Cardiac hypertrophy: causes, symptoms, diagnosis and treatment

Cardiac hypertrophy

Cardiac hypertrophy is an enlargement of the heart muscle, which occurs mainly due to an increase in the number of cardiomyocytes - specialized muscle cells of the heart. This condition occurs in children, adolescents, young adults and the elderly.

Cardiac hypertrophy is a manifestation of a special state of the body: physiological or pathological. That is, it is not a disease, but a symptom.

Physiological

Physiological hypertrophy of the heart is observed in athletes and people who lead an active lifestyle. For regular physical activity, the body requires large amounts of oxygen. Oxygen is delivered through the blood. And to meet the increased oxygen needs, the heart increases the frequency and strength of contractions. And this requires greater metabolism in the heart muscle itself. This gradually increases the volume and mass of cells (cardiomyocytes). More often in athletes, cardiac hypertrophy begins from the left ventricle. Sports that can lead to cardiac hypertrophy are rowing, hockey, football, cross-country skiing, cycling, long-distance running, etc. When you stop training, this condition reverses. That is, the hypertrophied heart again becomes of normal size with normal wall thickness.

Pathological

Pathological hypertrophy of the heart occurs due to various diseases of the body. The human heart consists of four sections: two atria and two ventricles. The atria are reservoirs where blood enters from the body's circulation (blue vessels). The ventricles are a buoyant force that pushes blood through the vessels (red vessels). So each department has its own reasons for increasing.

Causes:

Left ventricle – enlarges due to arterial hypertension, aortic valve stenosis, aortic atherosclerosis, general obesity, diabetes mellitus

Right ventricle – due to congestive heart failure, chronic pulmonary failure

Left atrium – with arterial hypertension, general obesity, aortic and mitral valve defects

Right atrium - due to pulmonary diseases (when there is stagnation in the pulmonary circulation).

Development

The above reasons force us to maintain normal blood flow by increasing the mass of the heart. It must be taken into account that an increase in one part of the heart leads to hypertrophy of another. In addition to cardiomyocytes, the heart also contains connective tissue. With cardiac hypertrophy, it also grows, and this leads to a decrease in the elasticity of the walls and disruption of the heart.

If the load on the heart does not decrease, then the myocardium is gradually depleted because the blood flow cannot cope with the nutrition of the enlarged heart. This can lead to disruption of nerve impulses (arrhythmia), sclerosis and atrophy of the heart muscle.

Symptoms

An asymptomatic course of cardiac hypertrophy is possible.

If the left half of the heart is affected: pain in the heart area (increases after physical activity), arrhythmia, loss of consciousness, shortness of breath, dizziness.

If the right half of the heart is affected: cough, shortness of breath, cyanosis (cyanosis) or pallor of the skin, swelling, arrhythmia.

Diagnostics

Ultrasound examination of the heart

ECG (electrocardiography)

X-ray of the chest organs.

Treatment It is necessary to eliminate the cause of cardiac hypertrophy.
If it is arterial hypertension, it is necessary to take antihypertensive and diuretic drugs. Severe heart valve defects require surgical treatment and prosthetics. Respiratory diseases require anti-inflammatory and bronchodilator therapy. In any case, the approach is always individual. To monitor blood pressure and early detect arrhythmia, I recommend using automatic tonometers from the manufacturer Microlife, presented in our online store.

The author of the article is a practicing neurologist Maxim Nikolaevich Starshinin.

Cardiomyopathy - symptoms and treatment

According to modern concepts, the patient's treatment strategy is determined by dividing patients into categories depending on the type of cardiomyopathy.

All patients with detected cardiomyopathy, regardless of the course of the disease (including asymptomatic ones), require dynamic monitoring . The frequency of observation and the volume of examinations are determined individually. The mandatory list includes standard tests (clinical and biochemical blood tests), ECG, echocardiography and Holter ECG monitoring.

Treatment tactics depend on many factors and are selected individually. This takes into account anatomical features - obstruction of the left ventricular outflow tract, distension of the heart cavities, the presence of valvular pathology, the stage of heart failure and also concomitant diseases. It is necessary to identify factors that increase the risk of sudden death and life-threatening arrhythmias [15]

General measures include limiting significant physical activity and avoiding sports that may cause further stress on the myocardium [9]. But patients with cardiomyopathy do not require complete exclusion of physical activity and bed rest [10]. The level of loads, their frequency, intensity and duration are selected individually. It is recommended to avoid drinking alcohol and smoking.

Right ventricular hypertrophy

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Right ventricular hypertrophy is accompanied by increased electrical activity when the right ventricle is excited. This is reflected on the ECG by an increase in the amplitude of the R waves in the right leads (III, aVF, V1-V3) and an increase in the depth of S in the left leads (I, aVL and V4-V6).

The main criteria for right ventricular hypertrophy on the ECG are the dominance of the R wave in lead V1 and the dominance of the S wave in leads V5 and V6, as well as deviation of the EOS to the right.

In this case, the following parameters must be met:

RV1 must be greater than 6 mm and/or greater than SV1;
S in lead V6 (or V5) should be greater than 7 mm and/or greater than RV6 (or RV5, respectively).

Look at the cardiograms below.

ECG 1. Cardiogram without deviations from the norm

ECG source.

ECG 1 shows no right ventricular hypertrophy. RV1 < 6 mm and RV1 < SV1. In the left leads: S in V5 and V6 is less than 7 mm and less than R in these same leads.

ECG 2. Right ventricular hypertrophy

ECG source.

ECG 2 shows right ventricular hypertrophy. RV1 = 12 mm, i.e. RV1 > 6 mm and at the same time RV1 > SV1. In the left leads: SV5 = 9 mm, SV6 = 7 mm and SV6 > RV6. The EOS is deviated to the right: (RIII - SIII) > (RII - SII) > (RI - SI).

Often, with right ventricular hypertrophy, the ECG shows ST segment depression and T wave inversion in the right precordial leads V1-V3, as well as in II, III, aVF, which is also recorded on ECG 2.

Look at another cardiogram with an incomplete set of parameters considered.

ECG 3. Right ventricular hypertrophy

ECG source.

On ECG 3, RV1 < 6 mm, in leads V5 and V6 R > S. At the same time, RV1 > SV1 (there is dominance of R in V1), the EOS is deviated to the right and the TV1 wave is negative. Therefore, in this case there is right ventricular hypertrophy. Thus, not all signs of right ventricular hypertrophy are always present. In such cases, the dominance of the R wave in lead V1 and the deviation of the EOS to the right is important.

The main signs of right ventricular hypertrophy:

EOS is deviated to the right.
R wave dominance in lead V1: RV1 > 6 mm and/or RV1 > SV1.
ST segment depression and negative T wave in leads V1-V3, as well as in leads II, III, aVF.
Dominance of the S wave in leads V5, V6: SV5,V6 > 7 mm and/or SV5,V6 > RV5,V6.

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What diseases can electrocardiography (ECG) tell about?

An electrocardiogram (ECG) is considered the main diagnostic method for identifying various diseases of the cardiovascular system. Our heart works in the body under the control of its own pacemaker, which produces electrical impulses and directs them to the conduction system, and they are recorded on the ECG. It turns out that using an electrocardiogram, we can record a peculiar language of our myocardium. Based on the deviations of the main teeth: P, Q, R, S and T, it is possible to determine which disease is the basis of cardiovascular pathology.

Hypertrophy of the heart

Hypertrophy of the heart chambers occurs as a result of hemodynamic disturbances in the bloodstream, which provoke overload of the ventricles or atria. On the ECG you can see seven main signs of cardiac muscle hypertrophy:

An increase in the time of internal deviation, since in the hypertrophied myocardium the excitation spreads longer in the area from the endocardium to the epicardium.
An increase in the amplitude of the R wave, while the excitation vector is larger in magnitude.
Ischemia of the subendocardial layers of the heart, due to the fact that they lack blood flowing through the coronary arteries.
Conduction disturbance.
Deviation of the electrical axis of the heart towards the hypertrophied section, as its mass increases due to the growth of cardiomyocytes.
Changes in the electrical position of the heart.
Displacement of the transition zone (V3), manifested by a change in the ratio of the R and S waves in the third chest lead.

Angina pectoris

The disease is characterized by attacks of anginal pain lasting from a few seconds to twenty minutes. This disease is one of the formischemic heart diseases. In the classic form of angina pectoris, electrocardiographic signs are manifested by changes in the final part of the ventricular QRS complex:

Depression of the S-T segment.
Various changes in the T wave, such as decreased amplitude, biphasicity, isoelectricity, or negativity.
The focal nature of these changes: they are recorded in one or two leads, since the observed hypoxia is local in nature, developing in the basin of a separate branch of the coronary artery.

During the periods between attacks, the ECG often shows no pathological changes at all. In addition, the above-described deviations are possible in many other heart diseases and pathological conditions. That is why in some cases the diagnosis of angina pectoris can be difficult.

Arrhythmia

Pathology of the cardiovascular system associated with a violation of the formation of an excitation impulse or its spread throughout the myocardium. In most cases, it manifests itself as an interruption in the rhythm of heart contractions, with periods of acceleration and gradual deceleration. Typically, your heart rate increases as you inhale and decreases as you exhale. The features of the ECG are as follows:

The frequency of changes in the R - R intervals is more than 0.1 seconds.
Unlike other rhythm disturbances, there is a gradual change in the duration of the R – R interval, usually due to the T – P segment.
Small fluctuations of P – Q and Q – T are characteristic.

The most reliable electrocardiographic sign of sinus arrhythmia is considered to be a gradual periodic shortening of the R - R section against the background of an increased rhythm and, conversely, a lengthening of the R - R intervals when the rhythm slows down.

Tachycardia

An increase in heart rate is called tachycardia. In this case, the heart rate accelerates to 100-150 beats per minute. A similar disorder can develop due to increased automatism of the sinus node. The pathology is also inherent in healthy individuals during physical exertion or emotional stress. The cause is often ischemia, dystrophic changes, various infections and toxic effects. Main ECG signs:

There is a decrease in the R–R interval as the T–P interval shortens.
With severe tachycardia, the P–Q segment shortens.
The degree of increase in heart rate is directly proportional to the decrease in Q – T.
An upward displacement of the RS – T segment downward from the isoelectric line.
The amplitude and direction of the teeth correspond to the norm.

Bradycardia

A deviation that is manifested by a reduced heart rate (less than 60 per minute). It occurs with reduced automatism of the sinus node; it can occur even in healthy people, for example in athletes, when exposed to various factors. A common cause is considered to be an increase in the tone of the vagus nerve. The electrocardiographic picture, in principle, differs little from the norm, only the rhythm is slowed down. The following changes are noted on the ECG:

The R interval increases due to the T – P shift.
Q – T increases according to the decrease in rhythm frequency.
The amplitude and vector of the teeth change slightly.

Heart aneurysm

A cardiac aneurysm is an enlargement of the myocardial cavity due to pathological changes in the muscle layers or abnormalities in the development of the organ at the stage of embryogenesis. The main signs of a cardiac aneurysm include protrusions in its area due to thinning of the wall, which can rupture. This is what can lead to irreparable consequences, which ECG research helps prevent. There are two leading signs that allow you to diagnose an aneurysm:

The QS wave is present in leads where high R is usually recorded.
A “frozen” ECG curve: instead of Q, a dome-shaped RS-T segment appears, shifted upward from the isoline, and sometimes a negative coronary T-wave appears.

Extrasystole

Extrasystole is the most common heart rhythm disorder. The pathology develops due to the appearance of an active heterotopic focus capable of generating an electrical impulse that interrupts the work of the sinus node. Manifested by extraordinary excitation and subsequent contraction of parts of the heart or its entirety:

On an ECG, extrasystoles differ in shape, relation to the isoline, location of the P wave or width, direction of the QRST complex teeth.
The presence of an increased pause (compensatory) after the extrasystole.
Atrial extrasystole is characterized by: interval R(c)-R(e) <interval R(c)-R(c), there is a wave P(e), different from the wave P(c), an incomplete compensatory pause.
The signs of ventricular extrasystole are as follows: interval R(s)—R(e) <interval R(s)—R(s), the P(e) wave is absent, the QRS complex is deformed, a complete compensatory pause.

Pulmonary embolism

Pulmonary embolism is accompanied by the development of pulmonary heart syndrome, since the resulting hypertension of the pulmonary circulation leads to acute overload of the right ventricle. In this case, the myocardium is in a state of hypoxia, and its hypertrophy develops. All of the above determines several ECG options for pulmonary embolism:

SI-QIII-TIII syndrome: deep S waves in standard I and Q waves in leads III, while T waves in lead III become negative.
acute hypertrophy of the right parts of the heart muscle, which is manifested by a high pointed P wave in standard lead II.
acute supraventricular tachyarrhythmias.

In some cases, with acutely developing cor pulmonale, metabolic changes in the area of the right ventricle provoke the occurrence of complete or partial blockade of the right bundle branch.

Pericarditis

The dynamic picture of the ECG during pericarditis depends on its etiology. However, there are also common characteristics, for example: inflammation of the pericardial tissue changes its electrical status, which leads to the emergence of so-called “inflammatory currents” coming from the heart. It is these “currents” that are recorded by the electrode located above the myocardial area:

This is graphically displayed on the ECG by the rise of the S-T segment in all leads (concordant rise of the S-T segment).
There is no displacement of the RS segment – Tbelow the isoline level.
Pathological Q-waves do not appear dynamically.

The above differences form and disappear in the case of acute pericarditis much more slowly than in the case of myocardial infarction. The appearance of effusion in the pericardial cavity is accompanied by a noticeable decrease in the voltage of all electrocardiographic waves, especially in the leads from the limbs of the subject.

Myocarditis

In all cases of myocarditis, parenchymal inflammation occurs and progresses in the wall of the ventricles, which is focal or diffuse in nature, affecting a certain area of the heart muscle:

The total T vector tilts in the direction opposite to the affected area, and a low or negative T wave is displayed on the ECG.
The S–T vector is directed towards the lesion.
The RST segment is displaced up and down from the isoelectric line.
Negative T can become symmetrical in acute myocarditis, it becomes pointed, as in coronary insufficiency. The localization of all noted disorders depends on the location of the inflammatory reaction.

These electrocardiographic shifts are best determined in the chest leads. A concomitant pathology is rhythm and conduction disturbances.

Myocardial dystrophy

Myocardial dystrophy is part of the complex of pathological clinical symptoms of menopausal hormonal changes in older people. The pathology is described by pain in the heart area, different from angina pectoris, and a disturbance in heart rhythm. There are cases when these symptoms occur before the onset of menopause. The most common electrocardiographic signs are the following:

A negative but not deep “coronal” T wave or it may be biphasic with a negative second phase.
Dynamic changes in electrocardiographic data.
A slight shift of the RS – T segment downward from the position of the isoelectric line.
More pronounced changes in the middle chest and right leads.

The main problem of ECG diagnostics is that many deviations and changes in the electrocardiographic picture are similar for a number of diseases. For example, coronary insufficiency, some forms of myocarditis and myocardial dystrophy are characterized by similar electrocardiograms. As practice shows, clinical symptoms need to coincide with the dynamics of ECG abnormalities. In this regard, it is important to note the development of the promising direction presented in the Kardi.ru project. The technique of monitoring the state of your heart allows you to register micro changes in the work of the heart muscle even before the appearance of serious disorders, which is displayed graphically by the CardiRu device and facilitates timely decision-making on appropriate therapeutic measures.