What is left ventricular hypertrophy? Left ventricular hypertrophy of the heart: what is it, symptoms, treatment The last ECG did not show left ventricular hypertrophy

Hypertrophy is a pathological process, which is based on an increase in the volume and number of cells. As a result, the mass of tissues increases, which leads to disruption of their functional activity. If such changes occur in the heart muscle, hypertrophic changes occur in the myocardium. Hypertrophy of various parts of the heart is not a disease, but only a sign of some kind of disorder.

In general, the topic of thickening the walls of the heart muscle is quite controversial. Some doctors call these changes an adaptive mechanism, while others argue that this is a dangerous condition with far-reaching consequences. It is known that such pathological changes in the ventricles are associated with the occurrence of diseases, but along with this, there are examples of people with this diagnosis who can even play sports, live to old age and not complain of any heart problems. So how should you feel about changes on the cardiogram?

The main job of the ventricles is to carry out the pumping function. In general, the term “hypertrophy” itself is a capacious concept that includes excess tissue, organ enlargement, thickening of the walls of the ventricles and an increase in the mass of the atria. Hyperfunction leads to hypertrophic changes.

The presence of disorders may be indicated by patient complaints: cardialgia of a pressing nature, swelling of the lower extremities, shortness of breath when walking, weakness and dizziness. The following categories of people are at risk: those who exhaust themselves with radical diets, engage in grueling physical training, and have bad habits, in particular, smoking and alcohol abuse. In addition, people who have close relatives with heart disease are at risk.

Athletes who increase their physical activity must be examined by a doctor. Decompensated changes may appear after a long time

Left ventricular hypertrophy on ECG

LVH can occur for a number of reasons, one of the provoking factors is high blood pressure, the left ventricle works at an accelerated rhythm. First, the walls of the chamber thicken, which subsequently leads to loss of elasticity and deterioration in functional activity. In a child, heart failure is usually associated with congenital heart defects.

Let us highlight the main reasons why left ventricular hypertrophy appears on the ECG:

• narrowing of the aortic valve;
• arterial hypertension;
• pathological enlargement of the heart muscle;
• grueling long-term strength physical activity;
• excess body weight.

Consider the clinical signs of left ventricular hypertrophy on the ECG:

• pain in the chest area;
• dyspnea;
• tachycardia;
• dizziness, even fainting;
• increased fatigue.

The left ventricle is the most important link in the circulatory system. It is responsible for supplying blood to tissues and organs, which is why hypertrophic changes will certainly affect the functioning of the most important systems of the body.

To avoid the development of serious complications, the pathological process should be identified in the early stages. To do this, when the first symptoms appear, you need to contact a cardiologist.

LVH can lead to the following complications, namely:

• heart failure;
• arrhythmia;
• myocardial infarction;
• cardiac arrest and death.

If we talk about left atrial hypertrophy, it occurs due to the following reasons: obesity, cardiomyopathy of various origins, pulmonary diseases, aortic stenosis, hypertension, stressful situations, etc.

Compared to the above-mentioned pathology, HPG is a rather rare phenomenon. There are four main causes of the violation:

• increased pressure in the pulmonary artery;
• congenital heart defects;
• pulmonary valve stenosis;
• defects on the side of the interventricular septum.

Let's look at the signs of right ventricular hypertrophy on the ECG:

• breathing problems;
• chest pain and squeezing sensation;
• feeling of heartbeat;
• feeling of heart fluttering and feeling as if it missed several beats;
• swelling;
• severe dizziness;
• loss of consciousness.

In the initial stages, prostate cancer may have absolutely no clinical manifestations.

Changes in the right atrium may also occur. The reason for this may be the following factors: lung diseases, heart defects, pulmonary embolism, etc. Patients experience breathing problems, fatigue, loss of strength, and chest pain.

What does the treatment consist of?

The initial stage of the treatment process is electrocardiographic diagnostics, which helps to identify the problem. An ultrasound may also be needed.

Due to the fact that hypertrophic changes in the ventricle are not an independent disease, but only a manifestation of some disorder, the maximum therapeutic effect can be achieved only by eliminating the underlying disease.

Drug treatment

In many ways, the treatment regimen depends on the stage of the pathological process. If the problem was identified at the compensated stage, then usually the disorder does not require special treatment. In this case, it is enough to follow certain recommendations to maintain heart function, namely:

• correct work and rest schedule;
• moderate physical exercise without overload;
• normalization of body weight;
• a balanced diet that includes a large amount of vitamins and unsaturated fats;
• giving up bad habits, in particular smoking and alcohol abuse.

Sometimes people with ventricular hypertrophy are given a disability group

In order to prevent further development of cardiac muscle overload, the following medications are prescribed:

• Atenolol or Metoprolol. These drugs restore heart rhythm and also reduce the oxygen demand of cells;
• Diltiazem or Verapamil. Prescribed to maintain normal blood pressure in blood vessels;
• Diroton or Enalapril. Effectively fight high blood pressure and heart failure;
• Losartan, Candesartan - reduce the mass of hypertrophied muscles.

Since the disorder is often accompanied by breathing problems, you will need to use drugs aimed at improving respiratory function:

• bronchodilators are drugs that improve the patency of the bronchi and increase their lumen;
• anti-inflammatory drugs normalize the functioning of the bronchi;
• drugs that reduce high pressure in the pulmonary artery.

The following can be said about the effectiveness of the treatment process:

• the size of the ventricle on the control study is much smaller;
• symptoms of heart failure disappear;
• there is a need to remove disability and restore working capacity;
• hypertensive crises, as well as attacks of angina pectoris and arrhythmia, pass;
• quality of life improves.

Drug therapy copes well with symptoms, but generally does not affect the etiological factor

Surgery

Surgical intervention is a last resort, which is resorted to only after the ineffectiveness of conservative methods or when severe heart defects are associated. The operation is usually performed at an early age. With the help of surgical intervention, a specialist acts on the root cause of the disorder.

Let's consider two main types of surgical intervention:

• aortic valve replacement. The operation is performed in two ways: either the chest is opened - this is a traditional technique, or the femoral artery is punctured - this is a minimally invasive intervention;
• prosthetics of not only the valve, but also the aortic part. Compared to the first type, this procedure is more traumatic and requires serious surgeon skills. In this case, either artificial prostheses or biological ones, made from pig tissue, are used.

Sometimes treatment is only possible after a heart transplant. This is a rather serious procedure that requires a large number of compatibility tests. In addition, even after the operation itself, the use of medications is required that will prevent rejection of the donor organ.

Allergy sufferers should use traditional recipes with caution

Traditional treatment

You should not reassure yourself by thinking that unconventional recipes will save you from the problem; miracles will not happen. It will not be possible to return the ventricles to their previous size and restore their previous function, but still folk recipes help lower blood pressure, strengthen the vascular wall and improve the contractility of the heart muscle.

It is best to buy medicinal plants in a pharmacy chain, where you are confident in the quality, correct collection and drying of the product. Let's look at three popular recipes:

• tincture of lily of the valley. The flowers of the plant should be placed in a dark glass container and filled with vodka. The product should infuse for two weeks. Once the tincture is filtered, it is ready for use. Take twenty drops three times a day;
• garlic tincture with the addition of honey and lemon helps stop atherosclerotic changes in blood vessels;
• St. John's wort decoction. For one hundred grams of dry St. John's wort, two liters of boiling water is used. After straining, you can add a small amount of honey. It is recommended to store in the refrigerator. People with serious liver disorders should not take this decoction.

So, despite the fact that ventricular hypertrophy is not a separate disease, its manifestation must be taken into account in the diagnosis of heart disease and subsequent treatment. The pathological process can lead to serious complications, including cardiac arrest. That is why you should regularly undergo a medical examination, and if you have any alarming symptoms from the heart, do not delay visiting a cardiologist.

Left ventricular hypertrophy is a thickening of the heart muscle and an increase in its size due to hypertrophy of cardiomyocytes.

The normal thickness of the walls of the left ventricle ranges from 9 to 14 mm. Cardiomyopathy is characterized by a significantly greater thickness of the walls of the LV, and different parts of it can be unevenly enlarged. Thus, the most common places subject to morphological changes are: the place of transition of the left ventricle into the aorta, the interventricular septum, the place of transition of the left atrium into the ventricle.

Diagnosis of pathology

The basis for diagnosis is two types of studies: electrocardiogram (ECG) and echocardiography (Echo-CG).
To date, there are about 10 known manifestations of left ventricular myocardial hypertrophy, which are recorded on an ECG. Unfortunately, most of them turn out to be nonspecific symptoms.
Normally, the muscle mass of the left ventricle is almost three times higher than the muscle mass of the right section of the heart of the same name. In individuals with hypertrophy, this difference is even more pronounced, therefore the ECG shows an increase in the electromotive force of the heart and the vector, these are signs indicating excitation of the LV. In addition, the duration of the period of excitation of the LV increases, which may be associated both with the hypertrophy of its cardiomyocytes and with the processes of sclerosis and dystrophy.

Features on the cardiogram during excitation of the LV myocardium.

1. An rS type electrocardiogram is recorded in the right thoracic branches (V1 and V2). The r wave in branch V1 is caused by the excitation process taking place in the left half of the interventricular septum. The height of S in the V1 lead is greater than it should be normally, which is also associated with the process of excitation of the myocardium of the hypertrophied LV.
2. An electrocardiogram of the qRs type, and more often qR, is recorded in the left thoracic branches. The height of the q wave in V6-thoracic is greater than normal, which is associated with the process of excitation of hypertrophied myocytes located in the left half of the interventricular septum. R in branch V6 also has a larger amplitude compared to normal. Its appearance is due to the process of excitation in the myocardium of the left ventricle. The process of excitation in the myocardium of the base of the LV is expressed in the appearance of the S wave in lead V6.

What does the electrocardiogram of a hypertrophied LV look like at the moment of repolarization:

1. location of the ST segment in the thoracic branch of V1 above the isoelectric line;
2. positive T in lead V1;
3. in lead V6, the ST segment is located below the isoelectric line;
4. in the V6 thoracic branch the T wave will be asymmetrical.

To confirm the diagnosis of LVH, it is necessary to know the signs of pathology in the thoracic branches.

1. Clear signs of the presence of LV hypertrophy are a significant height of R in the 5th and 6th thoracic branches. In this case, the pattern R V6 > R V5 > R V4 is important.
2. A high S wave is recorded in leads V1.2.
3. The more pronounced the degree of LV hypertrophy, the greater the R amplitude in the V5 and V6 thoracic branches, the deeper the S wave in V1 and V2 thoracic branches.
4. ST segments or ST segments with an upward-facing arc located lower than the isoelectric line in branch V5.
5. T will be asymmetrical and negative in the V5 and V6 chest leads, while the larger the R wave in the 5th and 6th chest leads, the greater the degree of reduction in the ST segment, the negativity of the T wave in the listed leads.
6. In the chest leads V1 and V2, the ST segment is recorded, with the convexity of the arc downwards, it is located above the isoelectric line.
7. In V1 and V2 chest leads, the T wave will be positive.
8. A pronounced rise in the ST segment and an increase in the amplitude of the positive T wave are observed in the right thoracic branches.
9. With LV hypertrophy on the cardiogram, the transition zone in most cases shifts to the right thoracic branches, the T wave in the 1st thoracic branch will be positive, and in the 6th thoracic branch it will be negative. The signs “T wave in V1 thoracic branch is greater than T wave in V6” are early in LVH in the absence of coronary circulatory insufficiency.

How is the EOS located for this symptom?

Most often, the EOS is located horizontally or can be moderately deviated to the left. For an isolated variant with left ventricular hypertrophy, it is not typical that the electrical axis is sharply shifted to the left. In a small percentage, the normal position of the EOS is recorded; the more common option is when the EOS has a semi-vertical position.

Specific quantitative signs on the cardiogram.

1. Sokolov-Lyon. The S wave in the V1 branch, together with the R wave in V5 thoracic and V6, will be greater than or equal to 35 mm.
2. Cornell sign: the sum of the R value in lead aVL + the S value in lead V3 + the S wave in lead 3 is equal to more than 28 mm for males, and more than 20 mm for women.
3. Gubner-Ungerleider: the sum of the R value in the 1st branch + the S value in the 3rd lead is equal to more than 25 mm.
4. In lead aVL, the R amplitude is greater than 7.5 mm, and the R in V5-6 is equal to or greater than 27 mm.

Classification of pathology according to signs on the electrocardiogram.

1. At the first stage, QRS complexes of high amplitude are recorded, the ST segment is not displaced, and T is positive.
2. In the second stage, the amplitude of the QRS complex increases, the ST segment is discordantly displaced, the T wave is reduced or has a flattened shape.
3. Third stage: QRS complexes are enlarged, the ST segment and T wave are changed discordantly.
4. Fourth stage. The development of cardiosclerosis leads to the appearance on the cardiogram of a secondary decrease in the amplitude of the QRS complex, repolarization is changed, as in the previous stage.

Left ventricular myocardial hypertrophy is also determined by a scoring system, according to the author of Romhilt-Estes. Definite LVH - when the sum is 5 points, possible LVH - the sum is 4 points.

1. Left atrial hypertrophy: in branch V1, the P wave is in a negative phase, duration 0.04 seconds or more = 3 points.
2. In branch V6 there is an ST segment and a T wave, discordantly displaced. If the patient takes cardiac glycosides = 1 point, persons not receiving glycoside therapy = 3 points.
3. If the EOS is deviated to the left by -30 degrees or even less, then this is equal to 2 points.
4. 1 point is given if the width of the QRS complex is equal to or more than 0.09 s.
5. If in branches V5 and V6 the duration of the internal deviation is 0.05 seconds or more, then another 1 point is added.
6. Voltage signs on the ECG: in the branches from the limbs, the amplitude of R and S is more than or equal to 20 mm, the height of the S wave in the branches of V1 and V2 is greater than or equal to 30 mm, and R in V5-V6 is equal to or more than 30 mm. For the presence of one of the signs, 1 point is added.

ECG signs of asymmetric LVH are important for differential diagnosis. The asymmetric form has two options: predominant hypertrophy of the myocardium of the interventricular septum or the apical region. Both variants are accompanied by a typical large R amplitude in the transitional and right thoracic branches. Negative symmetrical Ts appear in V5 - V6; they can be very deep, reaching a maximum in V3 - V4.
Among other signs, the appearance on the ECG in some cases of pathological Q is noted, most often in the following branches: aVF, aVL, in III, I.
The changes described above may be incorrectly assessed as a sign of coronary insufficiency or myocardial infarction.
The assessment of electrocardiogram data over time is of great clinical importance. The diagnosis of asymmetrical LVH can be confirmed using ventriculography or echocardiography.

With increased load on the myocardium, a gradual increase in its volume develops. This ultimately leads to hypertrophy.

Causes

The reasons why the load on the left ventricle of the heart increases can be either congenital or acquired. In the first case, valve defects or hereditary disorders of the heart structure are implied:

1. Aortic valve stenosis is accompanied by a decrease in the diameter of the left ventricular outlet, so it requires additional effort to move blood.
2. A similar mechanism of hypertrophy is observed when the diameter of the aorta itself decreases.
3. With a hereditary mutation in some genes responsible for the synthesis of proteins contained in myocardial muscle cells, an increase in the thickness of the walls of the heart occurs. This condition is called hypertrophic cardiomyopathy.

Acquired hypertrophy is most often associated with the following pathological conditions:

1. Hypertension ranks first among the causes of acquired increase in myocardial mass. Due to the fact that the heart constantly works at an increased rate and must maintain a higher level of systemic pressure, an increase in the volume of muscle cells gradually occurs.
2. Atherosclerosis of the aorta and its valve is accompanied by the deposition of cholesterol plaques, which calcify over time. In this regard, the main human artery and valve leaflets become less elastic and pliable. Therefore, resistance to blood flow increases and the tissue of the left ventricle of the heart experiences increased stress.

In 90% of cases, left ventricular hypertrophy is associated with hypertension.

Left ventricular hypertrophy in athletes is physiological and develops in response to constant load. Along with an increase in heart mass, this category of people experiences a decrease in heart rate and sometimes a slight decrease in resting blood pressure. This condition cannot be called pathological, because it does not lead to adverse consequences.

If in an athlete the increase in the mass of the left ventricle is so pronounced that it prevents the flow of blood into the systemic circle, one should look for other reasons for such changes.

Classification

Depending on whether the entire left ventricle is enlarged in volume or only some part of it, several types are distinguished:

1. Concentric, or symmetrical, hypertrophy is characterized by a uniform increase in the thickness of the walls of the ventricle.
2. Eccentric hypertrophy usually affects the interventricular septum, but sometimes the apical or lateral wall region may be involved.

Depending on the effect on systemic blood flow, hypertrophy can be:

1. Without outflow tract obstruction. In this case, the effect on systemic blood flow is minimal. Most often, concentric hypertrophy of the left ventricular myocardium, in contrast to the asymmetric form, is not accompanied by obstruction.
2. With obstruction of the outflow tract, when during contraction of the ventricle, that is, in systole, compression of the aortic mouth occurs. This creates an additional obstacle to the flow of blood and closes the so-called vicious circle. It further enhances hypertrophy

According to the degree of increase in the mass and thickness of the left ventricle, three stages are distinguished:

1. Severe hypertrophy is accompanied by an increase in thickness at the time of heart contraction of more than 25 mm.
2. The average degree is observed with the thickness of the myocardium.
3. Moderate left ventricular hypertrophy is diagnosed when the wall thickness is less than 21 mm, but more than 11 mm.

Symptoms

For quite a long time, symptoms of hypertrophy may be absent and it can only be detected through instrumental examination.

When increased myocardial mass begins to affect systemic blood flow, signs of disease gradually appear. At first they occur occasionally, only under significant loads. Over time, symptoms begin to bother the patient even at rest.

The most characteristic signs of left ventricular myocardial hypertrophy include:

• shortness of breath and feeling of lack of oxygen;
• heart rhythm disturbances (tachycardia, flicker, fibrillation, extrasystole), interruptions, pauses;
• characteristic anginal pain associated with a decrease in oxygen supply to the muscle cells of the heart;
• dizziness and fainting that occur when blood flow through the cerebral arteries is disrupted;
• heart failure, characterized by stagnation of blood in the respiratory circle (pulmonary edema, cardiac asthma).

Rarely, the first symptom of hypertrophy is cardiac death associated with circulatory arrest.

Diagnostics

Enlargement of the left ventricle can be suspected during examination, percussion and auscultation. In this case, there is a shift of the borders of the heart to the left. To clarify the diagnosis, a number of examinations should be performed:

1. Chest X-ray or fluorography is an imprecise diagnostic method, since the size of the heart in the image largely depends on the person’s position in front of the screen.
2. Voltage signs of left ventricular hypertrophy (increased amplitude of R waves) are usually more convincing, since this chamber makes the main contribution to the electrical activity of the heart.
3. However, left ventricular hypertrophy is not always noticeable on the ECG, especially in cases of moderate wall thickening. Therefore, all patients with suspected this pathology should undergo cardiac ultrasound. With ECHO-CG, it is possible not only to measure with very high accuracy the thickness of the left ventricle in various phases of contraction, but also to identify signs of outflow tract obstruction. It is usually expressed in mmHg. Art. and is referred to as the pressure gradient.
4. An exercise test provides an ECG recording while cycling or walking on a path. In this case, it is possible to evaluate the effect of hypertrophy on systemic blood flow during exercise. The results largely determine treatment tactics.
5. Daily monitoring allows you to register characteristic ECG signs of left ventricular hypertrophy: changes in the rhythm and frequency of heart contractions caused by oxygen starvation of muscle cells.

Diagnosis of hypertrophy is made during a routine examination, and several studies must be performed to confirm changes.

Additional methods of examining patients include:

• coronary angiography;
• ventriculography;
• myocardial biopsy;
• radioisotope research;
• MRI of the heart.

Treatment

Eccentric, concentric and moderate left ventricular hypertrophy are generally not curable. However, it is possible to stabilize the patient's condition, increase his life expectancy and improve his quality of life. Treatment should eliminate the cause of the disease. In this case, surgical techniques are more often used:

1. Aortic valve replacement, which is replaced with a metal structure or biological material obtained from a pig heart.
2. Mitral valve replacement is performed if severe valve insufficiency is observed. In this case, two types of valves are also used.
3. Partial removal of myocardial tissue or its dissection in the area of ​​the septum (myotomy and myectomy) is most often performed with eccentric hypertrophy of the left ventricle.
4. Aortic replacement is possible if there is a congenital defect. Usually the valve-aorta complex is transplanted.

Left ventricular hypertrophy can also be treated using symptomatic drug therapy. The most commonly prescribed drugs are:

1. Beta blockers reduce the heart rate, thereby reducing the load on the myocardium. By increasing the relaxation phase, they indirectly affect the volume of blood entering the aorta.
2. Calcium channel blockers dilate blood vessels and improve blood supply to central organs, including the heart.
3. ACE inhibitors are usually used for hypertension to lower blood pressure. They can also be used for severe heart failure.
4. Anticoagulants must be prescribed to all patients after valve replacement. Sometimes they are used as an independent method of treatment. These drugs prevent the formation of blood clots in the heart cavity and play a key role in the prevention of thromboembolism.
5. Antiarrhythmics are used for various heart contraction disorders, from harmless extrasystole to life-threatening ventricular tachycardia.
6. If the patient has an obstructive form of hypertrophy, then it is advisable to prevent endocarditis.

Treatment tactics for large thickness of the left ventricular wall are complex, but for aortic obstruction, the emphasis is on surgery.

In cases of serious rhythm disturbance, a pacemaker or cardioverter-defibrillator is installed. These devices are placed in the subclavian cavity, and wires are passed directly to the wall of the left ventricle and atrium. When tachycardia develops, the device generates a small electrical discharge and restarts the heart. In the event of a critical decrease in heart rate, the pacemaker stimulates muscle cells and forces the heart to contract in a given mode.

The prognosis for left ventricular hypertrophy is directly determined by the stage of its development. If there are no signs of obstruction and comprehensive treatment is carried out, the wall thickness usually no longer increases, and sometimes may even decrease slightly. In cases of obstruction, there is a high probability of disease progression. Even after surgery, the patient's life expectancy rarely exceeds 10 years.

Left ventricular hypertrophy - signs on the ECG. Treatment of myocardial hypertrophy of the left ventricle of the heart

LVH is a specific lesion of the heart, in which it increases in size and becomes more susceptible to any changes. Hypertrophy mainly affects the myocardium, the strongest muscle of the heart wall, making contractions difficult, as a result of which the risk of developing other diseases increases.

What is left ventricular hypertrophy of the heart?

Cardiac hypertrophy, or, in other words, hypertrophic cardiomyopathy, is a thickening of the wall of the left ventricle of the heart, which leads to malfunction of the aortic valve. The problem is common among patients with hypertension, as well as athletes, people leading a sedentary lifestyle, addicted to alcohol and those who have inherited a tendency to pathology.

Myocardial hypertension of the left ventricles of the heart belongs to class 9 on the ICD 10 scale, along with other diseases of the circulatory system. This pathology is mainly a syndrome of other heart diseases, of which it exhibits indirect signs. In order to prevent possible problems in the future, it is necessary to intensively treat the hypertrophied organ in a timely manner, immediately after pathologies are detected.

Degrees of left ventricular hypertrophy

Depending on the signs of LVH and the size of the deformed muscle tissue, several stages of the development of the disease can be distinguished:

Moderate left ventricular hypertrophy (LVH) occurs as a consequence of hypertension or other heart disease. This seemingly insignificant increase signals an overload of the heart and that the risk of myocardial diseases (heart attack, stroke) for the patient increases. It often occurs without any symptoms and is detected only by ECG analysis. If the left ventricle is enlarged, it is necessary to be treated with the help of specialists, preferably in an inpatient setting.

Severe LVH is characterized by dystrophic changes in which the mitral valve is located close to the surface of the septum and interferes with blood flow, causing excessive muscle tension and stress on the left ventricle.

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Enlargement of the left ventricle of the heart - causes

The causes of hypertrophy of the left ventricle of the heart can be varied, including both chronic and acquired diseases of different parts of the body:

• hypertension;
• obesity: the development of the disease is very dangerous in young children who are overweight;
• ischemia;
• diabetes;
• arrhythmia, atherosclerosis;
• frequent excessive physical activity;
• alcoholism, smoking;
• lung diseases;
• aortic stenosis;
• disturbances in the functioning of the mitral valve;
• stress, psychological illness, nervous exhaustion.

The development of the body in a child can occur with disruption of the processes of myocardial repolarization and, as a result, an increase in the walls of the ventricle. If such a situation arises, it must be prevented, and then monitored on a regular basis throughout adulthood and prevent progression. Constant exercise can naturally lead to heart enlargement, while work associated with heavy lifting is a potential threat of systolic overload, so you should normalize your physical activity and monitor your health.

Another indirect cause is sleep disturbance, in which a person stops breathing for a short period of time. It can be observed in women during menopause or in older people and entails consequences such as expansion of the diameter of the heart vessels, growth of the septum and walls of the heart, increased blood pressure, and arrhythmia.

Signs of left ventricular hypertrophy

Symptoms of cardiomyopathy are not always obvious, and people are often unaware that there is a problem. If the fetus does not develop properly during pregnancy, there may be a congenital defect and hypertrophy of the left side of the heart. Such cases must be observed from birth and complications should not be allowed. But if there are periodic interruptions in the heart's function and a person feels any of these signs, the walls of the ventricle may be abnormal. The symptoms of this problem are:

• labored breathing;
• weakness, fatigue;
• chest pain;
• low heart rate;
• swelling of the face in the afternoon;
• disturbed sleep: insomnia or excessive sleepiness;
• headache.

Types of left ventricular hypertrophy

The types of left ventricular hypertrophy vary depending on the structure of changes in the heart muscles. It happens: concentric and eccentric LVH, ventricular dilatation. They are distinguished based on echocardiographic indicators (cardiogram) and the thickness of the organ walls. Each type of LVH is not an independent disease, but occurs as a consequence of other pathologies in the human body.

Eccentric hypertrophy

Eccentric myocardial hypertrophy is characterized by an increase in the heart and the volume of its chambers in parallel with the thickening of the muscles of the left ventricle. It is provoked by a sharp growth of cardiomyocytes, their transverse size does not change. Also, eccentric LVH threatens to slow the pulse and cause breathing complications. Appears with heart defects or after a heart attack.

Concentric hypertrophy of the left ventricular myocardium

Concentric hypertension occurs due to hyperfunction of myocardiocytes due to pressure load. The size of the cavity does not change, sometimes it even becomes smaller. The size of the walls of the left ventricle, the total mass of the myocardium and the heart increase. Concentric hypertrophy occurs with hypertension, arterial hypertension; causes a decrease in coronary reserve.

Left ventricular dilatation

Dilatation is an expansion of the left ventricle of the heart and occurs when the myocardium changes or the healthy ventricle is overloaded. If the arc of the heart is lengthened, this can also be an initial symptom of LVH. Sometimes aortic stenosis leads to dilation, when the narrowed valve cannot perform its pumping function. Past illnesses are often the cause of heart enlargement; in rare cases, it can occur on its own, as a congenital pathology.

What is the danger of left ventricular hypertrophy?

If the left ventricle is hypertrophied, this is not a disease, but it can provoke many of them in the future, including fatal heart attacks, strokes, angina pectoris and other heart ailments. Often, organ enlargement occurs due to an active lifestyle, among athletes, when the heart works harder than in the average body. Such changes may not pose a threat, but in each individual case, qualified consultation and medical advice is necessary.

Diagnosis of cardiomyopathy

Diagnosis of left ventricular hypertrophy occurs in several ways: by identifying signs of the disease on an ECG, examining the heart using ultrasound or using a magnetic resonance imaging scanner. If you experience any heart problems or symptoms of illness, you should contact a cardiologist, and if you have already suffered some kind of defect and suspect complications, you need a cardiac surgeon and, possibly, a treatment system.

Left ventricular hypertrophy on ECG

ECG is a common diagnostic method that helps to find out the thickness of the heart muscle and voltage characteristics. However, it can be difficult to identify LVH on an ECG without the participation of other methods: an erroneous diagnosis of hypertrophy may be made, since on the ECG the signs that are characteristic of it can be observed in a healthy person. Therefore, if they are found in you, this may be due to increased body weight or its special constitution. Then it is worth conducting another echocardiographic examination.

LVH on ultrasound

Ultrasound examination helps to more likely judge individual factors and causes of hypertrophy. The advantage of ultrasound is that this method allows not only to diagnose, but also to determine the characteristics of the course of hypertrophy and the general condition of the heart muscle. Indicators of cardiac echocardiography reveal changes in the left ventricle such as:

• ventricular wall thickness;
• ratio of myocardial mass to body mass;
• coefficient of asymmetry of seals;
• direction and speed of blood flow.

MRI of the heart

Magnetic resonance imaging helps to clearly calculate the area and degree of enlargement of the ventricle, atrium or other compartment of the heart, and to understand how strong the degenerative changes are. MRI of the myocardium shows all the anatomical features and configuration of the heart, as if “stratifying” it, which gives the doctor complete visualization of the organ and detailed information about the condition of each department.

How to treat left ventricular hypertrophy of the heart

Many people are susceptible to cardiac hypertrophy. If the problem is severe, medical or surgical treatment of left ventricular hypertrophy is performed. In this case, depending on the extent of the damage, treatment can be aimed at preventing the progression of the disease or at returning the myocardium to its normal size. But it happens that this condition is reversible; if the disease cannot be cured completely, then regression can be achieved by correcting such things as:

• Lifestyle;
• food type;
• hormonal balance;
• excess weight;
• amount of physical activity.

Treatment of left ventricular hypertrophy with medication

Medicines for left ventricular hypertrophy of the heart can have an effective result if taken under the supervision of a doctor. It is impossible to completely eliminate the symptoms of hypertension, but taking antihypertensive drugs for this disease and following a diet will help fight the causes and prevent deterioration of health. To treat LVH, the following medications are prescribed:

Verapamil is an angiarrhythmic drug from the group of calcium channel blockers. Reduces myocardial contractility, reduces heart rate. Can be used by both adults and children, doses are set individually.

Beta blockers - reduce the pressure and volume load in the heart cavity, help to even out the rhythm and reduce the risk of defects.

Sartans - effectively reduce the overall load on the heart and remodel the myocardium.

Myocardial hypertension of the left heart belongs to class 9 on the ICD-10 scale, along with other diseases of the circulatory system. Preference should be given exclusively to drugs whose quality has been tested and proven clinically; experimental drugs may not only not have the expected effect, but also negatively affect overall health.

Cardiomyopathy surgical treatment

Surgery for left ventricular hypertrophy may be necessary to remove the hypertrophied portion of the muscle in late and advanced stages of the disease. To do this, a transplant of the entire heart or its individual parts is performed. If the cause of LVMH is damage to a valve or septum, transplantation of these specific organs is first attempted, which is simpler than whole-heart surgery. In the case of such an intervention, the patient will have to be under the supervision of a cardiologist for the rest of his life and take medications to prevent coronary thrombosis.

Traditional treatment of left ventricular hypertrophy

Treatment of hypertrophy of the left ventricle of the heart with folk remedies cannot help in the later stages of lesions, but it can be effective with minor increases, to prevent their development, and reduce the risk of more serious consequences. You will not be able to completely cure the disease, but traditional medicine can relieve discomfort, chest pain, weakness and fainting. The following means are known:

Herbal infusions as an auxiliary therapy during the main treatment (blueberry, motherwort, blasphemous hawthorn, horsetail, cornflower flowers, adonis)

Infused milk: boil and pour into a thermos overnight, or put in the oven until it turns brown.

Lily of the valley in the form of drops of tincture or gruel. For the tincture, pour vodka or alcohol into the lily of the valley, leave in a dark place for 2 weeks, take 10 drops 3 times a day for 2 months. Gruel: pour boiling water over lily of the valley flowers, leave for 10 minutes. Then drain the water, chop the plant and take a tablespoon 2 times a day. Recommended in combination with drops.

Garlic honey: mix crushed garlic with honey in a 1:1 ratio, leave for a week in a dark place, take 1 tablespoon 3 times a day before meals.

Dry red wine infused with dried rosemary. Pour wine over the leaves, leave for about a month in a dark place, strain and take before eating.

Cranberries, mashed with sugar: a teaspoon 4 times a day.

Diet for left ventricular hypertrophy of the heart

To adjust your diet for cardiomyopathy, follow these tips:

• give up salt;
• eat often, about 6 times a day, but in small portions;
• stop smoking, drink less alcohol;
• choose foods that are lower in fat and cholesterol;
• limit the amount of animal fats;
• Fermented milk, dairy products, fresh vegetables and fruits are healthy;
• eat less flour and sweets;
• if you are overweight, follow a diet to lose weight and reduce the load on your heart.

Video: left ventricular myocardial hypertrophy

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

What is left ventricular hypertrophy?

Left ventricular hypertrophy or cardiomyopathy is a very common heart disorder in patients diagnosed with hypertension. This is a rather dangerous disease, since its final stage is often death in 4% of all cases.

1. What is it?

Hypertrophy implies thickening of the walls of the left ventricle and this does not occur due to the characteristics of the internal space. The septum between the ventricles changes, and tissue elasticity is lost.

The thickening is not necessarily uniform, but can occur only in some areas of localization.

Hypertrophy itself is not a diagnosis, but is one of the symptoms of any disease of the cardiovascular system. This is mainly hypertension. In addition, we can distinguish various types of heart defects, frequent and heavy loads on the heart muscle.

In order for the heart muscle to begin to increase in size, the following conditions are necessary:

• A large load, which leads to expansion of the internal cavity of the heart. At the same time, during systole, the myocardium begins to contract more strongly.
• Pressure load on the heart, which is characterized by the fact that in order to expel blood, muscle contraction must occur much more often and stronger.

Both of these provoking factors will contribute to the thickening of contractile fibers - myofibrils of cardiomyocytes. At the same time, mechanisms for increasing connective tissue are launched. The heart needs to increase its ability to expand more and more, so collagen development will occur faster.

Therefore, it turns out that hypertrophy in almost all cases leads to disruption of the structure of the myocardium. The more intense the process of hypertrophy, the faster the ratio of collagen and myocytes decreases.

The most dangerous situation is intense and sudden physical activity. This applies to people who smoke, abuse alcohol, or sedentary individuals whose physical activity increases sharply. If a modification of the left ventricle did not lead to death, this does not mean that it is safe for health. It can lead to quite serious disorders - it could be a myocardial infarction or stroke.

Left ventricular hypertrophy is a signal that indicates a worsening of the conditions in which the myocardium is located at that time. This is like a warning, indicating to a person the need to stabilize his blood pressure and correctly distribute the load.

2. Causes of hypertrophy

One of the main causes of left ventricular hypertrophy is heredity. A genetic predisposition has been observed in those people who have a history of heart disease in their family. Thickening of the walls of the left ventricle in such people is observed quite often.

The reasons also include the following:

• hypertonic disease;
• cardiac ischemia;
• diabetes;
• atrial fibrillation;
• atherosclerosis;
• aortic valve stenosis;
• heavy weight;
• diseases of the peripheral system;
• great physical activity;
• emotional instability;
• anxiety, excitement, stress;
• muscular dystrophy;
• insufficient sleep and rest;
• inactivity;
• smoking;
• alcoholism;
• Farby's disease.

Long and intense sports and frequent training can also cause left ventricular hypertrophy. All of the above factors contribute to an increase in blood pulsation, as a result of which the heart muscle thickens. And this leads to thickening of the walls of the left ventricle.

3. Symptom

Hypertrophy provokes changes not only in the area of ​​the walls of the left ventricle. This expansion also extends outward. Very often, along with thickening of the inner wall, the septum between the ventricles becomes thicker.

The symptoms of the disease are heterogeneous. In some cases, patients do not even know for several years that they have left ventricular hypertrophy. It is also possible that at the very beginning of the disease the state of health becomes simply unbearable.

Angina pectoris is the most common symptom indicating ventricular hypertrophy. Its development occurs due to compression of the blood vessels that provide nutrition to the heart muscle. Atrial fibrillation also occurs, atrial fibrillation and myocardial starvation are observed.

Very often a person has a condition in which the heart seems to freeze for a moment and does not beat at all. This leads to loss of consciousness. Sometimes the appearance of shortness of breath may indicate hypertrophy.

There are a number of additional symptoms of left ventricular hypertrophy:

• high blood pressure;
• pressure changes;
• headache;
• arrhythmia;
• poor sleep;
• general weakness and poor health;
• heartache;
• chest pain.

The list of diseases in which hypertrophy is one of the symptoms is as follows:

• congenital heart defect;
• swelling in the lungs;
• glomerulonephritis in the acute stage;
• myocardial infarction;
• atherosclerosis;
• heart failure.

4. Treatment

In order to carry out qualified treatment, it is necessary not only to diagnose the disease, but also to determine its nature of occurrence and the characteristics of its course. Based on the examination data obtained, the most optimal method of treating hypertrophy is selected, the purpose of which is to normalize myocardial function and provide adequate medical or surgical treatment.

Treatment of hypertrophy involves the use of the drug verampil along with beta blockers. Their combined use reduces the symptoms of the disease and improves the general condition of the patient. As additional therapy, it is recommended to follow a certain diet and give up unhealthy habits. Physical activity should be moderate.

The possibility of surgical intervention should not be ruled out. Its essence is to eliminate a section of the heart muscle that has been hypertrophied.

If symptoms relevant to this disease appear, you should consult a cardiologist. Do not delay treatment, as the disease can cause serious complications and death.

Drugs

Correctly prescribed therapy includes drugs that normalize blood pressure and reduce heart rate. ACE inhibitors are also used to prevent the progression of hypertrophy. Thanks to them, the symptoms of the disease gradually decrease.

All medications are primarily aimed at improving myocardial nutrition and restoring normal heart rhythm. These include: Verapamil, beta blockers and antihypertensive drugs (Ramipril, Enalaprim and others).

Treatment with folk remedies

Traditional methods of treating traditional medicine in the treatment of hypertrophy are used, but not often. The exception is those substances that have antioxidant properties, as well as some plants that have a calming effect.

Plants that can strengthen the walls of blood vessels and cleanse the blood of atherosclerotic plaques are also used. Taking vitamins and dietary supplements containing potassium, omega, calcium, magnesium and selenium is useful.

As additional remedies for hypertrophy, decoctions and infusions of the following medicinal herbs are used:

• Mix 3 tablespoons of motherwort herb, 2 tablespoons of dried rosemary and wild rosemary, 1 spoon of kidney tea. Pour a large spoonful of this mixture into one and a half glasses of cold water and boil for 5 minutes. Wrap the broth in a warm cloth and leave for 4 hours. After straining, take half a glass warm three times a day before meals. The interval between taking the decoction and eating should be a quarter of an hour.
• Pounded cranberries with sugar, a small spoonful three times a day after meals, is considered very healthy.

Diet

A therapeutic diet is an integral part of the treatment of hypertrophy. You should eat up to 6 times a day in small portions.

You should avoid salt, fried, fatty and smoked foods. The diet should always include dairy and fermented milk products, fresh fruits and vegetables, seafood, and lean meats. Flour products should be limited, as well as reduce the consumption of sweet foods to a minimum, and limit animal fats.

What is myocardial hypertrophy? Description and history of the development of the disease.

5. Prevention

The main preventive actions to prevent the occurrence of left ventricular hypertrophy include:

1. Lifestyle changes:
   • to give up smoking;
   • alcohol abuse;
   • following a diet that includes cholesterol limited to 300 mg per day and minimal fat intake;
   • moderately active lifestyle.
2. Combating risk factors:
   • bringing body weight to normal levels;
   • normalization of blood pressure.
3. Control of hypertension and hyperlipidemia with medications is necessary if lifestyle correction does not bring results:
   • maintaining normal sugar levels;
   • control of other risk factors for diabetes;
   • reducing the tendency to the formation of blood clots;
   • Women of childbearing potential are advised to avoid taking oral contraceptives.

Compliance with all preventive measures in combination will avoid the occurrence of left ventricular hypertrophy. It will also improve overall well-being and improve the quality of life.

Left ventricular hypertrophy: symptoms and treatment

Left ventricular hypertrophy - main symptoms:

• Headache
• Weakness
• Sleep disturbance
• Dyspnea
• Chest pain
• Heart sinking
• Heartache
• Heart rhythm disturbance
• Loss of consciousness
• High blood pressure
• Discomfort behind the sternum
• Fluctuations in blood pressure
• Temporary absence of heartbeat

Left ventricular hypertrophy (cardiomyopathy) is a typical heart lesion in patients diagnosed with hypertension. Left ventricular hypertrophy, the symptoms of which allow us to consider this pathology as a process that involves structural adaptation of the heart in relation to the metabolic needs relevant to the myocardium, as well as changes occurring in hemodynamic parameters, is quite dangerous in the sense that the disease often ends in death.

general description

As statistics indicate, the mortality rate for left ventricular hypertrophy is about 4%. Let's consider the features of this disease.

Hypertrophy provokes a significant thickening of the wall of the left ventricle, and this thickening does not occur due to the characteristics of the internal space, which does not undergo changes. Quite often, hypertrophy leads to modification of the septum located between the right and left ventricles. Due to the ongoing hypertrophic changes, the wall loses elasticity, while its thickening can occur both uniformly and in specific areas of localization. All these features directly affect the course of the disease.

What is noteworthy is that left ventricular hypertrophy is often observed among young people, and often in itself it is not even a disease, nor is it a diagnosis, representing only one of the possible symptoms of any type of heart disease.

As we have already noted, left ventricular hypertrophy can develop due to hypertension. In addition, predisposing factors include various types of heart defects, frequent and significant stress.

This disease also occurs against the background of persistently high blood pressure. Meanwhile, it has been revealed that hypertrophy with its characteristic changes can also occur, as we noted, during physical activity, which in particular involves the appearance of a state of borderline load (loaders, athletes who unstably distribute loads).

The sharp and, at the same time, intense load that the myocardium receives in people whose lifestyle is predominantly sedentary, as well as in people who smoke and drink alcohol daily, becomes dangerous. And if left ventricular hypertrophy does not lead to death, this does not make it safe for the patient, because it can cause a stroke or myocardial infarction, which often entails quite serious consequences for the body. The nature of the disease can be congenital (hereditary) or acquired.

To summarize, it can be noted that left ventricular hypertrophy acts as a signal indicating the complication of the conditions in which the myocardium currently finds itself. That is, this is in some way a warning, which indicates the need to stabilize blood pressure, as well as correct distribution of the load.

Symptoms of left ventricular hypertrophy

Hypertrophy provokes significant modifications that occur in the area of ​​the walls of the left ventricle. A characteristic feature of the disease is that the expansion is distributed outward. Quite often, along with wall thickening, the septum located between the ventricles also becomes thickened.

The symptoms of the disease in question are characterized by heterogeneity of manifestations. In some cases, patients for many years may not even realize that they have left ventricular hypertrophy, but the possibility cannot be ruled out that its very beginning is literally unbearable for the patient due to poor health.

The most common symptom indicating left ventricular hypertrophy is angina pectoris, whose development occurs as a result of compression of the vessels that provide nutrition to the heart muscle. Ultimately, there is an increase in muscle size and its consumption of more oxygen in combination with nutrients. In addition to this symptom, atrial fibrillation also occurs, and manifestations in the form of atrial fibrillation and myocardial starvation are noted.

A frequent condition may also be in which the heart freezes for several moments and does not beat at all, which, in turn, provokes loss of consciousness. Sometimes shortness of breath may indicate the presence of the disease we are considering. Additionally, a number of the following symptoms are noted:

Among the diseases in which hypertrophy itself is one of the symptoms characterizing their course, the following are distinguished:

Left ventricular hypertrophy: treatment

Treatment of hypertrophy involves the use of verapamil in combination with beta blockers, which reduce symptoms caused by the cardiovascular system. As a complement to drug therapy, it is assumed to follow a diet, as well as give up existing bad habits.

Accordingly, you will have to quit smoking, reduce your salt intake, and lose weight. The diet should include dairy/fermented milk products, seafood, fresh vegetables and fruits. You will also need to reduce the amount of flour products, sweets and animal fats you consume. Physical activity should be moderate.

The possibility of surgical intervention, which involves removing a section of the heart muscle that has undergone hypertrophy, is also not excluded. It is noteworthy that the development of left ventricular hypertrophy is often observed over several decades.

If symptoms relevant to left ventricular hypertrophy occur, you should consult a cardiologist.

If you think that you have left ventricular hypertrophy and the symptoms characteristic of this disease, then a cardiologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Cardiomyopathies are a group of diseases that are united by the fact that during their progression, pathological changes in the structure of the myocardium are observed. As a result, this heart muscle ceases to function fully. Typically, the development of pathology is observed against the background of various extracardiac and cardiac disorders. This suggests that there are quite a lot of factors that can serve as a kind of “push” for the progression of pathology. Cardiomyopathy can be primary or secondary.

Extrasystole is one of the most common types of arrhythmias (that is, disturbances in the heart rhythm), characterized by the appearance of an extraordinary contraction from the heart muscle or several extraordinary contractions. Extrasystole, the symptoms of which occur not only in patients, but also in healthy people, can be provoked by overwork, psychological stress, as well as some other external irritants.

Neurocirculatory dystonia, or cardiac neurosis, is a disorder in the functioning of the cardiovascular system, which is associated with a violation of physiological neuroendocrine regulation. Most often it manifests itself in women and adolescents due to the influence of severe stress or heavy physical exertion. It appears much less frequently in people under fifteen and over forty years of age.

Diabetic nephropathy is a process of pathological changes in the renal vessels, which is caused by diabetes mellitus. This disease leads to the development of chronic renal failure and there is a high risk of death. The diagnosis is made through not only a physical examination of the patient, but also requires laboratory and instrumental examination methods.

Ventricular extrasystole is one of the forms of cardiac arrhythmia, which is characterized by the occurrence of extraordinary or premature contractions of the ventricles. Both adults and children can suffer from this disease.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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Update: December 2018

“Pumped” or “overworked heart”, under these names in everyday life, left ventricular hypertrophy (LVH) often appears. The left ventricle pushes out the bulk of the blood, which reaches the organs and limbs, the brain and nourishes the heart itself.

When this work takes place under extreme conditions, the muscle gradually thickens and the cavity of the left ventricle expands. Then, after different times in different people, the compensatory capabilities of the left ventricle fail and heart failure develops. The result of decompensation can be:

• ​shortness of breath
• ​swelling
• ​heart rhythm disturbances
• ​loss of consciousness.

The most unfavorable outcome may be death from.

Causes of left ventricular hypertrophy

​Persistent hypertension

The most likely cause of thickening of the left ventricular muscle of the heart is arterial hypertension, which does not stabilize for many years. When the heart has to pump blood against a high pressure gradient, pressure overload occurs and the myocardium is trained and thickened. Approximately 90% of left ventricular hypertrophies occur for this reason.

Cardiomegaly

This is a congenital hereditary or individual feature of the heart. A large heart in a large person may initially have wider chambers and thicker walls.

Athletes

​The heart of athletes hypertrophies due to physical exertion at the limit of what is possible. Exercising muscles constantly release additional volumes of blood into the general bloodstream, which the heart has to pump additionally. This is hypertrophy due to volume overload.

​ Heart valve defects

Heart valve defects (acquired or congenital) that impair blood flow in the systemic circulation (supravalvular, valvular or subvalvular stenosis of the aortic mouth, aortic stenosis with insufficiency, mitral insufficiency, ventricular septal defect) create conditions for volume overload.

Cardiac ischemia

With coronary heart disease, hypertrophy of the walls of the left ventricle occurs with diastolic dysfunction (impaired myocardial relaxation).

​ Cardiomyopathy

This is a group of diseases in which, against the background of sclerotic or dystrophic post-inflammatory changes, an increase or thickening of the parts of the heart is noted.

About cardiomyopathies

Pathological processes in myocardial cells are based on hereditary predisposition (idiopathic cardiopathy) or dystrophy and sclerosis. The latter are caused by allergies and toxic damage to heart cells, endocrine pathologies (excess catecholamines and somatotropic hormone), and immune disruptions.

Types of cardiomyopathies occurring with LVH:

Hypertrophic form

It may produce diffuse or limited symmetrical or asymmetrical thickening of the muscle layer of the left ventricle. At the same time, the volume of the heart chambers decreases. The disease most often affects men and is inherited.

Clinical manifestations depend on the severity of obstruction of the heart chambers. The obstructive variant gives the clinical picture of aortic stenosis: heart pain, dizziness, fainting, weakness, pallor, shortness of breath. Arrhythmias may be detected. As the disease progresses, signs of heart failure develop.

The boundaries of the heart expand (mainly due to the left sections). There is a downward displacement of the apical impulse and dullness of heart sounds. A functional systolic murmur is characteristic, heard after the first heart sound.

Dilated form

It is manifested by expansion of the chambers of the heart and hypertrophy of the myocardium of all its parts. At the same time, the contractile capabilities of the myocardium decrease. Only 10% of all cases of this cardiomyopathy occur in hereditary forms. In other cases, inflammatory and toxic factors are to blame. Dilated cardiopathy often manifests itself at a young age (30-35 years).

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

Types of LVH

• Concentric hypertrophy results in a reduction in the cavities of the heart and thickening of the myocardium. This type of hypertrophy is characteristic of arterial hypertension.
• The eccentric version is characterized by expansion of the cavities with simultaneous thickening of the walls. This occurs when there is pressure overload, such as heart defects.

Differences between different types of LVH

Complications of LVH

Moderate left ventricular hypertrophy is usually harmless. This is a compensatory reaction of the body designed to improve blood supply to organs and tissues. For a long time, a person may not notice hypertrophy, since it does not manifest itself in any way. As it progresses, the following may develop:

• myocardial ischemia, acute myocardial infarction,
• chronic cerebrovascular accidents, strokes,
• severe arrhythmias and sudden cardiac arrest.

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

Diagnosis of LVH

Inspection

Left ventricular hypertrophy can be suspected already during the initial examination of the patient. Upon examination, the bluish color of the nasolabial triangle or hands, increased breathing, and swelling are alarming. When tapping, there are expansions of the boundaries of the heart. When listening - noise, dullness of tones, accent of the second tone. The survey may reveal complaints about:

• shortness of breath
• interruptions in heart function
• dizziness
• fainting
• weakness.

ECG

Left ventricular hypertrophy on the ECG shows a characteristic change in the voltage of the R waves in the chest leads on the left.

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

ECG may cause errors in assessing hypertrophy. For example, an incorrectly placed chest electrode will give an incorrect idea of ​​the state of the myocardium.

Ultrasound of the heart

With ECHO-CS (ultrasound of the heart), hypertrophy is already confirmed or refuted based on visualization of the heart chambers, septa and walls. All cavity volumes and myocardial thickness are expressed in numbers that can be compared with the norm. ECHO-CS can establish a diagnosis of left ventricular hypertrophy, clarify its type and suggest the cause. The following criteria are used:

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

An increase in the last two indicators indicates concentric hypertrophy. If only the myocardial index exceeds the norm, there is eccentric LVH.

Other methods

• Doppler echocardioscopy- additional capabilities are provided by Doppler echocardioscopy, in which coronary blood flow can be assessed in more detail.
• MRI - magnetic resonance imaging is also used to visualize the heart, which fully reveals the anatomical features of the heart and allows you to scan it layer by layer, as if making slices in the longitudinal or transverse direction. Thus, areas of damage, dystrophy or sclerosis of the myocardium become better visible.

Treatment of left ventricular hypertrophy

Left ventricular hypertrophy, treatment of which always requires normalization of lifestyle, is often a reversible condition. It is important to give up smoking and other intoxications, lose weight, correct hormonal imbalances and dyslipidemia, and optimize physical activity. There are two directions in the treatment of left ventricular hypertrophy:

• Prevent progression of LVH
• An attempt to remodel the myocardium with a return to the normal size of the cavities and the thickness of the heart muscle.

• Beta blockers allow you to reduce the volume and pressure load, reduce the myocardial oxygen demand, solve some problems with rhythm disturbances and reduce the risks of cardiac accidents - Atenolol, Metoprolol, Betolok-Zok, Nadolol.
• Calcium channel blockers become the drugs of choice for severe atherosclerosis. Verapamil, Diltiazem.
• ACE inhibitors - and significantly inhibit the progression of myocardial hypertrophy. Enalapril, Lisinopril, Diroton are effective for hypertension and heart failure.
• Sartans (Candesartan, Losartan, Valsartan) very actively reduce the load on the heart and remodel the myocardium, reducing the mass of hypertrophied muscle.
• Antiarrhythmic drugs prescribed in the presence of complications in the form of heart rhythm disorders. Disapyramide, Quinidine.

Treatment is considered successful if:

• obstruction at the exit of the left ventricle decreases
• The patient's life expectancy increases
• rhythm disturbances, fainting, angina pectoris do not develop
• heart failure does not progress
• quality of life improves.

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

Atrial and ventricular hypertrophy

Atrial and ventricular hypertrophy is usually reflected on the ECG. However, in the early stages of hypertrophy of the heart, the ECG changes little, and in some cases even pronounced hypertrophy is not accompanied by noticeable electrocardiographic changes. In this regard, the value of electrocardiography in the diagnosis of atrial and ventricular hypertrophy is relative.

ECG changes during hypertrophy are associated with an increase in the mass of muscle fibers of a certain part of the heart. This is accompanied by an increase in the vector of this section, which is manifested on the ECG by an increase in the amplitude of the P waves with atrial hypertrophy and the QRS complex with ventricular hypertrophy. This increase is detected in leads whose axes are parallel to the total vector. Due to the enlargement of the teeth, the electrical axis deviates towards the hypertrophied section.

An increase in the time required to excite the hypertrophied part of the heart leads to the expansion of the corresponding waves on the ECG. An increase in the amplitude and width of the waves causes a change in the shape of the P waves and QRS complexes, characteristic of hypertrophy. At later stages of ventricular hypertrophy, a displacement of the ST segment appears discordant to the main wave of the QRS complex, as well as smoothness and then inversion of the T wave. Changes in the terminal part of the ventricular complex indicate the development of myocardial dystrophy and dilatation of the cavity of the hypertrophied ventricle.

Left atrial hypertrophy

With hypertrophy of the left atrium, the total atrial vector deviates to the left and backward. For hypertrophy of the left atrium, the most typical expansion of the P wave is more than 0.11 s, its splitting and increase in amplitude in leads I, II, aVR, aVL. In these leads, the P wave has a double-humped shape.

The height of the P II wave becomes equal to the height of the Ra wave and may even exceed it. In some cases, there is a vertical position of the atrial vector. In this case, the amplitude of the P wave in leads III and aVF exceeds that in leads I and aVL.

In the right chest leads with hypertrophy of the left atrium, a wide and deep negative phase of the P wave is noted. In leads V 3 -V 6, an extended and double-humped P wave is detected. The described shape of the P wave in standard and chest leads is known as P - mitrale, since it more common with mitral heart defects.

As mentioned above, the expansion and splitting of the P wave during left atrial hypertrophy is caused by a slowdown in impulse transmission along the atrial pathways.

A typical example of P-mitrale is presented on the ECG of a 48-year-old patient with a diagnosis of rheumatic heart disease, mitral valve insufficiency.

Right atrial hypertrophy

With hypertrophy of the right atrium, the total atrial vector deviates downward and slightly to the right. The main sign of right atrial hypertrophy is an increase in the amplitude of the P wave in leads II, III and aVF. The height of the P wave in these leads significantly exceeds the height of the P I wave. A negative P wave is often detected in lead aVL.

The P waves in leads II, III and aVF have a pointed shape, their width usually does not exceed normal. In lead aVR, the P wave is usually negative, deep, and pointed.

In the right chest leads, pointed positive P waves of increased amplitude are recorded. In some cases, with pronounced hypertrophy of the right atrium, the P waves in leads V 1 and V 2 may be negative.

Changes in the P wave, characteristic of hypertrophy of the right atrium, are called P-pulmonale; they are more common in diseases associated with increased pressure in the pulmonary artery system.
Hypertrophy of both atria

With hypertrophy of the two atria, the ECG reveals signs characteristic of both P-pulmonale and P-mitrale. There is a significant increase in the amplitude of the P wave, its expansion and splitting in the limb leads. Both the positive and negative phases of the P wave in lead V 1 are increased.

In the remaining chest leads, the amplitude and width of the P wave are also increased. This form of the P wave is known as the P cardiale. Signs of enlargement of one atrium in standard leads may be combined with signs of enlargement of the other atrium in chest leads.

The figure shows an ECG of a 35-year-old patient diagnosed with lung cancer, rheumatic mitral heart disease with predominant stenosis. The ECG shows an increase in the amplitude of the P wave in leads I and II, a negative P wave in lead III, the width of this wave exceeds 0.11 s. There is a pronounced negative phase of the P wave in lead V 1, high-amplitude P waves in leads V 5 and V 6.

All of these signs indicate hypertrophy of the left atrium. Along with this, there are undoubted signs of right atrium hypertrophy, in particular a pronounced positive phase of the P wave in lead V 1, high-amplitude, pointed P waves in leads V 2 and V 3, deep P waves in lead aVR. In addition, this ECG shows signs of right ventricular hypertrophy: deviation of the electrical axis of the heart to the right, shift of the transition zone to the left, ventricular complex of the qR type in lead V 1.
Left ventricular hypertrophy

With left ventricular hypertrophy, the total QRS vector deviates back and to the left relative to its original position. This deviation may be insignificant and often does not affect the position of the electrical axis in the frontal plane. Only when studying the ECG in dynamics can it be noted that the axis of the heart has become more horizontal (or less vertical) than before. In the initial horizontal position, the electrical axis can deviate up to -30°, and in some cases even more.

The most important diagnostic sign of left ventricular hypertrophy should be considered an increase in the amplitude of the R wave in leads V 4 -V 6. An increase in the R wave in these leads of more than 25 mm is considered reliable. The R wave in leads V5 and V6 is often higher than in lead V4, which is also important for diagnosing this pathology.

In addition to the increase in the R wave in the left chest leads, there is an increase in the S wave in leads V 1 - V 3, the amplitude of which can exceed 25 mm. However, an increase in the R wave in the left and the S wave in the right precordial leads is not always combined.

Often only one of these signs is detected. With left ventricular hypertrophy, the sum of the amplitudes of the R waves in lead V 5 or V 6 and S in lead V 1 exceeds 35 mm. The transition zone sometimes shifts to the right (closer to lead V 1).

Severe left ventricular hypertrophy is characterized by an increase in the time of internal deviation in leads V 5 and V 6 by more than 0.05 s, i.e., a picture of incomplete blockade of the left leg appears.

In some cases, with left ventricular hypertrophy, there is a rather deep q wave in the leads where high R waves are recorded (usually in leads I, aVL, V 5 and V 6), which may be due to hypertrophy of the interventricular septum.

In this case, the width of the q wave usually does not exceed 0.03 s, and the depth– 0.25% of the amplitude of the R wave. Occasionally, in patients with left ventricular hypertrophy, a QS-type ventricular complex is observed in the right precordial leads.

With dystrophy of the left ventricular myocardium, the final part of the ventricular complex changes on the ECG. In leads where a high R wave is recorded, ST segment depression and T wave inversion are noted. These changes are usually most pronounced in the left precordial leads. In the right precordial leads, on the contrary, there is ST segment elevation above the isoelectric line along with a deep S wave. These changes progress over time.

Left ventricular hypertrophy (changes in the terminal part of the ventricular complex)

Changes in the terminal portion of the ventricular complex sometimes mimic signs of acute ischemia and myocardial damage. Correct diagnosis is helped by clinical manifestations, the absence of rapid ECG dynamics characteristic of acute coronary insufficiency, as well as other electrocardiographic signs of left ventricular hypertrophy.

Typical signs of severe left ventricular hypertrophy with dystrophic changes in the myocardium can be seen on the ECG of a 63-year-old patient diagnosed with rheumatic heart disease, aortic stenosis. There is a deviation of the electrical axis of the heart to the left up to -15°, an increase in the amplitude of the R wave in lead V5 by more than 30 mm and the amplitude of the S wave in V 1 by more than 25 mm. The R wave in lead V5 is higher than in lead V4. The internal deviation time in the left precordial leads exceeds 0.05 s. There is ST segment depression and T wave inversion in leads I, aVL, V 5 and V 6, as well as ST segment elevation in leads V 1 and V 2. Signs of left atrial hypertrophy are also detected.

In rare cases, a significant enlargement of the left ventricle leads to a pronounced rotation of the heart around the longitudinal axis with the right ventricle forward and to the left. The left ventricle is located behind. With this rotation, ventricular complexes of the QS type are recorded in the right chest leads, and with a predominant S wave in the left chest leads. The appearance of such an electrocardiographic picture is also facilitated by blockade of the left anterior branch.

The figure shows an ECG of an 82-year-old patient with a diagnosis of stage III hypertension, coronary heart disease, exertional and resting angina, atherosclerotic cardiosclerosis. The ECG shows signs of atrial hypertrophy, mainly the left one, as indicated by the expansion and splitting of the P wave in leads II, III, V 3 -V 6 and the pronounced negative phase of this wave in lead V 1.

First degree atrioventricular block is noted, probably of the proximal type. In addition, there are obvious signs of left ventricular hypertrophy, in particular a significant increase in the amplitude of the S wave in leads II, III, aVF, V 3 and V 4 with discordant ST segment elevation, signs of slower conduction along the left branches, mainly the anterior one. The axis of the heart is sharply deviated to the left to -75°. Noteworthy is the predominance of the S wave in leads V 4 -V 6, which is apparently associated with a significant backward rotation of the heart by the left ventricle and with blockade of the left anterior branch.

Right ventricular hypertrophy (type 1)

Slight hypertrophy of the right ventricle, as a rule, is not detected on the ECG due to the physiological predominance of the potentials of the more massive left ventricle. Severe hypertrophy of the right ventricle leads to deviation of the electrical axis of the heart to the right and rotation of the heart around the longitudinal axis clockwise. Sometimes, due to pulmonary emphysema, the heart deviates with its apex posteriorly.

Deviation of the electrical axis of the heart to the right is one of the most common signs of right ventricular hypertrophy. More often you see a slight axis deviation from +95° to +110°. A deviation to the right of more than 110° more reliably indicates right ventricular enlargement.

The QRS complex in leads I and aVL usually has the form rS, and in leads III and aVF- qR. When the heart turns its apex posteriorly, a deep, sometimes dominant, S wave is revealed in leads I, II and III (the so-called 5-type, or “three S syndrome”).

An important and common sign of right ventricular hypertrophy– an increase in the amplitude of the R wave in lead aVR by more than 5 mm (0.5 mV).

The most common sign of right ventricular hypertrophy in the precordial leads is a shift of the transition zone to the left. In this case, a pronounced S wave is recorded up to lead V 6, and sometimes even further to the left.

An important diagnostic sign of right ventricular hypertrophy– an increase in the time of internal deviation in lead V 1, which is associated with a slowdown in the activation of the hypertrophied section.

The QRS complex in lead V1 can have different shapes. Depending on this, 3 types of ECG can be distinguished for right ventricular hypertrophy. The first type is characterized by a high R wave in lead V1. This wave reflects the potentials of an enlarged right ventricle, therefore an increase in the amplitude of the R wave in lead V 1 by more than 7 mm very reliably indicates hypertrophy of this section.

The ventricular complex can have the form R, RS or qR. This type of ECG is observed with severe hypertrophy of the right ventricle and occurs infrequently, mainly in patients with congenital heart defects. Some authors believe that the q wave in lead V 1 indicates pronounced hypertrophy and dilatation of the right ventricle and classify this option as a separate type of ECG [Bober S. et al., 1974].

The figure shows an ECG of a 28-year-old patient diagnosed with congenital heart disease, pulmonary artery stenosis. The ECG shows signs of right ventricular hypertrophy of the first type: an increase in the R wave in lead V 1 to 20 cm, a displacement of the transition zone to the left of V 6, a deviation of the electrical axis of the heart to the right (A QRSII = +120°).

Right ventricular hypertrophy (type 2)

The second type of ECG is manifested by splitting of the ventricular complex in lead V 1 in the form of rSR I, i.e., a picture of incomplete blockade of the right bundle branch, which is considered one of the signs of right ventricular hypertrophy. This form of the ventricular complex may be associated not only with right bundle branch block, but also with other factors. This type of ECG occurs more often than the first, mainly in patients with mitral stenosis, as well as with chronic pulmonary diseases.

Over time, incomplete blockade of the right leg in such patients can transform into complete blockade; some authors consider it as a special type of ECG for right ventricular hypertrophy. With this option, the amplitude of the R wave in lead V 1 is increased.

The third type of ECG is characterized by a low-amplitude r wave and a pronounced S wave (ventricular complex of the rS type) in lead V 1 and in subsequent precordial leads. Sometimes this reveals a pronounced S wave in leads I, II and III (S-type ECG). Sometimes with this type of ECG the QRS complex in leads I and aVL or III and aVF has the form rSr I. This type of ECG is more common in patients with pulmonary emphysema with the development of chronic pulmonary heart disease.

The figure shows an ECG of an 83-year-old patient with a diagnosis of chronic obstructive bronchitis, pulmonary emphysema, and pneumosclerosis. There is an increase in the amplitude of the P wave with a typical change in its shape in leads II, III and aVF, inversion of the P wave in lead aVL, which indicates hypertrophy of the right atrium. Low-amplitude QRS complexes, split in leads II, III and aVF, a predominant S wave in leads V 1 -V 5 and a sharp shift of the transition zone to the left indicate hypertrophy of the right ventricle.

In some patients with cor pulmonale, the ECG reveals a QS-type ventricular complex in the right precordial leads, along with clear signs of right ventricular hypertrophy in the limb leads and left precordial leads. The QS wave in leads V1-V3 requires differential diagnosis with myocardial infarction.

With hypertrophy of the right ventricle with dystrophic processes in the myocardium, changes in the final part of the ventricular complex are observed in the form of depression of the ST segment and inversion of the T wave in the leads where a high R wave is recorded (III, aVF, V 1). In leads where a deep S wave is detected, there is ST segment elevation.

Right ventricular hypertrophy is indirectly indicated by signs of enlargement of the right atrium.

Hypertrophy of both ventricles

Electrocardiographic manifestations of combined hypertrophy occur only in a small part of patients with this pathology, since signs of enlargement of the right and left ventricles often cancel each other out. With a significant predominance of the potentials of one of the ventricles on the ECG, only signs of its hypertrophy are possible, and with a uniform increase in both ventricles, the ECG may not differ from normal.

However, sometimes the ECG shows signs of hypertrophy of the right and left ventricles simultaneously. Thus, signs of left ventricular hypertrophy in the precordial leads can be combined with deviation of the heart axis to the right, a high R wave in lead aVR and other manifestations of right ventricular hypertrophy in the limb leads.

Sometimes you can see the opposite combination: indication of right ventricular hypertrophy in the precordial leads (high R wave in lead V 1, displacement of the transition zone to the left, etc.) and signs of left ventricular hypertrophy in the limb leads (deviation of the heart axis to the left). In the chest leads there are simultaneously signs of hypertrophy of both ventricles, for example, a ventricular complex of the rSR 1 type in lead V 1 and a high R wave in the left chest leads.

Signs of right ventricular hypertrophy in standard and precordial leads can be combined with an increase in the amplitude of the S wave in leads V 1 -V 3, which is an indicator of a concomitant enlargement of the left ventricle.

An example of hypertrophy of both ventricles is the ECG shown in the figure of a 28-year-old patient with a diagnosis of rheumatic combined heart disease, recurrent rheumatic carditis, atrial fibrillation, and circulatory failure of the second degree. The ECG shows signs of right ventricular hypertrophy, in particular deviation of the electrical axis of the heart to the right, with a clockwise rotation around the longitudinal axis (Q III S I syndrome), an increase in the amplitude and width of the R wave in leads V 1 and V 2.

In addition, there are indications of left ventricular hypertrophy: an increase in the amplitude of the R wave in lead V 5 is more than 25 mm, the R wave in leads V 5 and V 6 is higher than in V 4. There are signs of diffuse changes in the myocardium.