruit.
- Lunch: pasta with tomato sauce and chicken, compote.
- Afternoon snack: kefir.
- Dinner: barley, beef meatballs, baked vegetable salad with vegetable oil, jelly.
Friday.
- Breakfast: fruit pilaf, juice.
- Lunch: fruit.
- Lunch: vegetarian borscht, chicken and carrot cutlets, milk.
- Afternoon snack: jelly.
- Dinner: mashed potatoes, boiled fish with vegetables, compote.
Saturday.
- Breakfast: milk soup, juice or compote.
- Lunch: cottage cheese with fruit.
- Lunch: chicken cutlets with cheese, stewed vegetables, compote.
- Afternoon snack: freshly squeezed juice.
- Dinner: vinaigrette, barley, vegetable vegetarian cutlets.
Sunday.
- Breakfast: steam omelette, tea with milk.
- Lunch: fruit jelly.
- Lunch: potato soup with buckwheat, chicken fillet with vegetables, compote.
- Afternoon snack: rosehip decoction.
- Dinner: potato cutlets with prunes, vegetables, compote.

Prevention

give up alcohol and smoking;
follow a diet and daily routine;
reduce salt intake as much as possible;
Avoid drinks containing caffeine;
eat moderately in small portions;
bring your weight back to normal levels;
reduce the consumption of baked goods, sweets and fats of animal origin;
Visit a cardiologist regularly.

It should be remembered that with left ventricular hypertrophy, treatment is carried out for the rest of your life. If the pathology begins to progress, surgical intervention is possible.

In general, tips for preventing left atrial hypertrophy are well known to everyone. The main one is a healthy lifestyle, no matter how trivial it may sound. Normal eight-hour sleep, a healthy diet without extreme diets and overeating, regular but not excessive physical activity are quite capable of preventing the development of dangerous pathologies, and most importantly, the diseases hiding behind them.

Don’t think that by exhausting yourself on exercise machines, you can avoid health problems. Quite the contrary, due to heavy loads, an athlete’s heart is forced to work at the limit of its capabilities, so thickening of the heart tissue can rather be considered a common occurrence for a sports fan than an exception.

And for those who simply want to avoid left atrial hypertrophy, a quiet walk before bed, swimming, cycling or skiing is enough. Outdoor games also bring great benefits: you can play badminton with friends or catch a ball with your child - and then good health and good mood will be ensured.

In order to prevent left atrial hypertrophy, it is important to promptly and fully treat diseases that can lead to the development of this pathology. If left atrial hypertrophy has already been diagnosed, then immediate treatment will help avoid extremely unpleasant complications, including the need for surgical intervention.

Prognosis of left atrial hypertrophy

Like treatment, the prognosis of left atrial hypertrophy largely depends on what causes the pathology and how affected the heart is. With early diagnosis, timely treatment, and proper prevention, in most cases, left atrial hypertrophy can be avoided or the harm from it can be minimized, and the patient can calmly enjoy a full life and not fear sad consequences for himself.

But we must not forget that hypertrophy of the left atrium can serve as a signal for the onset of more dangerous cardiac pathologies and provoke hypertrophic changes in other parts of the heart. Thus, if there are problems with the left atrium, there is a high probability of increased pressure in the left ventricle, and, as a result, its hypertrophy may gradually develop.

In mitral valve insufficiency, an increase in left atrial pressure is followed by an increase in pulmonary artery pressure and, often, right ventricular hypertrophy.

Left atrial hypertrophy should be taken very seriously, because in the absence of appropriate treatment, the prognosis worsens significantly: this pathology can not only disrupt the usual way of life, lead to complications and health problems, but also become a real threat to life.

Thus, with far-reaching changes in the heart muscle, pulmonary edema may develop, and attacks of cardiac asthma may begin. In the worst case scenario, increasing circulatory problems can lead to disability or even death.

But you should not think that left atrial hypertrophy has a uniquely negative prognosis. Even with congenital heart defects, even if surgical intervention is necessary, patients can easily return to a full life without limiting themselves due to health problems.

After drug treatment and surgical intervention, a person can return to his normal life without limiting himself due to illness. The prognosis for recovery is favorable; the main thing is not to delay seeing a doctor. When the first signs appear, you should immediately go to the clinic.

Mild malaise and barely noticeable pain cannot be an accident; this is the body signaling the occurrence of problems in the functioning of the cardiovascular system. The sooner they are identified, the faster the recovery will be.

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. Great importance has food. 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 analysis blood.

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), and an unhealthy lifestyle (smoking, alcohol, lack of fresh air, unhealthy foods).

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 left ventricular myocardium 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 in 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

Left ventricular overload can be caused by: long-distance running, intensive 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 aortic 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. Mortality in 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. Second group - 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).

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 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 they are used special indicators that can be assessed by a trained physician:

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);
sartanov - comparatively new class 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. WITH therapeutic purpose well-known recommendations are used to lower blood pressure, strengthen the vascular wall, and improve myocardial contractility.

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, prolonged overloads, especially in combination with fashionable low-calorie diets, contribute 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 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 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%.

Such segment changes RS-T and G waves are somewhat more often observed during acute systolic overload of the ventricles, when an obstacle to the expulsion of blood occurs in the form of a narrowing of the outlet or increased pressure in the systemic or pulmonary circulation. For example, overload of the left ventricle can develop due to a sharp increase in blood pressure, hypertensive crisis, physical overstrain, etc. In these cases, segment depression may appear on the ECG RS-TV left chest leads (V, 6). As the patient's condition normalizes, these ECG changes quickly disappear. An example of such ECG dynamics in a patient with a hypertensive crisis is presented in Fig. 7.19. The initial ECG (Fig. 7.19, a) shows signs of left ventricular hypertrophy: increased amplitude R in the left chest leads (V s 6) and amplitude L 1 in the right leads (Vj 2), rotation of the heart around the longitudinal axis counterclockwise (complex QR in lead V 6), displacement of the electrical axis of the heart to the left, etc. Small signs of impaired ventricular repolarization are also noticeable (tendency to shift RS-T, smoothed tooth 7).

On an ECG recorded during a hypertensive crisis with a rise in blood pressure to 220/130 mm Hg. Art., severe depression appeared RS-Ti negative asymmetric G waves in the left precordial leads (Fig. 7.19, b), which can be regarded as signs of systolic overload of the left ventricle against the background of its hypertrophy. A day after normalization of blood pressure (Fig. 7L9, c), the described disturbances in the process of ventricular repolarization were no longer detected, and the ECG returned to the original one.

Overload of the right ventricle can develop with an acute increase in pressure in the pulmonary circulation, for example, in patients with pulmonary embolism, pulmonary edema, status asthmaticus in patients with bronchial asthma, etc. In these cases, an ECG in the right chest leads (V 12) transient segment displacement can be detected RS-Ti smoothness or inversion of G, quickly disappearing after normalization of the patient’s condition.

An example of such ECG dynamics is presented in Fig. 7.5. On the ECG recorded during status asthmaticus in a patient suffering from bronchial asthma (Fig. 7.5, b), in addition to signs of atrial overload (P - pulmonale), there is segment depression RS-Ti negative teeth Th leads V t - V r After relief of the asthmatic status, the ECG quickly returned to the original (Fig. 7.5, c)

It should be emphasized that the concept of ventricular overload is not generally accepted. Changes in the process of ventricular repolarization, as is known, can be observed not only with pronounced hypertrophy of the ventricular myocardium, but also with intraventricular blockades, coronary heart disease, WPW syndrome and other pathological conditions. Therefore, we can talk about systolic overload of the ventricles only after how other causes of repolarization disorders were excluded and a clear connection between segment changes was discovered RS-Tz clinical and instrumental signs of increased pressure in the systemic or pulmonary circulation.

Now, using the general plan for ECG analysis (see Chapter 4), independently decipher the ECG presented in Fig. 7.20-7.24. At the same time, to identify quantitative criteria for diagnosing compensatory ventricular hypertrophy, it will be necessary, firstly, to measure the amplitudes of the waves R And S:

secondly, the calculation of the following quantitative indicators: Lu 5 (or Lu 6) + 5 V 1 (or 5^)

and thirdly, measuring the interval of internal deviation in leads V, and V 6.

Otherwise, to diagnose atrial and ventricular hypertrophy, the operations that were described in Chapter 4 and the diagnostic criteria for hypertrophy given in this chapter are sufficient. Check the accuracy of the tasks you completed.

Right ventricular hypertrophy on ECG

Pumped up muscles of the human body are the result of everyday work, during which muscle tissue experiences a certain load. What happens to the chambers of the heart if the load on their walls exceeds normal? Everything is correct. The muscle cells of the heart also “swing”: they increase in size and thicken.

In medical language, this condition of the heart muscle is called hypertrophy. All cardiac chambers can hypertrophy: both the ventricles and the atria. And only some of them can thicken. Let's talk about right ventricular hypertrophy, its causes and clinical manifestations, and also consider the signs of right ventricular hypertrophy on the ECG.

1 Why does the heart “sway”?

Right ventricular hypertrophy

In a healthy adult heart, the left ventricle has a larger mass than the right. This is understandable, because the left ventricle pushes blood into the aorta, experiencing a heavy load. More often, when it comes to myocardial hypertrophy, doctors primarily mean thickening of the left ventricle. Often, but not always. The right ventricle can also undergo hypertrophy. The pulmonary trunk departs from the right lower cardiac chamber, which gives rise to the pulmonary circulation. In the small circle, the blood is enriched with oxygen in the lungs.

The right ventricle pushes venous blood coming into it from all organs into the vessels going to the lungs. They branch into small capillaries and envelop the alveolar tissue of the lungs, where gas exchange occurs. Carbon dioxide and metabolic products leave the capillaries, and oxygen enters the blood from the lungs. Oxygenated blood flows through the pulmonary veins into the right atrium. This completes the most important function of blood gas exchange and closes the pulmonary circulation. But the right ventricle may experience increased load, resulting in its thickening and hypertrophy.

Pulmonary stenosis

What are the reasons for its thickening?

Heart defects. Heart defects in children are often congenital. The so-called “blue” defects, which are often manifested by cyanosis of the skin in children, shortness of breath, and palpitations. This is Tetralogy of Fallot, ventricular septal defect. This severe vices, often requiring the intervention of cardiac surgeons. Overload of the right ventricle can be caused by pulmonary artery stenosis, when blood from the ventricle cannot flow freely into the vessels, during a cardiac contraction the ventricle is not completely emptied, and a new volume of blood enters from the atrium, volume overload occurs.
Lung diseases. Bronchial asthma, COPD, bronchiectasis, tuberculosis - all these diseases lead to an increase in pressure in the pulmonary artery system, and it becomes more difficult for the ventricle to push blood into the vessels, it has to contract with greater force than with normal pressure in the pulmonary vessels.

Thus, the main causes of thickening of the myocardial wall of the right ventricle and an increase in its mass are diseases of the lungs and pulmonary vessels, as well as heart defects, both congenital and acquired.

2 How does right ventricular hypertrophy manifest in a child?

Tricuspid valve stenosis

Manifestations of hypertrophy in a newborn child in the first hours and days of life can be caused by physiological changes, the restructuring of blood circulation from intrauterine. But most often, pediatricians and neonatologists diagnose right ventricular hypertrophy due to intrauterine heart defects: tricuspid valve stenosis, ventricular septal defect, tetralogy of Fallot.

The severity of the defects may vary; with mild defects, compensation of cardiac activity may initially occur; with severe defects, children experience cyanosis of the skin, shortness of breath at rest or with minimal exertion; older children complain of heart pain, weakness, and palpitations. Children experience retarded growth and development, chest deformities like a heart hump, and frequent fainting.

3 Clinic of right ventricular hypertrophy in adults

Tricuspid valve insufficiency

It would be wrong to say that hypertrophy itself leads to the development of symptoms and complaints in an adult. Rather, hypertrophy, an enlargement of the right ventricle, can over time be complicated by heart failure, which has very specific symptoms:

Dyspnea. Initially, under loads, running, fast walking. With progression - at rest;
Dry cough. Without connection with infectious, bacterial agents. Intrusive, constant, worsens when lying down;
Weakness, increased fatigue. The previously performed load becomes difficult to bear. Feeling weak, lethargic in the morning;
Palpitations, rhythm disturbances;
Hemoptysis. When coughing, blood streaks may be released with sputum;
Heartache;
Dizziness;
Fainting.

One of the most common and accessible methods for diagnosing right ventricular hypertrophy is an electrocardiogram.

4 ECG and signs of hypertrophy

ECG signs of right ventricular hypertrophy

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
S wave in V5 and V6 greater than or equal to 2 mm
qR type complexes in V1

5 Difficulties in diagnosing right ventricular hypertrophy

When to refrain from diagnosing right ventricular hypertrophy using ECG

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:

WPW syndrome

6 Diagnostic assistants

EchoCG with Doppler

Hypertrophy is not limited to ECG diagnostics. There are other methods to determine its presence:

EchoCG is the most informative method; it allows you to accurately determine the thickness of the ventricular wall, its volume, and ejection fraction. EchoCG with Doppler allows you to visually assess blood flow through the chambers of the heart and vessels, defects in the valves or septa of the heart, blood pressure in the cavities and vessels.
X-ray of the chest organs. An increase in the shadow of the heart in the right departments may indicate their hypertrophy.

Having collectively analyzed the data from the cardiogram and other methods of instrumental examination of the heart, supplementing them with an objective examination and auscultation of the heart, the doctor can diagnose hypertrophy. But even more important in diagnostic and therapeutic matters is to establish the cause that caused right ventricular hypertrophy. The degree of its progression and the effectiveness of treatment subsequently depend on finding the cause of hypertrophy.

If right ventricular hypertrophy is diagnosed before clinical symptoms, it is possible to avoid or slow down the onset of heart failure in the future.

Right ventricular hypertrophy: what is it and how can it be treated?

Signs of ventricular hypertrophy on the ECG of the right and left

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ECG for ventricular overload

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 ECG in most cases shows:

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

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).

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 (in other words, 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 different 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.

The disease is of moderate severity.

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.

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 the 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 tint). skin) face or whole 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, it becomes insufficient oxygenated. 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 prostate cancer

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 ( ultrasonography 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

Regarding the features of electrocardiography in diseases of cardio-vascular system, then 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

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. Fat people and those who are periodically exposed to physical activity are advised to see 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. Aimed at activation immune system, due to which the factor that provokes the underlying disease is neutralized.

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

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

Regular use of diuretics;
Beta-blockers (medicines of this pharmacological group are incompatible with alcoholic drinks 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.

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.

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

Treatment with folk remedies

Quite often, the treatment of this disease combines drug therapy with folk remedies. It is worth considering that ethnoscience acts as an auxiliary therapy, it 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.

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, characteristic symptoms venous congestion in the lungs - 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), such as defense mechanism with 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.

Heart Healthy Products

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.

Load on the right atrium

The walls of the chambers of the heart consist of muscle tissue - the myocardium, which allows them to push blood into the vessels when contracting. For various reasons, the chambers of the heart may experience increased stress, which affects the structure and function of the heart.

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 on later 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, and 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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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 provoke the development of myocardial hypertrophy are the following:

1. Pathology of the bronchopulmonary system

At severe course Some diseases, for example, bronchial asthma (especially hormone-dependent), chronic obstructive bronchitis, pulmonary emphysema, frequent recurrent pneumonia, bronchiectasis, first develop hypertrophy of the myocardium of the right ventricle, 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. At the same time, neighboring areas of the myocardium thicken 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, and also 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.

Diagnosis and treatment of right atrial hypertrophy

Enlargement of any of the chambers of the heart with thickening of the heart muscle leads to heart failure. Right atrium hypertrophy occurs when blood flow through the pulmonary artery is disrupted and is manifested by dilation of the cavities of the right side of the heart. Symptoms indicate an underlying disease, and cardiac changes are detected by electrocardiography or sonography. With the right approach to treating the disease that caused hypertrophic changes, heart function will improve and the size of the atrium will return to normal.

Causal factors for enlargement of the right chambers of the heart

Changes in wall thickness and dilatation of the internal cavity of the right atrium appear with increasing load: venous blood collects in the right parts of the heart, which enters the pulmonary circulation through the pulmonary artery and is saturated with oxygen in the lungs.

The main causes of myocardial hypertrophy on the right arise when there is difficulty in the flow of blood into the right ventricle and pulmonary arterial trunk in the following cases:

partial blockage of a vessel (pulmonary embolism);
pulmonary heart;
chronic diseases of the bronchopulmonary system;
congenital heart anomalies (atrial septal defect, transposition of great vessels);
acquired defects with significant narrowing of the opening between the atrium and the ventricle (valvular insufficiency or stenosis);
right ventricular myocardial hypertrophy;
myocardial infarction.

Factors contributing to pulmonary hypertension and the formation of hypertrophied cardiac chambers include:

obesity;
alcohol abuse;
smoking;
hard physical labor;
chest injuries;
congenital deformities of the bone skeleton (kyphosis, scoliosis).

The main causative factor is a pronounced load on the main artery of the pulmonary circulation with the formation of pulmonary hypertension. The right side of the heart tries to push venous blood toward the lungs, resulting in one of 3 types of hypertrophic thickening of the heart muscle:

compensatory (myofibrillar), which occurs during severe physical activity;
replacement (with pronounced tension of the heart muscle against the background of lung diseases and cardiovascular pathology);
regenerative, which is a consequence of recovery processes in the heart against the background of myocardial infarction.

Having found out the probable cause of heart disease, it is necessary to evaluate the symptoms and conduct all the necessary diagnostic tests.

Symptoms of the disease

Typical signs of right atrial hypertrophy are absent. All manifestations are caused by the underlying disease and symptoms of developing heart failure. It is important to promptly pay attention to the following symptoms:

discomfort and pain in the left side of the chest;
a periodic feeling of interruptions in heart rhythm;
shortness of breath when moving and at rest;
night cough;
breathing problems, especially in a horizontal position;
change in vascular tone towards hypertension;
swelling of the limbs;
pronounced pallor;
fast fatiguability.

As heart failure progresses with impaired blood flow in the pulmonary circle, typical manifestations of cor pulmonale occur.

It is advisable to identify cardiac pathology earlier than signs of serious complications appear.

Diagnostic principles

Based on the patient’s complaints, the doctor will make a presumptive diagnosis, which can be confirmed by the following studies:

duplex ultrasound scanning;
Dopplerometry of blood vessels;
tomography.

Hypertrophy of the right atrium on the ECG is manifested by the following signs:

increase in height and sharpening of the P wave;
change in P wave width;
increase in S wave amplitude.

Echocardiographic signs are sufficiently reliable and informative to prove the presence of hypertrophy. An ultrasound scan will help assess the size of the heart, the amount of dilatation and the degree of thickening of the wall of the right atrium, which normally should not exceed 12 mm. Doppler measurements will reveal hemodynamic disorders, and with tomography, the doctor will be able to examine in detail a three-dimensional image of the atria and ventricles.

Therapy tactics

To obtain the desired positive effect from complex treatment You must follow the following doctor's recommendations:

complete cessation of smoking and alcohol;
gradual loss of body weight;
regular performance of a complex of physical therapy;
normalization of the diet under the supervision of a nutritionist.

Effective treatment tactics require mandatory treatment of the underlying disease. If there are indications (congenital or acquired defects, thromboembolism), surgical intervention is performed. In other cases, drug treatment aimed at normalizing blood flow through the pulmonary artery, correcting diseases of the lungs and bronchi, normalizing blood pressure and preventing myocardial infarction will be optimal.

Hypertrophy of the right heart is almost always secondary changes, therefore, with timely treatment of the primary pathology serious problems it will not be in the atrium and ventricle.

Possible complications

Dilation of the right atrium cavity with thickening of the myocardial wall in the absence of adequate therapy can cause the following dangerous complications:

chronic heart failure;
progressive cor pulmonale;
cardiac arrhythmia and conduction disturbances such as blockade;
complete pulmonary embolism;
myocardial infarction;
sudden cardiac death.

Combination therapy and long-term medical observation are the best option for treatment tactics: with the right approach to treatment, you can prevent deadly complications, reduce the size of the heart and significantly improve the quality of life of a sick person.

load on the right atrium on ECG

Questions and answers on: right atrium load on ECG

Ventricular rhythm: 60 beats. per minute

PR interval: 170 ms

QRS duration: 81 ms

QT/QTC interval: 393/394 ms

P/QRS/T angle: 67/30/45

RV5/SV1 amplitude: 0.98/0.37 mV

RV5+SV1 amplitude: 1.35 mV

Sinus bradyarrhythmia with heart rate min. Incomplete SA blockade, stage 2. Load on the right atrium. NBPNPG.

Ventricular rhythm: 75 beats. per minute

PR interval: 155 ms

QRS duration: 94 ms

QT/QTC interval: 384/429 ms

P/QRS/T angle: 69/49/47

RV5/SV1 amplitude: 0.66/0.00 mV

RV5+SV1 amplitude: 0.66 mV

Incomplete right bundle branch block

Sinus rhythm with heart rate 76/min. Load on the right atrium. Moderate metabolic changes in the myocardium.

On two ECGs there is RBBB, why then is the ECG normal in the first case, and pathological in the second? Where could the SA blockade and bradyarrhythmia have gone? As I understand it, these are purely functional changes, since they are temporary, right? Is it possible that the load on the PP is the result of smoking? How dangerous are all these changes, provided that the ECHO CG is normal, not counting minimal prolapse and an additional chord in the area of the left ventricle? In advance, thank you very much for your answer. All the best!

I am 27 years old, I recently did an ECG and they wrote that I have sinus tachycardia, a load on the right atrium. Moderate disturbance of repolarization processes along the posterior diaphragmatic wall of the left ventricle. Tell me it's not dangerous. Thank you in advance.

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 mitral valve 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.

Hemoglobin().

Red blood cells - 3.5 (3.9-4.7).

Color index - 0.93 (0.85-1.05).

Leukocytes - 8.4 (4.0-9.0).

Band neutrophils - 2 (1-6).

Segmented neutrophils - 46 (47-72).

Eosinophils - 4 (0.5-5.0).

Lyphocytes - 38 (19-37).

Monocytes - 10 (3-11).

Leukocytes - 9.72 (4.0-9.0).

Red blood cells - 4.08 (3.7-4.7).

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).

Thrombocrit - 0.25 (0.1-0.5).

Neutrophil granulocytes - 48.6% (47-72).

Lymphocytes - 39.7 (19-37).

Monocytes - 7.3 (3-10).

Eosinophils - 4.2 (0.5-5.0).

Basophils - 0.2 (0.0-1.0).

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.

Urea - 3.39 (2.99-6.24).

Creatinine - 50.7 (53-115).

Uric acid - 151.1 ().

Amylase - 55 (28-100).

Lipase - 28.5 (13.0-60.0).

Cholinesterase)

Calcium - 2.35 (2.05-2.54).

Glucose - 4.97 (4.2-6.4).

C-reactive protein is negative.

Antistreptolysin O - negative.

Seromucoid - 0.19 units.

Thymol test - 0.58 units.

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).

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.

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

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.

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.

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

The ECG showed ventricular extrasystole.

There were no additional ischemic changes on the ECG and no complaints that could be regarded as equivalent to angina pectoris. During the recovery period without any peculiarities. Prescribed: Enap 10 mg, Nebilet 1.25, cardiomagnyl 75 mg, omega 3, atorvacor 20 mg. daily, consultation with a cardiac surgeon. Please, if possible, write down the next steps and, if possible, tell us a little more clearly about the results of the examination. We won’t be able to get to the heart surgeon for almost another month, since the building to which we were sent is closed for renovation. And every day we “sit on pins and needles,” not knowing how bad the results of the examination are and what the heart surgeon can say at least approximately. And maybe you can recommend someone in Kharkov? If surgery is needed, approximately how much will it cost? Maybe add some other supportive medications before consulting a cardiac surgeon? Thanks in advance.

All about car tuning

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