Hypertrophy of the myocardium of the left ventricle of the heart - Causes, symptoms and treatment. MF.

Causes of myocardial hypertrophy
Symptoms of
Diagnosis
Treatment and lifestyle
Complications and prognosis

The left ventricle is a chamber of the heart that is a cavity that receives arterial blood from the left atrium through the mitral valve and pushes it into the aorta through the aortic valve for further advancementblood on the vessels of the body. The thickness of the muscular wall of the left ventricle in the apex region is about 14 mm, in the region of the septum between the right and left ventricles - 4 mm, in the lateral and posterior sections - 11 mm. The function of the ventricular muscle cells is to relax in the diastolic phase and take blood, and then contract into the systole phase and expel blood to the aorta, and the more blood enters the ventricle and the more it stretches its walls, the stronger will be the muscle contraction.

If more blood enters the ventricle or its walls have to overcome greater resistance when pushing blood into the aorta than normal, ventricular overload with volume or pressure, respectively, develops. At the same time, the compensatory( adaptive) response of the ventricular myocardium to overload occurs gradually, which is manifested by thickening and elongation of muscle cells, an increase in the number of intracellular structures in them and an increase in the total mass of the myocardium. This process is called

hypertrophy of the myocardium .As a result of the increase in the mass of the myocardium, its need for oxygen increases, but it is not satisfied by the available coronary arteries, which leads to oxygen starvation of muscle cells( hypoxia).

Hypertrophy of left ventricular myocardium is classified as follows:

1. Concentric and eccentric .
Concentric hypertrophy develops when the ventricle is overloaded with pressure, for example, with aortic stenosis or arterial hypertension, and is characterized by a uniform thickening of its wall with a possible decrease in the ventricular cavity. The muscle mass of the ventricle is increased in order to push blood into the narrowed valve or spasmodic vessels in hypertension.

Heart in cross section. Reduction of the cavity of the left ventricle.

The eccentric type of hypertrophy develops when volume is overloaded, for example, with mitral, aortic valve insufficiency, and with alimentary-constitutional obesity( food origin) and is characterized by an expansion of the ventricular cavity with thickening of the walls or preservation of their normal thickness, with this type increasing the total mass of the leftventricle. The left ventricle does not thicken as much as it fills up with blood and swells, like a balloon filled with water.
This division is important for the doctor and the patient, since at the first type the cardiac output can remain unchanged, and at the second type it decreases, that is, in the second type, the heart can not cope with the ejection of blood into the aorta.

2. With obstruction of the outflow tract, without obstruction and asymmetric types of .
Obstruction of the vestibular tract means thickening of the muscular wall and bulging it into the ventricle lumen, with narrowing of the ventricle cavity at the site of the exit of the aorta, which leads to subaortal stenosis and further aggravation of the systemic blood flow. In this case, the cavity of the ventricle can be divided into two parts like an hourglass. Obstruction does not develop with uniform, diffuse hypertrophy of the concentric type. Asymmetric hypertrophy is characterized by thickening of the interventricular septum and can be either with obstruction or without it.

3. By the degree of thickening of the muscular wall - up to 21 mm, from 21 to 25 mm, more than 25 mm.

The figure shows a thickening of the heart muscle in comparison with the normal myocardium.

The danger of hypertrophy is that the processes of relaxation and contraction of the myocardium are disturbed, and this leads to disturbances of intracardiac blood flow and, as a result, to the disturbance of blood supply to other organs and systems. Also increases the likelihood of developing coronary heart disease, acute myocardial infarction, stroke, chronic heart failure.

Causes of hypertrophy of the left ventricle of the heart

To lead to the fact that the walls of the ventricle thicken and stretch, it can be overloaded by pressure and volume, when the heart muscle needs to overcome the obstruction to the blood flow by expelling it into the aorta or push out a much larger volume of blood than occurs in the norm. Causes of overload may include diseases and conditions such as:

- arterial hypertension( 90% of all cases of hypertrophy associated with high blood pressure for a long time, as a constant vasospasm and increased vascular resistance develops)
- congenital heart defects and acquired aortic stenosis, aortic and mitral valve insufficiency, coarctationnarrowing of the site) of the aorta
- atherosclerosis of the aorta and deposition of calcium salts in the valves of the aortic valve and on the walls of the aorta
- endocrine diseases - diseases of the thyroid gland(hyperthyroidism), adrenal glands( pheochromocytoma), diabetes mellitus
- obesity of food origin or due to hormonal disorders
- frequent( daily) consumption of alcohol, smoking
- professional sports - athletes develop myocardial hypertrophy as a response to a constant load on the skeletal musculatureand the heart muscle. Hypertrophy in this contingent of persons is not dangerous in the event that the current of blood in the aorta and the large circle of blood flow is not disturbed.

The risk factors for hypertrophy are as follows:

- weakened heredity for heart diseases
- obesity
- sex( more often male)
- age( over 50 years old)
- increased consumption of table salt
- cholesterol metabolism disorders

Symptoms of left ventricular hypertrophyof the heart

The clinical picture of myocardial hypertrophy of the left ventricle is characterized by the absence of strictly specific symptoms and consists of manifestations of the underlying disease that led to it, and manifestations of the heartary failure, arrhythmias, myocardial ischemia and other effects of hypertrophy. In most cases, the period of compensation and the absence of symptoms can last for years until the patient passes a planned ultrasound of the heart or notices the appearance of complaints from the heart.
It is possible to suspect hypertrophy if the following symptoms are observed:

- a long-term increase in blood pressure, for many years, especially difficult to medicate and with high blood pressure( more than 180/110 mm Hg)
- the appearance of general weakness, increased fatigue, dyspnea in the exercise of those loads that were previously tolerated well by
- there are feelings of heart failure or obvious rhythm disturbances, most often atrial fibrillation, ventricular tachycardia
- edema on the legs, hands, face, often occurring towards the end of the day and passing in the morning
- episodes of cardiac asthma, suffocation and dry coughing in the supine position, often at night
- cyanosis( blueing) of fingertips, nose, lips
- attacks of pain in the heart or behind the breastbone during exercise or at rest( angina)
- frequent dizziness or unconsciousness
If you feel slightly worse and feel heart problems, you should consult a doctor for further diagnosis and treatment.

Diagnosis of the disease

Hypertrophy of the myocardium can be suspected during examination and questioning of the patient, especially if there is an indication in the anamnesis of heart defects, arterial hypertension or endocrine pathology. For more complete diagnosis, the doctor will prescribe the necessary examination methods. These include:

- laboratory methods - general and biochemical blood tests, blood for hormones, urine tests.
- radiography of chest organs - a significant increase in the shadow of the heart, augmentation of the aortic aorta with aortic valve insufficiency, aortic configuration of the heart in aortic stenosis - underlining of the waist of the heart, displacement of the left ventricle to the left.
- ECG - in most cases, the electrocardiogram amplitude shows an increase in the amplitude of the R wave in the left, and the S wave in the right thoracic leads, the deepening of the Q wave in the left leads, the displacement of the electric axis of the heart to the left, the ST segment displacement below the isoline,blockade of the left leg of the bundle.
- Echo - KG( echocardiography, ultrasound of the heart) allows you to accurately visualize the heart and see its internal structures on the screen. With hypertrophy, a thickening of the apical, septal zones of the myocardium, anterior or posterior of its walls is determined;zones of decreased myocardial contractility( hypokinesia) may be observed. The pressure in the chambers of the heart and large vessels is measured, the pressure gradient between the ventricle and the aorta, the cardiac output fraction( in the norm of 55-60%), the stroke volume and the dimensions of the ventricular cavity( BWW, CSR) are calculated. In addition, heart defects are visualized, if they are the cause of hypertrophy.
- stress tests and stress - Echo - CG - ECG and ultrasound of the heart are recorded after exercise( treadmill test, veloergometry).It is necessary to obtain information on endurance of the heart muscle and tolerance to physical exertion.
- 24-hour ECG monitoring is assigned to record possible rhythm disturbances if they have not been recorded on standard cardiograms earlier, and the patient complains of cardiac disruptions.
- invasive methods of examination may be prescribed by indications, for example, coronary angiography for assessing the patency of the coronary arteries in the presence of coronary heart disease in a patient.
- MRI of the heart for accurate visualization of intracardiac formations.

Treatment of left ventricular hypertrophy

Treatment of hypertrophy is primarily aimed at treating the underlying disease that led to its development. This includes correction of blood pressure, medical and surgical treatment of heart defects, therapy of endocrine diseases, fight against obesity, alcoholism.

The main groups of drugs aimed directly at preventing further cardiac arrhythmias are:

- ACE inhibitors( hartyl( ramipril), fosinocarp( fosinopril), prestarium( perindopril), etc.) possess oranoprotective properties, that is, not only protect the target organs, affected by hypertension( brain, kidneys, vessels), but also prevent further remodeling( restructuring) of the myocardium.
- beta blockers( nebilet( nebivalol), anaprilin( propranolol), recardium( carvedilol), etc.) reduce the heart rate, reducing the need for muscle in oxygen and reducing the hypoxia of cells, resulting in further sclerosis and replacement of sclerosis zones with hypertrophied muscle slowed. Also prevent the progression of angina, reducing the incidence of heart attacks and dyspnea.
- calcium channel blockers( norvask( amlodipine), verapamil, diltiazem) reduce the calcium content inside the heart muscle cells, preventing the build-up of intracellular structures leading to hypertrophy. Also reduce heart rate, reducing the need for myocardium in oxygen.
- combined preparations - prestan( amlodipine + perindopril), noliprel( indapamide + perindopril) and others.

In addition to these drugs, depending on the main and concomitant cardiac pathology, the following can be prescribed:

- antiarrhythmic drugs - cordarone, amiodarone
- diuretics - furosemide, lasix, indapamide
- nitrates - nitromite, nitrospray, isoket, cardiac, monochinque
- anticoagulantsand antiplatelet agents - aspirin, clopidogrel, plavix, quarantil
- cardiac glycosides - strophanthin, digoxin
- antioxidants - mexidol, actovegin, coenzyme Q10
- vitamins and drugs that improve heart nutrition - thiamine, pfor flavin, nicotinic acid, magneter, panangin

Surgical treatment is used for correction of heart defects, implantation of an artificial pacemaker( artificial pacemaker or cardioverter-defibrillator) with frequent paroxysms of ventricular tachycardias. Surgical correction of the direct hypertrophy is applied with pronounced obstruction of the vesting tract and consists in carrying out the Morrow operation - excision of a part of the hypertrophic cardiac muscle in the septum area. At the same time, an operation can be performed on the affected heart valves.

Lifestyle with hypertrophy of the left ventricle

The lifestyle of hypertrophy differs little from the main recommendations for other heart diseases. It is necessary to observe the foundations of a healthy lifestyle, including excluding or at least limiting the number of cigarettes smoked.
The following components of the way of life can be distinguished:

- mode. It is necessary to walk more in the open air and develop an adequate mode of work and rest with sufficient sleep for the restoration of the body.

- diet. Dishes should preferably be cooked in boiled, steam or baked form, limiting the preparation of fried foods. From products are allowed low-fat varieties of meat, poultry and fish, sour-milk products, fresh vegetables and fruits, juices, kissels, fruit drinks, compotes, cereals, vegetable fats. Limited copious intake of liquid, salt, confectionery, fresh bread, animal fats. Alcohol, spicy, fatty, fried, spicy food, smoked products are excluded. Take food at least four times a day in small portions.

- physical activity. Limit significant physical exertion, especially with severe obstruction of the outflow tract, with a high functional class of IHD or in advanced stages of heart failure.

- Compliance( adherence to treatment).It is recommended that you regularly take prescribed medications and visit a doctor in a timely manner to prevent the development of possible complications.

Ability to work with hypertrophy( for working contingent of persons) is determined by the main disease and the presence / absence of complications and concomitant diseases. For example, with a severe heart attack, stroke, severe heart failure, the expert commission may decide to have permanent disability, with a worsening of the course of hypertension, there is a temporary disability, recorded on the sick list, and in the stable course of hypertension and absence of complications, the work capacity is fully preserved.

Complications of left ventricular hypertrophy

With severe hypertrophy, it is possible to develop complications such as acute heart failure, sudden cardiac death, fatal rhythm disturbances( ventricular fibrillation).With the progression of hypertrophy, chronic heart failure and myocardial ischemia gradually develop, which can cause acute myocardial infarction. Violations of the rhythm, for example, atrial fibrillation, can lead to thromboembolic complications - stroke, thromboembolism of the pulmonary artery.

Forecast

The presence of myocardial hypertrophy in vices or hypertension significantly increases the risk of developing chronic circulatory insufficiency, coronary heart disease and myocardial infarction. According to some studies, the five-year survival of patients with hypertension without hypertrophy is more than 90%, while with hypertrophy decreases and is less than 81%.Nevertheless, with the condition of regular intake of drugs for regression of hypertrophy, the risk of complications decreases, and the prognosis remains favorable. At the same time, for heart defects, for example, the prognosis is determined by the degree of circulatory disturbance caused by the defect and depends on the stage of heart failure, since in its late stages the prognosis is unfavorable.

Doctor therapist Sazykina O.Yu.