How to treat left ventricular hypertrophy , its causes , diagnosis

"pumped" or "peretruzhennoe heart", with titles in everyday life often appears hypertrophy of the left ventricle (LVH).The left ventricle ejected main mass of blood that falls to the organs and limbs, the brain and feeding the heart itself.

When this work takes place in extreme conditions, muscle is gradually thickens, expanding the left ventricular cavity.Then, after different times for different people, there comes a breakdown of compensatory possibilities of the left ventricle - developing heart failure.The result of decompensation may be:

  • shortness
  • swelling
  • rhythm disturbance of the heart
  • loss of consciousness.

most unfavorable outcome could be death from sudden cardiac arrest.

Causes of left ventricular hypertrophy

Resistant hypertension

most likely cause thickening of the muscles of the left ventricle - arterial hypertension, which has stabilized over the years.When the heart has to pump against high pressure gradient, the pressure is overloaded, trains and myocardium thickens.Approximately 90% of left ventricular hypertrophy occur for this reason.

Cardiomegaly

It is a congenital hereditary or a characteristic of the heart.Large heart big man may initially have greater chambers and thick walls.

Athletes

Heart hypertrophy of athletes because of the physical load on the limits of the possible.Trains the muscles are constantly thrown into the general bloodstream additional volumes of blood that the heart has to pump as it further.This hypertrophy by volume overload.

Malformation of the heart valves

Malformation of the heart valves (congenital or acquired) that violate the blood flow in the systemic circulation (supravalvular, valve or subvalvular aortic stenosis, aortic stenosis with insufficiency, mitral insufficiency, ventricular septal defect) create conditions for volume overload.

Coronary heart disease is coronary heart disease there is hypertrophy of the left ventricular wall with diastolic dysfunction (myocardial relaxation violation).

Cardiomyopathy is a group of diseases in which on the background of sclerotic and degenerative changes poslevospalitelnyh there is an increase or a thickening of the heart.

About cardiomyopathy

Underlying pathological processes in the cells of the myocardium are genetic predisposition (idiopathic cardiomyopathy) or dystrophy and multiple sclerosis.The latter are myocarditis, allergies and toxic damage to the cells of the heart, endocrine pathology (excess catecholamines and growth hormone), immune failure.

Species cardiomyopathies occurring with LVH:

Hypertrophic form

It may make a limited or diffuse symmetrical or asymmetrical thickening of the left ventricular muscle layer.The volume of the heart chambers is reduced.The disease most often affects males and is inherited.

Clinical manifestations depend on the severity of the obstruction of the heart chambers.Obstructive option gives clinic aortic stenosis: heart pain, dizziness, fainting, weakness, paleness, shortness of breath.Can detect arrhythmia.As the disease progresses develop signs of heart failure.

Borders heart dilate (mainly due to left heart).There is a downward displacement of the apex beat and voiceless heart tones.Characteristic functional systolic murmur, to listen to the first heart sound.

Dilated form

It manifests enlargement of the heart chambers and myocardial hypertrophy of all its departments.At the same time the possibility of falling contractile myocardium.Only 10% of all cases of cardiomyopathy accounts for hereditary forms.In other cases, guilty of inflammatory and toxic factors.Dilated cardiomyopathy is often manifested at a young age (30-35 years).

most typical manifestation of the clinic becomes a left ventricular failure: cyanosis of the lips, shortness of breath, asthma, heart or lung edema.Also suffering and the right ventricle, resulting in cyanosis of hands, liver enlargement, fluid accumulation in the abdomen, peripheral edema, swelling of the neck veins.Observed and heavy rhythm disorders: paroxysmal tachycardia, atrial fibrillation.Patients may die on the background of ventricular fibrillation or asystole.

Hypertrophy of the left ventricle with diffuse.Expansion of heart cavities prevails over thickening of the myocardium.Learn more about the symptoms and treatment of cardiomyopathy.


Types LVH

  • concentric hypertrophy gives a reduction of heart cavities and thickening of the myocardium.This type of hypertrophy is characteristic of hypertension.
  • eccentric variant is characterized by the expansion of the cavities with simultaneous thickening of the walls.This occurs when the pressure forces, such as in cardiac defects.

Differences between different types of LVH

Cardiomyopathy

Arterial gipertneziya

Athletic heart

Age under 35 over 35 30
Paul both sexes both sexes most men
Heredity burdened by hypertension burdened by cardiomyopathy not burdened
Complaints dizziness, shortness of breath, fainting, heart pain, disordersrhythm headaches, shortness of breath less stabbing pain in my heart, bradycardia
Type LVH asymmetric uniform symmetrical
myocardial thickness greater than 1.5 cm less than 1.5 cm decreases the termination loads
LV Expansion rare, more often decrease possible more than 5.5 cm

Complications LVH

moderate left ventricular hypertrophy are usually not dangerous.This compensatory response of the body, designed to improve the blood supply to organs and tissues.For a long time people may not notice hypertrophy, as it does not manifest itself.As its progression can be developed:

  • myocardial ischemia, acute myocardial infarction,
  • chronic ischemic attacks, strokes,
  • severe arrhythmias and sudden cardiac arrest.

Thus, left ventricular hypertrophy is a marker of cardiac overload and indicates potential risks of cardiovascular accidents.The most unfavorable combination of it with coronary heart disease, the elderly, and smokers with concomitant diabetes mellitus and metabolic syndrome (obesity and lipid disorders).

Diagnostics LVH

Inspection

Suspected left ventricular hypertrophy may be already at the initial examination of the patient.When viewed alarming cyanosis of nasolabial triangle or arms, shortness of breath, swelling.When percussion are expanding the boundaries of the heart.When listening to - noise deafness tones accent the second tone.In a survey can be detected in the complaint:


  • wheezing
  • outages heart
  • dizziness fainting
  • weakness.

ECG

Left ventricular hypertrophy on electrocardiogram indicated a characteristic change in the voltage of R waves in the left precordial leads.

  • The V6 tooth more than the V It is asymmetric.
  • ST interval in the V6 rises above the contour lines, in V4 is below.
  • The V1 tooth T becomes positive, and S wave above the norm in V1,2.
  • The V6 Q wave larger than normal and there appears prong S.
  • T is negative in V5,6.

When ECG possible error in the assessment of hypertrophy.For example, incorrectly delivered chest electrode will give the wrong impression about the state of the myocardium.

US

heart At ECHO CS (ultrasound of the heart) hypertrophy has confirmed or refuted on the basis of imaging of the heart chambers, partitions and walls.All volumes of the cavities and the thickness of the myocardium can be expressed in figures, which can be compared with the norm.At ECHO CS can establish the diagnosis of left ventricular hypertrophy, specify the type and suggest the cause.Use the following criteria:

  • myocardial wall thickness equal to or greater than 1 cm for men and 1.1 cm for men.
  • skewness infarction (bolshe1.3) indicates the type of asymmetric hypertrophy.
  • index of relative wall thickness (normal less than 0.42).
  • ratio of myocardial mass to body mass (myocardial index).Normally, for men it is equal to or greater than 125 grams per square centimeter, for women - 95 grams.

Increase the last two figures indicate concentric hypertrophy.Unless infarction index higher than normal - has eccentric LVH.

Other methods

  • Doppler eohokardioskopiya -additional opportunities offered Doppler eohokardioskopiya for being able to evaluate the coronary blood flow in more detail.
  • MRI - also for visualization of the heart used magnetic resonance imaging, which completely reveals the anatomical features of the heart and allows you to scan it in layers, as if performing cuts in the longitudinal or transverse direction.Thus, it becomes more visible areas of damage, degeneration or sclerosis of the myocardium.

treatment of left ventricular hypertrophy

hypertrophy of the left ventricle, which should always be treated with normalization of lifestyle is often a reversible condition.It is important to stop smoking and other intoxications, lose weight, spend correction of hormonal imbalance and dyslipidemia, optimize the exercise.In the treatment of left ventricular hypertrophy, there are two directions:

  • Preventing the progression of LVH
  • Trying to myocardial remodeling with a return to normal size and thickness of the cavities of the heart muscle.

Next we treat the underlying cause, which led to the hypertrophy (correction of hypertension and treatment of cardiomyopathy).

  • Beta-blockers reduce the volume and pressure load, reducing myocardial oxygen demand, to solve some of the problems with the rhythm disturbances and reduce the risks of cardiac events - atenolol, metoprolol, Betolok-KRC, nadolol.
  • calcium channel blockers are the drugs of choice in patients with severe atherosclerosis.Verapamil, Diltiazem.
  • ACE inhibitors - means of lowering blood pressure and significantly inhibiting the progression of cardiac hypertrophy.Enalapril, Lisinopril, Diroton effective in hyperon and heart failure.
  • Sartana (Candesartan, Losartan, Valsartan) actively reduce the strain on the heart and remodel the myocardium, reducing the mass of the hypertrophied muscle.
  • antiarrhythmic drugs administered in the presence of complications such as heart rhythm disorders.Dizapiramid, quinidine.

Treatment is considered successful if:

  • reduced obstruction at the outlet of the left ventricle
  • increasing patient life expectancy
  • not develop arrhythmias, syncope, angina
  • not progressing heart failure
  • improved quality of life.

Thus, left ventricular hypertrophy should be as early as possible is suspected, diagnosed and corrected.This will help avoid severe complications with a reduction in quality of life and sudden death.