How to treat left ventricular hypertrophy, causesits occurrence, diagnosis

Update: December 2018

“Pumped” or “overloaded heart”, under such names
in everyday life, hypertrophy of the left ventricle of the heart (LVH) often occurs.
The left ventricle pushes the bulk of the blood entering the
organs and limbs, brain and nourishing heart itself.

When this work takes place in extreme conditions, the muscle
gradually thickens, expands the cavity of the left ventricle. Then,
after different times in different people, there comes a breakdown of compensatory
possibilities of the left ventricle – cardiac develops
failure. The result of decompensation can be:

  • Shortness of breath
  • Swelling
  • Heart rhythm disturbances
  • Loss of consciousness.

The most unfavorable outcome can be a sudden death.
cardiac arrest.

Causes of left ventricular hypertrophy

Persistent Arterial Hypertension

The most likely cause of thickening of the muscles of the left ventricle
heart disease – arterial hypertension that does not stabilize in
for many years. When the heart has to pump blood against
high pressure gradient, pressure overload occurs,
myocardium is trained and thickened. Approximately 90% of left hypertrophies
The ventricles arise for this reason.

Cardiomegaly

it врожденная наследственная или индивидуальная особенность
hearts. A large heart in a large person may initially have
wider chambers and thicker walls.

Athletes

The heart of athletes is hypertrophied due to physical exertion.
at the limit of the possible. Exercising muscles are constantly being thrown away.
the total bloodstream is the extra blood that the heart
it is necessary to pump as if in addition. it гипертрофия за
volume overload account.

Heart valve flaws

Heart valve defects (acquired or congenital),
violating the blood flow in the great circulation of blood (supravalvular,
valvular or subvalvular stenosis of the aorta, aortic stenosis with
insufficiency, mitral insufficiency, defect
interventricular septum) create conditions for bulk
overload.

Coronary heart disease

With ischemic heart disease, wall hypertrophy occurs.
left ventricle with diastolic dysfunction (violation
myocardial relaxation).

Cardiomyopathy

it группа заболеваний, при которых на фоне склеротических или
dystrophic post-inflammatory changes increase
или утолщение отделов hearts.

Pro cardiomyopathy

The basis of pathological processes in myocardial cells are
genetic predisposition (idiopathic cardiopathy) or
dystrophy and sclerosis. Myocarditis, allergies and
toxic damage to heart cells, endocrine pathologies
(excess catecholamines and somatotropic hormone), immune
failures.

Varieties of cardiomyopathy occurring with LVH:

Hypertrophic form

It may give a diffuse or limited symmetric or
asymmetric thickening of the muscle layer of the left ventricle. Wherein
the volume of the heart chambers decreases. The disease most often affects
men and inherited.

Clinical manifestations depend on the severity of chamber obstruction.
hearts. Obstructive option gives the clinic aortic stenosis:
heart pain, dizziness, fainting, weakness, pallor,
shortness of breath. Arrhythmias can be detected. As the disease progresses
signs of heart failure develop.

The borders of the heart expand (mainly due to the left
departments). A downward displacement and a deafness is observed.
heart tones. Characteristic functional systolic murmur,
heard after the first heart tone.

Dilatation form

It is manifested by the expansion of the heart chambers and myocardial hypertrophy.
all its departments. Wherein падают сократительные possiblyсти
myocardium. Only 10% of all cases of this cardiomyopathy occur in
hereditary forms. In other cases, inflammatory and
toxic factors. Dilated cardiopathy is often manifested in
young age (in 30-35 years).

The most typical manifestation of the clinic becomes
left ventricular insufficiency: cyanosis of the lips, shortness of breath, heart
asthma or pulmonary edema. The right ventricle also suffers, which
expressed in cyanosis of the hands, enlarged liver, fluid accumulation
in the abdominal cavity, peripheral edema, swelling of the neck veins.
Severe rhythm disorders are also observed: paroxysms of tachycardia,
atrial fibrillation. Patients may die due to fibrillation
ventricular or asystole.

Left ventricular hypertrophy of the left ventricle with diffuse.
Расширение сердечных полостей преобладает над утолщением myocardium.
Read more about the symptoms and treatment of cardiomyopathy.

Types of LVH

  • Concentric hypertrophy gives a reduction in the cavities of the heart and
    утолщение myocardium. This type of hypertrophy is characteristic of
    arterial hypertension.
  • The eccentric version is characterized by the expansion of cavities with
    simultaneous thickening of the walls. it происходит при перегрузке
    pressure, for example, with heart defects.

Differences between different types of LVH

Cardiomyopathy

Arterial hypertension

Sports heart

Age younger than 35 over 35 from 30
Floor both sexes both sexes more often men
Heredity отягощена по гипертензии burdened by cardiomyopathy not burdened
Complaints dizziness, shortness of breath, fainting, heartache, disturbances
rhythm
headaches, rarely shortness of breath stitching pains in the heart, bradycardia
LVH type asymmetrical uniform symmetrical
Myocardial thickness  more than 1.5 cm less than 1.5 cm decreases when loads are terminated
LV expansion rarely, often decrease possibly more than 5.5 cm

Complications of LVH

Moderate left ventricular hypertrophy is usually not dangerous. it
compensatory response of the body, designed to improve
blood supply to organs and tissues. For a long time a person may not
notice hypertrophy, as it does not manifest in any way. As her
progression may develop:

  • myocardial ischemia, acute myocardial infarction,
  • chronic disorders of cerebral circulation, strokes,
  • тяжелые аритмии и внезапная остановка hearts.

Thus, left ventricular hypertrophy is a marker
overloading of the heart and indicative of potential risks
cardiovascular accidents. Its combinations are most unfavorable.
with coronary heart disease, in elderly and smokers with concomitant
diabetes and metabolic syndrome (overweight and
disorders of lipid metabolism).

Diagnosis of LVH

Inspection

Suspected hypertrophy of the left ventricle can be already at the primary
examination of the patient. When inspecting the cyanotic nasolabial
triangle or hand, increased breathing, swelling. Percussion
имеются расширения границ hearts. When listening – noises, deafness
tones, accent second tone. Complaints may be identified during the survey.
on:

  • shortness of breath
  • heart failure
  • dizziness
  • fainting
  • weakness.

ECG

Гипертрофия левого желудочка на ECG отмечается характерное
change in the voltage of the R teeth in the chest leads on the left.

  • In V6 the prong is larger than in V It is asymmetrical.
  • The ST interval in V6 rises above the isoline, in V4 it drops
    below.
  • In V1, the T wave becomes positive, and the S wave is above normal in
    V1,2.
  • In V6, the Q wave is larger than normal and a tooth appears here.
    S.
  • T is negative in V5,6.

При ECG возможны погрешности в оценке гипертрофии. For example,
incorrectly placed chest electrode will give an incorrect idea of
состоянии myocardium.

Ultrasound of the heart

При ЭХО-КС (Ultrasound of the heart) гипертрофия уже подтверждается или
refuted on the basis of visualization of the chambers of the heart, partitions and
walls. All cavity volumes and myocardial thickness are expressed in numbers,
which can be compared with the norm. On the ECHO-KS it is possible to establish the diagnosis
left ventricular hypertrophy, to clarify its type and assume
reason. The following criteria are used:

  • The thickness of the walls of the myocardium is equal to or greater than 1 cm for women and 1.1
    cm for men.
  • The coefficient of asymmetry of the myocardium (more than 1.3) indicates
    asymmetric type of hypertrophy.
  • The relative wall thickness index (the norm is less than 0.42).
  • The ratio of myocardial mass to body mass (myocardial index). AT
    for men, it is equal to or greater than 125 grams per square
    centimeter, for women – 95 grams.

The increase in the last two indicators indicate
concentric hypertrophy. If only myocardial index exceeds
norm – there is an eccentric LVH.

Other methods

  • Доплеровская эохокардиоскопия -дополнительные possiblyсти
    provides Doppler echocardioscopy, in which you can
    to evaluate coronary blood flow in more detail.
  • MRI – also used to visualize the heart
    magnetic resonance imaging, which fully discloses
    anatomical features of the heart and allows you to scan it
    layer by layer, as if performing cuts longitudinally or transversely
    direction. This way the areas become better visible.
    повреждения, дистрофии или склероза myocardium.

Treatment of left ventricular hypertrophy

Left ventricular hypertrophy, the treatment of which is always necessary
with the normalization of lifestyle, often reversible state. ATажно
stop smoking and other intoxications, reduce weight, hold
correction of hormonal imbalance and dyslipidemia, optimize
physical exercise. AT лечении гипертрофии левого желудочка
There are two directions:

  • Preventing Progression of LVH
  • Attempt to remodeling myocardium with a return to normal
    the size of the cavities and the thickness of the heart muscle.

Next is the treatment of the underlying cause that led to
hypertrophy (correction of arterial hypertension and treatment
myocardiopathy).

  • Beta-blockers can reduce the load volume and
    pressure, reduce myocardial oxygen demand, solve part
    проблем с нарушениями rhythm и снизить риски по сердечным
    disasters – Atenolol, Metoprolol, Betolok-Zok, Nadolol.
  • Calcium channel blockers become the drugs of choice when
    pronounced atherosclerosis. ATерапамил, Дилтиазем.
  • ACE inhibitors – blood pressure lowering and
    существенно тормозящие прогрессирование гипертрофии myocardium.
    Enalapril, Lisinopril, Diroton are effective for hypertension and cardiac
    failure.
  • Сартаны (Кандесартан, Лозартан,ATалсартан) очень активно снижают
    load on the heart and remodeling myocardium, reducing weight
    hypertrophic muscle.
  • Antiarrhythmic drugs prescribed in the presence of complications in
    form of heart rhythm disorders. Disapiramide, quinidine.

Treatment is considered successful if:

  • reduced obstruction at the exit of the left ventricle
  • patient’s life span increases
  • do not develop rhythm disturbances, fainting, angina
  • heart failure does not progress
  • improving the quality of life.

Thus, left ventricular hypertrophy should be like
may be suspected earlier, diagnosed and corrected. it
will help to avoid serious complications with reduced quality of life and
sudden death.

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