Do you know enough about right ventricular hypertrophy and its treatment?
May 16, 2018
The heart performs a very important role in our body, moving the blood through the vessels to all tissues and organs. Normally, the heart has 4 chambers - 2 atriums( right and left) and 2 ventricles. From the ventricles, blood is pushed into the bloodstream under a certain pressure, which is created by contraction of the ventricles. Blood from the right ventricle gets into the lungs( small circle of blood circulation) to enrich with oxygen, and from the left enters the large circle of blood circulation.
With increased stress, and also due to various other causes, the ventricular muscle may increase in size, and this condition is called ventricular hypertrophy. For the growth of the muscle, the heart responds to special cells - cardiomyocytes, and right ventricular hypertrophy, in fact, is not an independent disease, but is a symptom or syndrome of cardiovascular and other diseases.
Right ventricular hypertrophy is rare in young people, and is usually diagnosed in the elderly at the age of 50-60.But right ventricular hypertrophy is also common in children who have congenital heart disease.
At birth, right ventricular hypertrophy in the child manifests itself immediately and is characterized by extensive cyanosis of the face, fingertips, other parts of the body. There are cases when right ventricular hypertrophy in children is physiological, and manifests itself in those cases when the load on the right heart increases.
The causes of right ventricular hypertrophy
According to statistics, right ventricular hypertrophy is much less common than left ventricular hypertrophy. Normally, the weight of the left ventricle is about 3 times less than that of the left ventricle, and even with a slight increase in the right ventricle its weight still remains smaller compared to the leftthe ventricle.
The increase in the right ventricle is mainly influenced by the following reasons:
- Elevated blood pressure in the pulmonary artery, also called pulmonary hypertension. This condition is usually accompanied by fainting, dizziness, dyspnea at rest.
- Stenosis( constriction) of the pulmonary valve, which is located at the site of the exit of the pulmonary artery from the right ventricle.
- Defect( developmental defect) of the interventricular septum, in which blood is mixed between the right and left sides of the heart. In this case, the blood entering the organs and tissues does not contain the norm of dissolved oxygen, and therefore the heart is compelled to compensate for this by increasing the contractions of the ventricles. In this case, both ventricles increase in size.
- The tetralogy of Fallot, in which there are 4 deviations from the norm - right ventricular hypertrophy, stenosis of the pulmonary valve, defect of the interventricular septum and displacement to the right of the aorta. This vice is also called a "blue" blemish, since the main symptom is the blueing of many parts of the face and body.
- Various lung diseases( chronic pneumonia, chronic bronchitis, emphysema, pneumosclerosis).
Symptoms of right ventricular hypertrophy
Symptoms of right ventricular hypertrophy are not pronounced in early stages, but in later stages of the disease the symptoms are as follows:
- Patients experience severe chest pains, a feeling of heaviness, difficulty breathing.
- An arrhythmia or a palpitation disturbance disturbs( a tachycardia).Often, patients note a feeling of "fluttering" of the heart in the chest.
- Fainting conditions, sudden attacks of dizziness.
- Pronounced edema on the legs.
The clinic of right ventricular hypertrophy is also called "pulmonary heart", which can be acute and chronic. The main cause of acute pulmonary heart is pulmonary embolism, which can be multiple or massive. For the clinic of acute pulmonary heart, characteristic symptoms are acute right ventricular failure, severe shortness of breath, tachycardia, lowering of blood pressure. In most cases, the acute form of right ventricular failure results in the death of patients.
The chronic form of the pulmonary heart does not differ from the acute picture of the disease until a decompensation process occurs. Severe cases of chronic right ventricular failure result in a clinical picture of chronic obstructive pulmonary disease.
Diagnosis of right ventricular hypertrophy
Diagnosis is based on complaints and examination of the patient, as well as electrocardiography and ultrasound. Hypertrophy of the right ventricle on the ECG looks in three versions:
- rSR1-type ECG, which is characterized by the presence of V1 split QRS complex with two positive teeth, the second of which hasgreater importance. These changes are observed at the absolutely normal width of the QRS complex.
- R-type ECG, which is characterized by the presence in the V1 lead of the complex QRS type Rs or gR.This deviation is revealed, as a rule, with severe right ventricular hypertrophy.
- S-type ECG, which is characterized by the presence in all thoracic leads from V1 to V6 complex QRS type rS, as well as RS with a pronounced tooth S.
- In the diagnosis draw attention to the size of the right ventricle, depending on which distinguish three variants of right ventricular hypertrophy:
- Moderate hypertrophy - there is an increase in the walls of the myocardium, but the weight of the right ventricle remains smaller compared with the left ventricle.
- The expressed ventricular hypertrophy-the mass of the right ventricle is still less than the left mass, but the process of excitation of the cardiac muscle lasts longer than in the left.
- Acute hypertrophy - by mass, the right ventricle is larger than the size and mass of the left.
Treatment of right ventricular hypertrophy
In patients with right ventricular hypertrophy, treatment should be aimed at normalizing lung function, eliminating pulmonary valve stenosis, and treating heart defects. In addition, the treatment should be necessarily symptomatic, that is, it is aimed at maintaining the functioning of the heart muscle, supplementing its nutrition, normalizing the pulse and blood pressure. In some cases, surgical treatment is indicated( in the presence of heart disease as a cause of the syndrome), especially in children with congenital heart disease. Unfortunately, virtually no one can manage to eliminate hypertrophy of the myocardium.