Hypertrophy of the interventricular septum. What is hypertrophic cardiomyopathy? The course of hypertrophic hypertrophic cardiomyopathy

External manifestations of the disease are usually preceded by a long asymptomatic period.
The first symptoms usually occur in young age(20-35 years).

Shortness of breath (rapid breathing), often accompanied by dissatisfaction with breathing. Initially, shortness of breath appears with significant exertion, then with light exertion and at rest. In some patients, shortness of breath increases with the transition to a vertical position, which is associated with a decrease in blood flow to the heart.
Dizziness, fainting (loss of consciousness) are associated with a deterioration in the blood supply to the brain due to a decrease in the volume of blood ejected from the left ventricle into the aorta (the largest vessel in the human body). Dizziness and fainting are provoked by a rapid transition to a vertical position, physical exertion, straining (for example, with constipation and weight lifting), and sometimes by eating.
Pressing, squeezing pain behind the sternum (the central bone of the anterior chest to which the ribs are attached) occurs due to reduced blood flow to the heart's own arteries. The reasons for this: insufficient relaxation of the heart muscle and an increase in oxygen demand and nutrients increased muscle mass of the heart. Taking drugs from the nitrate group (nitric acid salts that dilate the heart's own vessels) does not relieve pain in such patients (unlike pain in coronary heart disease, a disease associated with obstruction of blood flow through the heart's own arteries).
The feeling of an accelerated heartbeat and interruptions in the work of the heart appear with the development of heart rhythm disturbances.
Sudden cardiac death (non-violent death caused by heart disease, manifested sudden loss consciousness within 1 hour of onset acute symptoms) may be the first and only manifestation of the disease.

Forms

Depending on the symmetry of hypertrophy (increase in thickness), the muscles of the heart secrete symmetrical And asymmetrical shape.

symmetrical shape hypertrophic cardiomyopathy - the same thickening of the anterior and posterior walls of the left ventricle, as well as the interventricular septum - concentric (that is, in a circle) hypertrophy (thickening). In some patients, the thickness of the muscle of the right ventricle simultaneously increases.
Asymmetric form of hypertrophic cardiomyopathy - predominant hypertrophy of the upper, middle or lower third interventricular septum (septum between the left and right ventricles of the heart), the thickness of which becomes 1.5-3.0 times greater than that of rear wall left ventricle (normally they are the same). In some patients, hypertrophy of the interventricular septum is combined with hypertrophy of the anterior, lateral, or apical region of the left ventricle, but the thickness of the posterior wall never increases. This form occurs in about 2/3 of patients.

Depending on the presence of obstructions to the blood flow from the left ventricle to the aorta, obstructive And non-obstructive form.

Obstructive form of hypertrophic cardiomyopathy (a thickened muscle of the interventricular septum creates an obstruction to blood flow). Another name for this form is subaortic (that is, under the aorta) subvalvular stenosis.
Non-obstructive form of hypertrophic cardiomyopathy (no obstruction to blood flow).

Etiological (that is, depending on the cause) classification of hypertrophic cardiomyopathies is distinguished idiopathic (primary) And secondary cardiomyopathy.

idiopathic (that is, the cause of which is unknown), or primary hypertrophic cardiomyopathy. Associated with the inheritance of altered genes (carriers of hereditary information) or with spontaneous mutation(sudden persistent changes) of genes that control the structure and function of the contractile proteins of the heart muscle.
Secondary hypertrophic cardiomyopathy (develops in elderly patients with arterial hypertension(prolonged increase in blood pressure), if during their prenatal development there were special changes in the structure of the heart). Many physicians disagree with the etiological classification and consider only idiopathic (primary) cases as hypertrophic cardiomyopathy.

Causes

Primary hypertrophic cardiomyopathy in half of the cases is familial, that is, a special structure of the contractile proteins of the heart is inherited, which contributes to the rapid growth of individual muscle fibers.
In cases where there is no hereditary nature of hypertrophic cardiomyopathy, the disease is associated with a spontaneous mutation (sudden persistent changes) of genes that control the structure and function of the contractile proteins of the heart muscle. The mutation is likely to occur under the influence adverse factors external environment (ionizing treatment, smoking, infections, etc.) during the mother's pregnancy.
The cause of secondary hypertrophic cardiomyopathy is a long-term persistent increase in blood pressure in elderly patients with special changes in the structure of the heart that occurred during their prenatal period.
Risk factors for hypertrophic cardiomyopathy include hereditary predisposition and age of 20-40 years.
The risk factor for the development of mutations that can lead to hypertrophic cardiomyopathy is the effect of ionizing treatment, smoking, infections, etc. on the body of a pregnant woman.

Diagnostics

Analysis of the anamnesis of the disease and complaints (when (how long ago) shortness of breath, dizziness, fainting, a feeling of irregular heartbeat appeared, with which the patient associates the appearance of complaints).
Life history analysis. It turns out what the patient and his close relatives were ill with, whether hypertrophic cardiomyopathy was detected in the patient's relatives, whether he had a persistent increase in blood pressure, whether he was in contact with toxic substances.
Physical examination. Color is determined skin(with hypertrophic cardiomyopathy, pallor or cyanosis - cyanosis of the skin - due to insufficient blood flow may develop). With percussion (tapping), an increase in the heart to the left is determined. During auscultation (listening) of the heart, systolic (that is, during ventricular contraction) noise above the aorta can be heard due to narrowing of the cavity of the left ventricle under the aortic valve. Blood pressure is normal or high.
Blood and urine tests are performed to detect comorbidities.
Blood chemistry. The level of cholesterol and other lipids (fat-like substances), blood sugar, creatinine (a breakdown product of protein), uric acid (a breakdown product of substances from the cell nucleus) is determined to identify concomitant organ damage.
A detailed coagulogram (determination of indicators of the blood coagulation system) allows you to determine increased clotting blood, a significant consumption of coagulation factors (substances used to build blood clots), to detect the appearance of blood clots decay products in the blood (normally there should be no clots and their decay products).
Electrocardiography (ECG). With hypertrophic cardiomyopathy, an increase in the ventricles of the heart is detected. Perhaps the appearance of heart rhythm disturbances and intracardiac blockades (disturbances in the conduction of an electrical impulse through the heart muscle).
24-hour monitoring of the electrocardiogram (SMEKG) makes it possible to assess the frequency and severity of cardiac arrhythmias and intracardiac blockades, to evaluate the effectiveness of the treatment of arrhythmias.
Stress electrocardiographic studies are an ECG test with dosed physical activity using a bicycle ergometer (specialized bicycle) or treadmill (treadmill). These research methods allow us to assess the tolerance of physical activity, to give recommendations for treatment.
A phonocardiogram (a method for analyzing heart sounds) in hypertrophic cardiomyopathy demonstrates the presence of systolic (that is, during ventricular contraction) murmur over the aorta due to narrowing of the left ventricular cavity under the aortic valve.
Plain chest x-ray allows you to assess the size and configuration of the heart, to determine the presence of stagnation of blood in the vessels of the lungs. Hypertrophic cardiomyopathy is characterized by normal or slightly enlarged heart size, since thickening of the heart muscle occurs predominantly inward.
Echocardiography (ultrasound examination (ultrasound) of the heart) allows you to assess the size of the cavities and the thickness of the heart muscle, to detect heart defects. With hypertrophic cardiomyopathy, echocardiography reveals a decrease in the cavity of the left, less often - the right ventricle with an increase in the thickness of the interventricular septum and (in every third patient) the free walls of the left ventricle. Doppler echocardiography (ultrasound examination of the movement of blood through the vessels and cavities of the heart) reveals disturbances in the movement of blood during the formation of heart defects (most often - insufficiency of the mitral and tricuspid valves).
Spiral CT scan(SCT) - a method based on a series of x-rays on different depth- allows you to get an accurate image of the organs under study (heart and lungs).
Magnetic resonance imaging (MRI) - a method based on building chains of water when exposed to strong magnets on the human body - allows you to get an accurate image of the examined organs (heart and lungs).
Genetic analysis to identify genes (carriers of hereditary information) responsible for the development of hereditary hypertrophic cardiomyopathy is carried out in close relatives of patients with this disease.
Radionuclide ventriculography (a research method in which a radioactive drug is injected into the patient's blood - that is, emitting gamma rays - a drug, and then images of radiation from the patient are taken and analyzed on a computer). It is carried out mainly in the case of low information content of echocardiography (for example, in patients with obesity), as well as in preparing the patient for surgical treatment. Radionuclide ventriculography in hypertrophic cardiomyopathy demonstrates an increase in the thickness of the walls of the ventricles and interventricular septum, a decrease in the cavity of the left (rarely right) ventricle, normal contractility hearts.
Cardiac catheterization (a diagnostic method based on the introduction of catheters - medical instruments in the form of a tube - into the cavity of the heart and measurement of pressure in the atria and ventricles). With hypertrophic cardiomyopathy, a slow blood flow from the left ventricle to the aorta is determined, while the pressure in the cavity of the left ventricle becomes significantly higher than in the aorta (normally they are equal). This method of research is carried out mainly for performing endomyocardial biopsy (see below) only if other methods of research do not allow the diagnosis.
Endomyocardial biopsy (taking a piece of heart muscle for examination along with the inner lining of the heart) is performed during cardiac catheterization only if other research methods do not allow the diagnosis to be made. In the biopsy (test material obtained by biopsy) with hypertrophic cardiomyopathy, an increase in the thickness and length of individual muscle fibers, their chaotic location, the presence of cicatricial changes in the heart muscle, and thickening of the walls of the small own arteries of the heart are characteristic.
Coronary cardiography (CCG) is a method in which a contrast (dye) is injected into the own vessels of the heart and the cavity of the heart, which makes it possible to obtain an accurate image of them, as well as to evaluate the movement of blood flow. It is performed in patients over 40 years of age to identify the state of their own heart vessels and determine the presence of coronary heart disease (a disease associated with insufficient blood flow to the heart muscle through the own vessels of the heart), as well as before the planned surgical treatment.
Consultation is also possible.
It is also possible to consult a cardiac surgeon.

Treatment of hypertrophic cardiomyopathy

Non-drug treatment is carried out according to general principles.

Conservative (that is, without surgery) treatment. specific treatment hypertrophic cardiomyopathy does not exist.
- In hypertrophic cardiomyopathy, drugs are started with the smallest dosages, followed by an individual dose increase (to reduce the risk of worsening blood flow from the left ventricle to the aorta).
- The effectiveness of drugs in different patients is different, which is associated with individual sensitivity, as well as different severity structural disturbances hearts.
- Drugs used in the treatment of hypertrophic cardiomyopathy in pregnancy:
  - beta-blockers (drugs that block beta-adrenergic receptors of the heart, blood vessels and lungs) control blood pressure and heart rate, reduce heart rhythm disturbances. Beta-blockers are used only in the third trimester of pregnancy. IN rare cases beta-blockers can cause fetal growth retardation, oxygen starvation of the fetus, low level glucose (simple carbohydrate) in the baby's blood immediately after birth;
  - calcium antagonists (drugs that prevent the entry of calcium ions - a special metal - into the cell) of the verapamil group increase blood flow through the heart's own arteries, improve relaxation and reduce heart stiffness. Calcium antagonists are approved for use in the second half of pregnancy;
  - calcium antagonists of the diltiazem group have positive effects, close to the verapamil group, but to a lesser extent improve the performance of patients;
  - treatment and prevention of thromboembolism (separation of blood clots from the place of their formation (with hypertrophic cardiomyopathy - mainly on the inner shell of the heart of the heart above the zone of thickening of the heart muscle and their movement with the blood flow, followed by closure of the lumen of any vessel) is carried out according to general principles.

Surgical treatment of patients with severe hypertrophy (increase in muscle thickness) of the interventricular septum (septum between the left and right ventricles) is preferably performed before pregnancy. Types of operations.
- Myotomy (myoectomy) - surgical removal inside of the interventricular septum. The operation is carried out on open heart.
- Ethanol ablation - the introduction of a concentrated solution of medical alcohol into the thickened interventricular septum using a puncture of the chest and heart under ultrasound control. Alcohol causes the death of living cells. After resorption dead cells and the formation of a scar in their place, the thickness of the interventricular septum becomes smaller, which reduces the obstruction to blood flow from the left ventricle to the aorta.
- Resynchronization therapy is a method of treatment by restoring impaired intracardiac conduction. It is performed using the implantation (implantation) of a three-chamber (with the placement of electrodes in the right atrium and both ventricles) electrical stimulator (a device that generates electrical impulses and transmits them to the heart). In patients with non-simultaneous contraction of the left and right ventricles of the heart or non-simultaneous contraction of individual muscle bundles of the ventricles (determined by electrocardiography) this method treatment allows to improve intracardiac blood flow, prevent the development severe complications.
- Implantation of a cardioverter-defibrillator: implantation under the skin or muscle of the abdomen or chest of a special device connected by electrodes (wires) to the heart and constantly taking an intracardiac electrocardiogram. When a life-threatening cardiac arrhythmia occurs, the cardioverter-defibrillator delivers an electrical shock through the electrode to the heart, causing recovery heart rate.

Complications and consequences

Complications of hypertrophic cardiomyopathy (in descending order of frequency of occurrence).

Rhythm and conduction disturbances. According to the daily monitoring of the electrocardiogram, arrhythmias (cardiac arrhythmias) are observed in almost every patient with hypertrophic cardiomyopathy. In some cases, they significantly aggravate the course of the disease, leading to the development of severe heart failure, fainting, thromboembolism. Heart blocks (disturbances in the passage of an electrical impulse through the heart muscle) develop in about every third patient with hypertrophic cardiomyopathy, and can cause fainting and cardiac arrest.
Sudden cardiac death (non-violent death caused by heart disease, manifested by a sudden loss of consciousness within 1 hour of the onset of acute symptoms) develops due to serious disturbances in the rhythm and conduction of the heart.
Infective endocarditis (infectious (that is, arising from the introduction and reproduction in the human body of pathogenic - that is, disease-causing- microorganisms) damage to the endothelium (the inner lining of the heart) and valves by various pathogens) occurs in about every twentieth patient with hypertrophic cardiomyopathy. As a result of the infectious process, heart valve insufficiency develops.
Thromboembolism (closing of the lumen of the vessel with a blood clot formed elsewhere and carried by the blood flow) complicates the course of hypertrophic cardiomyopathy in approximately one in thirty patients. Usually there is a thromboembolism of the vessels of the brain, less often - the vessels of the extremities and internal organs. As a rule, they occur with atrial fibrillation (a heart rhythm disorder in which individual parts of the atria contract independently of each other, and only a part of the electrical impulses are conducted to the ventricles).
Chronic heart failure is a disease with a complex of characteristic symptoms (shortness of breath, fatigue, decreased physical activity), which are associated with insufficient blood supply to the organs with blood at rest or during exercise, and are also often accompanied by fluid retention in the body. Chronic heart failure develops with a long course of hypertrophic cardiomyopathy with the replacement of a large number of muscle fibers with scar tissue.

Prognosis for hypertrophic cardiomyopathy . The natural course of hypertrophic cardiomyopathy is quite variable. For many patients, their health improves or stabilizes over time. The highest risk of sudden cardiac death is observed in young people with minor structural changes heart, and death often occurs during or immediately after exercise.

Prevention of hypertrophic cardiomyopathy

Methods for the specific prevention of cardiomyopathies have not been developed.
Examination of close relatives of a patient with hypertensive cardiomyopathy (including genetic analysis- determination of the presence in the body of genes - carriers of hereditary information - responsible for the occurrence of hypertrophic cardiomyopathy) allows you to identify their disease at an early stage, start complete treatment and thereby lengthen the lifespan. Echocardiography (ultrasound examination of the heart) for young relatives of a patient with hypertrophic cardiomyopathy (from birth to 40 years) should preferably be performed repeatedly (for example, once a year).
Annual medical examination of the population (preferably with daily monitoring of the electrocardiogram) is able to detect this disease at an early stage, which contributes to timely treatment and lengthening the patient's life.

Additionally

The incidence of hypertrophic cardiomyopathy is 2-5 people per 100,000 population per year.
Men get sick more often than women.
For the first time the disease usually manifests itself at a young age (20-35 years).
The sudden death of athletes in many cases is associated with the development of cardiac arrhythmias in hypertrophic cardiomyopathy.

One of the characteristic symptoms of hypertrophic cardiomyopathy is hypertrophy of the IVS (interventricular septum). When this pathology occurs, thickening of the walls of the right or left ventricle of the heart and the interventricular septum occurs. In itself, this condition is a derivative of other diseases and is characterized by the fact that the thickness of the walls of the ventricles increases.

Despite its prevalence (IVS hypertrophy is observed in more than 70% of people), it is most often asymptomatic and is detected only during very intense physical exertion. Indeed, in itself, hypertrophy of the interventricular septum is its thickening and the resulting reduction in the useful volume of the heart chambers. With an increase in the thickness of the heart walls of the ventricles, the volume of the chambers of the heart also decreases.

In practice, this all leads to a reduction in the volume of blood that is ejected by the heart into the vascular bed of the body. In order to provide the organs with a normal amount of blood in such conditions, the heart must contract harder and more frequently. And this, in turn, leads to its early wear and the occurrence of diseases of the cardiovascular system.

Symptoms and Causes of Hypertrophic Cardiomyopathy

A large number of people around the world live with undiagnosed IVS hypertrophy, and only with increased physical exertion does its existence become known. As long as the heart can provide normal blood flow to organs and systems, everything is hidden and the person will not experience any painful symptoms or other discomfort. But it is still worth paying attention to some symptoms and contacting a cardiologist when they appear. These symptoms include:

chest pain;
shortness of breath with increased physical activity (for example, climbing stairs);
dizziness and fainting;
increased fatigue;
tachyarrhythmia occurring on short intervals time;
heart murmur on auscultation;
labored breathing.

It is important to remember that undetected IVS hypertrophy can cause sudden death even young and physically strong people. Therefore, you can not neglect the dispensary examination by a therapist and / or a cardiologist.

The causes of this pathology lie not only in the wrong lifestyle. smoking, alcohol abuse, overweight- all this becomes a factor contributing to the growth of severe symptoms and the manifestation of negative processes in the body with an unpredictable course.

And doctors call gene mutations the cause of the development of thickening of the IVS. As a result of these changes at the level of the human genome, the heart muscle in some areas becomes abnormally thick.

The consequences of the development of such a deviation become dangerous.

After all, additional problems in such cases will already be violations of the conduction system of the heart, as well as weakening of the myocardium and the associated decrease in the volume of blood ejection during heart contractions.

Possible complications of IVS hypertrophy

What complications are possible with the development of cardiopathy of the type under discussion? Everything will depend on the specific case and individual development person. After all, many will never know for their entire lives that they have this condition, and some may experience significant physical ailments. We list the most common consequences of thickening of the interventricular septum. So:

1. Violation of the heart rhythm by the type of tachycardia. Common types such as atrial fibrillation, ventricular fibrillation, and ventricular tachycardia are directly related to IVS hypertrophy.
2. Violations of blood circulation in the myocardium. Symptoms that occur when there is a violation of the outflow of blood from the heart muscle will be chest pain, fainting and dizziness.
3. Dilated cardiomyopathy and associated volume reduction cardiac output. The walls of the heart chambers in conditions of pathological high load become thinner over time, which is the cause of the appearance of this condition.
4. Heart failure. The complication is very life-threatening and in many cases ends in death.
5. Sudden cardiac arrest and death.

Of course, the last two states are awesome. But, nevertheless, with a timely visit to the doctor, if any symptom of a violation of cardiac activity occurs, a timely visit to the doctor will help to live a long and happy life.

Update: December 2018

“Pumped” or “overworked heart”, under such names in everyday life, hypertrophy of the left ventricle of the heart (LVH) often appears. The left ventricle pushes out the bulk of the blood that gets to the organs and limbs, the brain and feeds the heart itself.

When this work is in progress extreme conditions, the muscle gradually thickens, the cavity of the left ventricle expands. Then, after a different time different people, there comes a breakdown of the compensatory capabilities of the left ventricle - 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 arterial 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, the myocardium is trained and thickened. Approximately 90% of left ventricular hypertrophies occur for this reason.

Cardiomegaly

Is it congenital hereditary or idiosyncrasy hearts. big heart a large person may initially have wider chambers and thick walls.

Athletes

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

valvular heart disease

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

Cardiac ischemia

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

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 heart is noted.

About cardiomyopathy

At the core pathological processes in myocardial cells hereditary predisposition(idiopathic cardiopathy) or dystrophy and sclerosis. Lead to the latter, allergies and toxic damage heart cells, endocrine pathologies(excess of catecholamines and growth hormone), immune failures.

Varieties of cardiomyopathies occurring with LVH:

Hypertrophic form

It can give diffuse or limited symmetrical or asymmetric thickening of the muscle layer of the left ventricle. In this case, the volume of the chambers of the heart decreases. The disease most often affects men and is inherited.

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

The boundaries of the heart are expanding (mainly due to the left departments). There is a downward displacement of the apex beat and dullness of the heart tones. Functional systolic murmur heard after the first heart sound.

Dilated form

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

Most typical manifestation becomes a clinic of left ventricular failure: cyanosis of the 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, swelling of the neck veins. Severe rhythm disorders are also observed: paroxysms of tachycardia, atrial fibrillation. Patients may die on the background of ventricular fibrillation or asystole.

Types of LVH

Concentric hypertrophy gives a decrease 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 the expansion of the cavities with a simultaneous thickening of the walls. This occurs with pressure overload, for example, with heart defects.

Differences between different types of LVH

	cardiomyopathy	arterial hypertension	sports heart
Age	under 35	over 35	from 30
Floor	both sexes	both sexes	more often men
Heredity	aggravated by hypertension	aggravated by cardiomyopathy	not weighed down
Complaints	dizziness, shortness of breath, fainting, heart pain, rhythm disturbances	headaches, less often shortness of breath	stabbing pains in the heart, bradycardia
LVH type	asymmetric	uniform	symmetrical
Myocardial thickness	more than 1.5 cm	less than 1.5 cm	decreases when loading is stopped
LV expansion	rare, often decrease	Maybe	more than 5.5 cm

Complications of LVH

Moderate left ventricular hypertrophy is usually harmless. This is a compensatory reaction of the body, designed to improve the 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, it may develop:

myocardial ischemia, acute myocardial infarction,
chronic disorders cerebral circulation, strokes,
severe arrhythmias and sudden cardiac arrest.

Thus, left ventricular hypertrophy is a marker of cardiac overload and indicates potential risks of cardiovascular catastrophes. The most unfavorable are its combinations with coronary heart disease, in the elderly and smokers with concomitant diabetes And metabolic syndrome (overweight and lipid disorders).

Diagnosis of LVH

Inspection

Left ventricular hypertrophy can be suspected already during the initial examination of the patient. On examination, the cyanosis of the nasolabial triangle or hands, increased respiration, and edema are alarming. When tapping, there are expansions of the borders of the heart. When listening - noise, deafness of tones, accent of the second tone. The survey may reveal complaints about:

shortness of breath
interruptions in the work of the heart
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 the S wave appears here.
T is negative in V5.6.

With ECG, errors in the assessment of hypertrophy are possible. 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 on the basis of visualization of the chambers of the heart, partitions and walls. All cavity volumes and myocardial thickness are expressed in figures that can be compared with the norm. On the ECHO-CS, you can establish the diagnosis of left ventricular hypertrophy, clarify its type and suggest the cause. The following criteria are used:

Myocardial wall thickness equal to or greater than 1 cm for women and 1.1 cm for men.
The coefficient of myocardial asymmetry (greater 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 opportunities 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 anatomical features heart and allows you to scan it in layers, as if performing sections 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, the treatment of which is always necessary with the normalization of lifestyle, is often a reversible condition. It is important to stop smoking and other intoxications, to reduce weight, to correct hormonal imbalance and dyslipidemia, optimize physical activity. In the treatment of left ventricular hypertrophy, there are two directions:

Prevention of LVH progression
An attempt at myocardial remodeling with a return to normal sizes cavities and thickness of the heart muscle.

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

Treatment is considered successful if:

decreased obstruction at the outlet of the left ventricle
increasing patient life expectancy
rhythm disturbances, fainting, angina pectoris do not develop
no progression of heart failure
the quality of life improves.

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

Myocardial hypertrophy (hypertrophic cardiomyopathy) is a significant thickening and enlargement of the walls of the left ventricle of the heart. Its cavity inside is not expanded. In most cases, thickening of the interventricular septa is also possible.

Due to thickening, the heart muscle becomes less extensible. The myocardium can be thickened over the entire surface or in some areas, it all depends on the course of the disease:

If the myocardium hypertrophies mainly under the aortic origin, narrowing of the left ventricular outlet may occur. In this case, the thickening of the inner shell of the heart occurs, the valves are disturbed. In most cases, this occurs with uneven thickening.
Asymmetric thickening of the septum is possible without violations of the valvular apparatus and a decrease in the output from the left ventricle.
The occurrence of apical hypertrophic cardiomyopathy occurs as a result of an increase in the muscle at the apex of the heart.
Myocardial hypertrophy with symmetrical circular hypertrophy of the left ventricle.

Disease history

Hypertrophic cardiomyopathy has been known since the mid-19th century. It was only in 1958 that the English scientist R. Teare could describe it in detail.

Significant progress in the study of the disease was the introduction of some non-invasive methods of research, when we learned about the existence of obstructions of the outflow tract and impaired distolic function.

This was reflected in the corresponding names of the disease: "idiopathic hypertrophic subaortic stenosis", "subaortic muscular stenosis", "hypertrophic obstructive cardiomyopathy". Today, the term "hypertrophic cardiomyopathy" is universal and generally accepted.

With the widespread introduction of ECHO KG studies, it was found that the number of patients with myocardial hypertrophy is much greater than was thought in the 70s. Every year, 3-8% of patients with this disease die. And every year the death rate is increasing.

Prevalence and significance

Most often, people aged 20-40 suffer from myocardial hypertrophy, men are about twice as likely. Flowing very diversely, progressing, the disease does not always manifest itself immediately. In rare cases, from the very beginning of the course of the disease, the patient's condition is severe and the risk of sudden death is quite high.

The frequency of hypertrophic cardiomyopathy is about 0.2%. Mortality ranges from 2 to 8%. The main cause of death is sudden cardiac death and life-threatening cardiac arrhythmias. The main reason is hereditary predisposition. If the relatives did not suffer from this disease, it is believed that there was a mutation in the genes of the proteins of the heart muscle.

It is possible to diagnose the disease at any age: from birth to old age, but most often patients are young people of working age. The prevalence of myocardial hypertrophy does not depend on gender and race.

In 5-10% of all registered patients with a long course of the disease, a transition to heart failure is possible. In some cases, in the same number of patients, an independent regression of hypertrophy is possible, a transition from a hypertrophic to a dilated form. The same number of cases account for emerging complications in the form of infectious endocarditis.

Without appropriate treatment, mortality is up to 8%. In half of the cases, death occurs as a result of acute myocardial infarction, ventricular fibrillation and complete atrioventricular heart block.

Classification

In accordance with the localization of hypertrophy, myocardial hypertrophy is distinguished:

left ventricle (asymmetric and symmetrical hypertrophy);
right stomach.

Basically, asymmetric hypertrophy of the interventricular septum is detected on the entire surface or in some of its departments. Less often, hypertrophy of the apex of the heart, anterolateral or posterior wall can be found. In 30% of cases, there is a proportion of symmetrical hypertrophy.

Given the gradient systolic pressure in the left ventricle, hypertrophic cardiomyopathy is distinguished:

obstructive;
non-obstructive.

The non-obstructive form of myocardial hypertrophy includes, as a rule, symmetrical hypertrophy of the left ventricle.

Asymmetric hypertrophy can refer to both obstructive and non-obstructive forms. Apical hypertrophy mainly refers to the non-obstructive variant.

Depending on the degree of thickening of the heart muscle, hypertrophy is distinguished:

moderate (up to 20 mm);
medium (21-25 mm);
pronounced (more than 25 mm).

Based on clinical and physiological classifications, 4 stages of myocardial hypertrophy are distinguished:

I - pressure gradient at the outlet of the left ventricle, not more than 25 mm Hg. Art. (no complaints);
II - the gradient increases to 36 mm Hg. Art. (the appearance of complaints during physical exertion);
III - the gradient increases to 44 mm Hg. Art. (appear shortness of breath and angina pectoris);
IV - gradient above 80 mm Hg. Art. (impaired hemodynamics, sudden death is possible).

Left atrial hypertrophy is a disease in which thickening of the left ventricle of the heart occurs, due to which the surface loses its elasticity.

If the sealing of the cardiac septum has occurred unevenly, there may also be disturbances in the work of the aortic and mitral valves of the heart.

Today, the criterion for hypertrophy is myocardial thickening of 1.5 cm or more. This disease is by far the leading cause of early death in young athletes.

Hypertrophy of the left or right parts of the heart occurs due to damage to the muscles, valves of the organ, due to a violation of blood flow. Often this happens with congenital malformations, due to increased blood pressure, lung diseases, significant physical exertion. The most common finding is left ventricular hypertrophy. This is due to the greater functional load in this area.

Reasons for the appearance

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Reasons for the appearance

The disease occurs due to various violations that interfere with the normal functioning of the body. The myocardium begins to contract with an increased load, metabolism increases in it, tissue volume and cell mass increase.

On initial stage heart disease maintains normal blood flow due to an increase in its mass. But in the future, the myocardium is depleted, and hypertrophy is replaced by atrophy - the cells are significantly reduced in size.

There are two types of pathology: concentric - the heart increases, its walls thicken, the atria / ventricles decrease, and eccentric (the organ is enlarged, but the cavities are expanded).

Cardiac hypertrophy can affect healthy people engaged in physical labor and athletes. Against the background of such changes, acute heart failure may occur. Being engaged in bodybuilding, hockey, heavy physical labor, you need to monitor the state of the myocardium.

Due to the occurrence of ventricular hypertrophy, it is divided into 2 types:

working - due to the increased load on a healthy body;
replacement is the result of an adaptation to work with another disease.

Causes of damage to the left ventricle

Most often, the muscle of the left ventricle undergoes changes. If its thickness is greater than 1.2 cm, there is this violation. At the same time, hypertrophy of the IVS (interventricular septum) of the heart is also observed. In severe cases, the thickness can reach 3 cm, and weight - 1 kg.

Poor pumping of blood into the aorta is provoked, therefore, blood supply throughout the body is disturbed. Weight gain leads to a lack of oxygen and nutrients. The result is hypoxia and sclerosis.

Causes of changes in the left ventricle: arterial hypertension; cardiomyopathy; narrowing (stenosis) of the aortic valve; increased physical activity; hormonal disorders; obesity; kidney disease with secondary hypertension.

Causes of damage to the left atrium:

Arterial hypertension;
Hypertrophic cardiomyopathy;
Congenital pathologies of the heart / aorta;
General obesity, especially in children and adolescents;
Stenosis / insufficiency of the aortic or mitral valve.

Causes of damage to the right ventricle

Changes in the right atrium are usually associated with pulmonary pathologies and disorders in the pulmonary circulation. IN right atrium blood flows through the vena cava from tissues and organs. From there, it enters the ventricle through the tricuspid valve and on to the pulmonary artery and lungs.

In the latter, gas exchange takes place. It is for this reason that it disrupts the normal structure of the right sections due to various respiratory diseases.

The main factors provoking atrial hypertrophy of right-sided localization:

Congenital pathologies of development (pr. tetrad Fallot, IVS defect);
Chronic obstructive pulmonary diseases, for example, emphysema, pneumosclerosis, bronchial asthma, bronchitis;
Stenosis / insufficiency of the tricuspid valve, changes in the valve of the pulmonary artery, enlargement of the right ventricle.

Chronic pathology of the lungs provokes damage to the vessels of the small circle, the growth of connecting tissues, gas exchange and the microcirculation are reduced. As a result, blood pressure in the vessels of the lungs increases, so the myocardium begins to contract with greater force, which leads to hypertrophy.

Narrowing or incomplete closure of the tricuspid valve leads to the same violation of blood flow as in a similar case with mitral pathology.

Causes of changes in the right ventricle: congenital malformations, chronic pulmonary hypertension, narrowing of the pulmonary valve, increased venous pressure in congestive insufficiency.

Hypertrophy of the right ventricle of the heart occurs if the thickness of its wall is more than 3 mm. It leads to the expansion of departments and poor circulation. As a result, venous return through the vena cava is disturbed, stagnation appears. Patients develop swelling, shortness of breath, cyanosis of the skin, and then complaints about the work of internal organs.

It should be noted that if the left ventricle is damaged, the left atrium will also suffer. Then the right departments are subject to changes.

Symptoms of left and right ventricular hypertrophy

With damage to the myocardium of the left half, there are: fainting, dizziness, shortness of breath, arrhythmias, pain in this area, weakness, fatigue.

When the right side is damaged, the following symptoms: cough, shortness of breath, shortness of breath; swelling; cyanosis, pale skin; rhythm disturbance.

How is hypertrophy of both ventricles of the heart diagnosed?

The simplest and at the same time effective methods are ultrasound (ultrasound) and echocardiography (ECG). The process determines the wall thickness and size of the organ.

Indirect symptoms of changes found on the ECG:

When the right sections change, the electrical conductivity changes, the rhythm is disturbed, a deviation is observed electrical axis right;
Changes in the left sections are indicated by axis deviation to the left, respectively, voltage signs are recorded.

It is also possible to confirm or refute the diagnosis based on the results of a chest x-ray.

Treatment of various forms of cardiac hypertrophy

All efforts to eliminate the disease are directed primarily to the cause that caused it.

For example, if a disorder occurs due to a respiratory disease, the course of treatment is directed to compensate for lung function. Anti-inflammatory therapy is prescribed. Apply bronchodilator drugs and a number of others, depending on the underlying cause.

With damage to the left sections caused by arterial hypertension, treatment involves only taking antihypertensive drugs of different groups, as well as diuretics.

If severe valve defects are found, they may resort to surgical intervention and even prosthetics.

Treatment of hypertrophy of the left and right ventricles of the heart in all cases of the disease includes the elimination of symptoms of myocardial damage. For this, antiarrhythmic therapy is used, as well as cardiac glycosides.

Perhaps they will prescribe drugs that improve the metabolic process in the heart muscle (eg, riboxin, ATP, etc.). Patients are advised to follow special diet, limit fluid and salt intake. In obesity, efforts are directed to the normalization of body weight.

At birth defect heart pathology is eliminated surgically, if possible. In very severe cases, when the structure is severely damaged and hypertrophic cardiomyopathy develops, the only way out is organ transplantation.

As can be judged from the above, the approach to patients is carried out purely individually. Doctors take into account all the existing manifestations of organ dysfunction, the general condition of the patient, the presence of concomitant diseases.

It should be noted that in the vast majority of cases, myocardial pathology detected in time can be corrected. Feeling the first anxiety symptoms you should immediately seek advice from a specialist - a cardiologist. After the examination, he will identify the cause of the disease and prescribe adequate treatment.

mjusli.ru

Causes

The causes of hypertrophic cardiomyopathy were established after ultrasound examination of the patients' relatives. It turned out that 65% of members of the same family have similar changes in the heart muscle.

There are 2 forms of the disease according to the etiological sign.

Primary or idiopathic

Primary is called hereditary form cardiomyopathy. The development of genetics has made it possible to establish the exact gene responsible for the development of the disease in half of the cases. In 50% of families, an exact indication of altered genes has not been established.

The type of inheritance is autosomal dominant. This means that the disease necessarily manifests itself in the heirs, regardless of the sex of the child. Hypertrophic cardiomyopathy in children occurs with a probability of 50% if one of the parents is healthy and the other is a carrier of the mutant gene. If both parents have genetic changes, then the probability reaches 100%.

Scientists believe that gene mutation can occur under the influence of trouble during external environment(smoking, previous infections, radiation), which affects the expectant mother during pregnancy.

Secondary

Secondary changes form after the age of 60 in patients with hypertension who had changes in the structure of muscle tissue in the prenatal period.

It was found that 1/5 of patients who survived to old age may develop systole weakness and enlargement of the left ventricular cavity. In such cases, hypertrophic cardiomyopathy does not differ from the dilated form.

The mechanism of development of pathology

As a result of genetic mutations, “wrong” main protein molecules appear in muscle tissue, which provide the contraction process, actin and myosin. They do not produce the proper number of calories due to sharp decline content of essential enzymes. In 90% of patients, muscle cells lose their direction. In the myocardial tissue, areas incapable of contraction are formed.

In response, other fibers take over the work functions. Their muscle mass increases (hypertrophies) because they have to contract with increased load. The thickness of the left ventricle increases, although there are no data on congenital and acquired malformations and hypertension. At the same time there is a thickening of the interventricular septum. This leads to a narrowing of the ways of ejection of blood into the aorta.

Areas of hypertrophy may be focal (usually at the exit to the aorta) or affect most of the left ventricle. Less commonly, they spread to the right sections of the heart muscle. There is damage to the cusps of the valves (mitral and aortic), vessels that feed the myocardium.

During diastole, the atria have to work harder to fill the ventricles because the tissues become dense, hard, and lose elasticity. The pressure in the pulmonary circulation increases.

Increased muscle mass requires more oxygen. The discrepancy between the growth of myocardial demands and the possibilities leads to the development of ischemia. This is also facilitated by mechanical compression of the mouth of the left coronary artery.

Types of heart damage

In connection with the uniformity and symmetry of the development of areas of myocardial hypertrophy, the following forms are distinguished:

symmetrical (concentric) - the thickness of the walls of the left ventricle increases to the same extent along the anterior, posterior surfaces and in the region of the septum, less often hypertrophy of the right ventricle is added;
asymmetric - areas of thickening are formed in the upper or lower part of the interventricular septum, it becomes one and a half to three times thicker than the posterior wall of the left ventricle (in a normal heart they are equal), in 2/3 of patients these changes are combined with hypertrophy of the anterior, lateral walls of the left ventricle or apex, without changes in the posterior wall.

According to the strength of the obstacle to the flow of blood from the left ventricle to the aorta, it is customary to distinguish between:

obstructive hypertrophic cardiomyopathy (subaortic or subvalvular) - a change in anatomical relationships creates a barrier to blood flow;
non-obstructive - there is no barrier.

Clinical picture

Symptoms of hypertrophic cardiomyopathy first appear at 20-25 years of age. The most characteristic are the following:

Pain behind the sternum of a pressing nature, very similar to angina attacks, have a similar irradiation in left shoulder, neck, shoulder blade. Unlike angina pectoris, they are not relieved by drugs containing nitroglycerin. There are atypical pains of a aching or stabbing type.
An important sign is an increase in shortness of breath with a change horizontal position body to vertical. Over time, increased shortness of breath leads to cardiac asthma and pulmonary edema.
Arrhythmias, accelerated heartbeat.
Dizziness up to fainting associated with malnutrition of the brain. Increases with physical exertion, straining, after a heavy meal, with a quick rise from a place.

For hypertrophic cardiomyopathy characteristic manifestation is the sudden death of a person (the classification specifies that more than 1 hour should not elapse from the moment of loss of consciousness, the case cannot have any signs of violence).

How to identify the disease

Diagnosis of the disease is very difficult. The doctor needs to know the family history (cases of confirmed illness in relatives or sudden death at a young age), the course of the mother's pregnancy, association with industrial toxic substances, past infectious diseases, stay in areas with high radiation.

On examination, the doctor pays attention to the pallor of the skin, cyanosis of the lips, fingers. Increased or normal blood pressure is recorded.

A characteristic noise over the projection of the aorta is auscultated.

For the purpose of excluding possible pathology heart and blood vessels checked general analysis blood, urine, biochemical tests for metabolic products, glucose, blood coagulation.

Additional examination methods

Hardware diagnostics allows you to accurately identify the problems of the disease.

An ECG study captures information on a disturbed rhythm, hypertrophy of the heart, and the development of blockades.
On the phonocardiogram, noises are recorded from certain points, which makes it possible to establish a connection between the heard noise and the aorta.
An x-ray image shows an increase in the contours of the cardiac shadow, but the dimensions may be normal if hypertrophy develops inside the cavity.
Ultrasound is the main method in the diagnosis. The dimensions of the chambers of the heart, the thickness of the walls, the condition of the valvular apparatus, the interventricular septum are estimated, and there is a violation of blood flow.
Magnetic resonance imaging allows you to get a three-dimensional image of the heart, to identify obstruction, the degree of wall thickness.
Genetic research is the method of the future, which has not yet been developed enough.
With the help of the introduction of catheters into the cavity of the heart, the pressure in the atria and ventricles, blood flow velocity is studied and measured. The technique allows you to take the material for a biopsy.
Coronary angiography of the heart vessels is performed in patients over 40 years of age for differential diagnosis with ischemic lesions vessels of the heart.

A biopsy is permissible only with the exclusion of all other diseases and the absence of help from other diagnostic methods. Under the microscope, altered muscle fibers become visible.

Treatment

Specific elimination of gene mutations has not yet been achieved. Treatment of hypertrophic cardiomyopathy is carried out with medications that affect all aspects of the pathogenesis of the disease.

If signs of the disease are detected, it is required to limit physical activity, stop playing sports.

If the patient has any chronic infectious diseases, prophylactic antibiotics are prescribed.

Groups of drugs that block adrenoreceptors, calcium antagonists are used, agents are added that reduce blood clots in the heart cavities.

Surgical methods

The method of choice on the open heart is myotomy - the removal of part of the interventricular septum from the inside or through the aorta. Mortality in these operations reaches 5%, which is comparable to the overall mortality.

A more gentle technique is carried out - concentrated alcohol is injected into the septal region through a puncture of the chest and heart under ultrasound control. Artificially caused cell death, thinning of the septum. The obstruction to the passage of blood is reduced.

To treat a disturbed rhythm, an electrostimulator or defibrillator is implanted (depending on the type of violation).

Current data suggest that survival after surgical treatment within 10 years is 84%, and at a constant conservative treatment - 67%.

With obstruction, surgery is used to replace the mitral valve with an artificial one, this eliminates its contact with the septum and “clears” the passage for blood flow.

The course of the disease

Hypertrophy is possible from birth. But in most patients, it begins to manifest itself in adolescence. For three years, the thickness of the myocardial wall increases by 2 times. At the same time, symptoms of the disease are not detected in 70% of patients. By the age of 18 (less often up to 40), the progression of thickening of the heart wall stops.

In the future, clinical manifestations are formed with an obstructive variant of the pathology. In cases of non-obstructive forms, the course is favorable and is detected by chance during an ECG examination.

The frequency of annual sudden death from hypertrophic cardiomyopathy and its complications among the adult population is up to 3%, among children - from 4 to 6%. Ventricular fibrillation is believed to be the main cause.

What are the possible complications

Hypertrophic cardiomyopathy does not occur in isolation, the disease affects all aspects of the heart, causing serious complications.

Arrhythmias and impaired conduction are observed in almost every patient. Depending on the severity, they can come out on top in terms of the threat to the life of the patient. Are direct cause cardiac arrest or fibrillation.
Accession of infection of the mitral and aortic valves leads to the development of endocarditis with subsequent valvular insufficiency.
The separation of a thrombus and the entry of an embolus into the vessels of the brain (up to 40% of cases), into the internal organs, into the arteries of the extremities occurs with atrial fibrillation, a paroxysmal form.
The development of chronic heart failure is possible with a long course of the disease, when part of the muscle fibers of the myocardium is replaced by scar tissue.

Forecast

Treatment can lead to temporary stabilization of hypertrophy. Life expectancy does not directly depend on the form of the disease. The most favorable prognosis is considered with a long asymptomatic course, as well as with apical localization and the absence of cases of sudden death among relatives.

The main sign that aggravates the prognosis among patients from 15 to 50 years old are syncope, ECG detection of ischemia, ventricular tachycardia. The appearance of shortness of breath and chest pain in a patient dramatically increases the risk of sudden death.

Statistical studies show a five-year survival rate from 82 to 98% from the moment of detection, a ten-year survival rate from 64 to 89% with an average annual mortality of 1%.

Difficulties in the etiological factors of the disease make any prevention almost impossible. With this pathology, the main attention should be paid to identifying, starting from adolescence, conducting symptomatic therapy.

serdec.ru

What is myocardial hypertrophy

This is an autosomal dominant disease that betrays hereditary traits of gene mutation, affects the heart. It is characterized by an increase in the thickness of the walls of the ventricles. Hypertrophic cardiomyopathy (HCM) has a classification code according to ICD 10 No. 142. The disease is more often asymmetric, the left ventricle of the heart is more susceptible to damage. When this happens:

chaotic arrangement of muscle fibers;
damage to small coronary vessels;
the formation of areas of fibrosis;
obstruction of blood flow - obstruction of the ejection of blood from the atrium due to displacement of the mitral valve.

With heavy loads on the myocardium caused by diseases, sports, or bad habits, a protective reaction of the body begins. The heart needs to cope with overestimated volumes of work without increasing the load per unit of mass. Compensation begins to occur:

increased protein production;
hyperplasia - an increase in the number of cells;
increase in muscle mass of the myocardium;
wall thickening.

Pathological myocardial hypertrophy

With prolonged work of the myocardium under loads that are constantly increased, a pathological form of HCM occurs. The hypertrophied heart is forced to adapt to new conditions. Thickening of the myocardium occurs at a rapid pace. In this position:

the growth of capillaries and nerves lags behind;
blood supply is disturbed;
changing influence nervous tissue on metabolic processes;
the structures of the myocardium wear out;
the ratio of the size of the myocardium changes;
there is systolic, diastolic dysfunction;
repolarization is disrupted.

Myocardial hypertrophy in athletes

Imperceptibly, an abnormal development of the myocardium - hypertrophy - occurs in athletes. With high physical exertion, the heart pumps large volumes of blood, and the muscles, adapting to such conditions, increase in size. Hypertrophy becomes dangerous, provokes a stroke, heart attack, sudden stop heart, in the absence of complaints and symptoms. You can not abruptly quit training so that complications do not arise.

Sports myocardial hypertrophy has 3 types:

eccentric - muscles change proportionally - typical for dynamic activities - swimming, skiing, running long distances;
concentric hypertrophy - the cavity of the ventricles remains unchanged, the myocardium increases - is noted in game and static types;
mixed - inherent in activities with the simultaneous use of immobility and dynamics - rowing, cycling, skating.

Myocardial hypertrophy in a child

The appearance of myocardial pathologies from the moment of birth is not excluded. Diagnosis at this age is difficult. Often observed hypertrophic changes in the myocardium in adolescence when cardiomyocyte cells are actively growing. Thickening of the anterior and posterior walls occurs until the age of 18, then stops. Ventricular hypertrophy in a child is not considered a separate disease - it is a manifestation of numerous ailments. Children with HCM often have:

heart disease;
myocardial dystrophy;
hypertension;
angina.

Causes of cardiomyopathy

It is customary to distinguish between primary and secondary causes hypertrophic development of the myocardium. The first is influenced by:

viral infections;
heredity;
stress;
alcohol consumption;
physical overload;
excess weight;
toxic poisoning;
changes in the body during pregnancy;
drug use;
lack of trace elements in the body;
autoimmune pathologies;
malnutrition;
smoking.

Secondary causes of myocardial hypertrophy provoke such factors:

Hypertrophy of the left ventricle of the heart

The walls of the left ventricle are more often affected by hypertrophy. One of the causes of LVH is high blood pressure, which makes the myocardium work in an accelerated rhythm. Due to the resulting overloads, the left ventricular wall and the IVS increase in size. In such a situation:

the elasticity of myocardial muscles is lost;
blood circulation slows down;
the normal functioning of the heart is disturbed;
there is a danger of a sharp load on it.

Left ventricular cardiomyopathy increases the heart's need for oxygen and nutrients. You can notice changes in LVH during instrumental examination. There is a syndrome of small ejection - dizziness, fainting. Among the signs accompanying hypertrophy:

angina;
pressure drops;
heartache;
arrhythmia;
weakness;
high blood pressure;
bad feeling;
shortness of breath at rest;
headache;
fatigue;

Right atrial hypertrophy

Enlargement of the wall of the right ventricle is not a disease, but a pathology that appears during overloads in this department. It occurs due to the receipt of a large amount of venous blood from large vessels. The cause of hypertrophy can be:

congenital defects;
defects interatrial septum, in which blood enters simultaneously into the left and right ventricles;
stenosis;
obesity.

Hypertrophy of the right ventricle is accompanied by symptoms:

hemoptysis;
dizziness;
night cough;
fainting;
chest pain;
shortness of breath without exertion;
bloating;
arrhythmia;
signs of heart failure - swelling of the legs, enlarged liver;
malfunctions of internal organs;
cyanosis of the skin;
heaviness in the hypochondrium;
varicose veins in the abdomen.

Hypertrophy of the interventricular septum

One of the signs of the development of the disease is hypertrophy of the IVS (interventricular septum). The main cause of this disorder is gene mutations. Septal hypertrophy provokes:

ventricular fibrillation;
atrial fibrillation;
problems with the mitral valve;
ventricular tachycardia;
violation of the outflow of blood;
heart failure;
cardiac arrest.

Dilatation of the chambers of the heart

Hypertrophy of the interventricular septum can provoke an increase in the internal volume of the heart chambers. This expansion is called dilatation of the myocardium. In this position, the heart cannot perform the function of a pump, symptoms of arrhythmia, heart failure occur:

fast fatiguability;
weakness;
dyspnea;
swelling of the legs and arms;
rhythm disturbances;

Cardiac hypertrophy - symptoms

Danger of myocardial disease in asymptomatic course long time. It is often diagnosed incidentally during physical examinations. With the development of the disease, signs of myocardial hypertrophy may be observed:

chest pain;
violation of the heart rhythm;
shortness of breath at rest;
fainting;
fatigue;
labored breathing;
weakness;
dizziness;
drowsiness;
swelling.

Forms of cardiomyopathy

It should be noted that the disease is characterized by three forms of hypertrophy, taking into account the systolic pressure gradient. All together corresponds to the obstructive type of HCM. Stand out:

basal obstruction - a state of rest or 30 mm Hg;
latent - a state of calm, less than 30 mm Hg - it characterizes the non-obstructive form of HCM;
labile obstruction - spontaneous intraventricular fluctuations in the gradient.

Myocardial hypertrophy - classification

For the convenience of working in medicine, it is customary to distinguish between the following types of myocardial hypertrophy:

obstructive - at the top of the partition, over the entire area;
non-obstructive - the symptoms are mild, diagnosed by chance;
symmetrical - all walls of the left ventricle are affected;
apical - the muscles of the heart are enlarged only from above;
asymmetric - affects only one wall.

Eccentric hypertrophy

With this type of LVH, there is an expansion of the ventricular cavity and, at the same time, a uniform, proportional compaction of the myocardial muscles, caused by the growth of cardiomyocytes. With a general increase in the mass of the heart, the relative thickness of the walls remains unchanged. Eccentric myocardial hypertrophy can affect:

interventricular septum;
top;
side wall.

concentric hypertrophy

The concentric type of the disease is characterized by the preservation of the volume of the internal cavity with an increase in the mass of the heart due to a uniform increase in wall thickness. There is another name for this phenomenon - symmetrical myocardial hypertrophy. The disease occurs as a result of hyperplasia of myocardiocyte organelles, provoked by high blood pressure. This development is typical for arterial hypertension.

Myocardial hypertrophy - degrees

To correctly assess the patient's condition with HCM, a special classification has been introduced that takes into account myocardial thickening. According to how much the size of the walls increases with the contraction of the heart, 3 degrees are distinguished in cardiology. Depending on the thickness of the myocardium, the stages are determined in millimeters:

moderate - 11-21;
average - 21-25;
pronounced - over 25.

Diagnosis of hypertrophic cardiomyopathy

On initial stage, with a slight development of wall hypertrophy, it is very difficult to identify the disease. The process of diagnosis begins with a survey of the patient, finding out:

the presence of pathologies in relatives;
the death of one of them at a young age;
transferred diseases;
the fact of radiation exposure;
external signs during visual inspection;
blood pressure values;
indicators in blood tests, urine.

A new direction finds application - genetic diagnosis myocardial hypertrophy. Helps to establish the parameters of the HCM potential of hardware and radiological methods:

ECG - determines indirect signs - rhythm disturbances, hypertrophy of departments;
x-ray - shows an increase in the contour;
Ultrasound - evaluates the thickness of the myocardium, impaired blood flow;
echocardiography - fixes the place of hypertrophy, violation of diastolic dysfunction;
MRI - gives a three-dimensional image of the heart, sets the degree of thickness of the myocardium;
ventriculography - examines contractile functions.

How to treat cardiomyopathy

The main goal of treatment is to return the myocardium to its optimal size. Activities aimed at this are carried out in the complex. Hypertrophy can be cured when early diagnosis. An important part in the myocardial recovery system is played by lifestyle, which implies:

dieting;
refusal of alcohol;
smoking cessation;
weight loss;
exclusion of drugs;
restriction of salt intake.

Drug treatment for hypertrophic cardiomyopathy includes the use of drugs that:

reduce pressure - ACE inhibitors, angiotensin receptor antagonists;
regulate heart rhythm disturbances - antiarrhythmics;
relax the heart with drugs with a negative ionotropic effect - beta-blockers, calcium antagonists from the verapamil group;
remove fluid - diuretics;
improve muscle strength - ionotropes;
with the threat of infective endocarditis - antibiotic prophylaxis.

An effective method of treatment that changes the course of excitation and contraction of the ventricles is two-chamber pacing with a shortened atrioventricular delay. More complex cases - severe asymmetric IVS hypertrophy, latent obstruction, lack of effect from the drug - require the participation of surgeons for regression. Help save a patient's life:

installation of a defibrillator;
pacemaker implantation;
transaortal septal myectomy;
excision of a part of the interventricular septum;
transcatheter septal alcohol ablation.

Cardiomyopathy - treatment with folk remedies

On the recommendation of the attending cardiologist, you can supplement the main course with herbal remedies. Alternative treatment of left ventricular hypertrophy involves the use of viburnum berries without heat treatment, 100 g per day. It is useful to use flax seeds, which have a positive effect on heart cells. Recommend:

take a spoonful of seeds;
add boiling water - liter;
hold in a water bath for 50 minutes;
filter out;
drink per day - a dose of 100 g.

Good reviews have in the treatment of HCM oatmeal infusion to regulate the work of the muscles of the heart. According to the recipe of healers, you need:

oats - 50 grams;
water - 2 glasses;
heat up to 50 degrees;
add 100 g of kefir;
pour radish juice - half a glass;
mix, stand for 2 hours, strain;
put 0.5 tbsp. honey;
dosage - 100 g, three times a day before meals;
course - 2 weeks.

sovets.net

Definition.Р"РёРїРµСЂС‚СЂРѕС" РёСЏ of the myocardium of the left ventricle (LVM) - excess of the mass of the left ventricle relative to due due to thickening (growth) of the myocardium (heart muscle).

Methods for diagnosing LVH. Currently, 3 instrumental methods are used to diagnose LVH:

— Standard ECG. When verifying LVMH, a conventional ECG is generally characterized by low sensitivity - no more than 30%. In other words, from total number of patients who objectively have LVMH, ECG allows to diagnose it only in a third. However, the more pronounced hypertrophy, the higher the likelihood of recognizing it through a conventional ECG. Severe hypertrophy almost always has ECG markers. Thus, if LVMH is correctly diagnosed by ECG, this most likely indicates its severe degree. Unfortunately, in our medicine, conventional ECG is given too much importance in the diagnosis of LVMH. Often, using low-specific ECG criteria for LVMH, physicians speak affirmatively about the phenomenon of hypertrophy where it does not exist in reality. You should not expect more from a standard ECG than it actually shows.

— Ultrasound of the heart. It is the "gold standard" in the diagnosis of LVMH, since it allows real-time visualization of the walls of the heart, and perform necessary calculations. To assess myocardial hypertrophy, it is customary to calculate relative values that reflect the mass of the myocardium. However, for simplicity, it is permissible to know the value of only two parameters: the thickness of the anterior (interventricular septum) and posterior wall of the left ventricle, which makes it possible to diagnose hypertrophy and its degree.

— Magnetic resonance imaging (MRI)). An expensive method of layer-by-layer scanning of the "zone of interest". To assess LVMH, it is used only if, for some reason, ultrasound of the heart is not feasible: for example, in a patient with obesity and emphysema of the lungs, the heart will be covered on all sides by lung tissue, which will make its ultrasound imaging impossible (extremely rare, but this occurs).

To hypertrophy of the myocardium of the left ventricle, the thickness of the IVS and ZSLZh is directly related (the clinical significance of the KDR in hypertrophy will be discussed PSRёP¶Pµ). If the normal value of even one of the two parameters presented is exceeded, it is legitimate to speak of "hypertrophy".

Causes and pathogenesis of LVH. Clinical conditions that can lead to LVMH (in order of decreasing frequency of occurrence):

1. Diseases leading to increased afterload on the heart:

— Arterial hypertension (hypertension, secondary hypertension)

— Heart disease (congenital or acquired) - aortic stenosis.

Afterload is understood as a set of physical and anatomical parameters cardiovascular organism that create an obstacle to the passage of blood through the arteries. Afterload is determined mainly by tone peripheral arteries. A certain basic value of arterial tone is the norm and one of the obligate manifestations of homeostasis, which maintains the level of blood pressure, according to the current needs of the body. An excessive increase in arterial tone will mark an increase in afterload, which is clinically manifested by an increase in blood pressure. So, with spasm of the peripheral arteries, the load on the left ventricle increases: it needs to contract more strongly in order to “push” blood through the narrowed arteries. This is one of the main links of pathogenesis in the formation of a "hypertonic" heart.

Aortic stenosis is the second most common cause of increased afterload on the left ventricle, and therefore obstruction of arterial blood flow. In aortic stenosis, the aortic valve: it wrinkles, calcifies, deforms. As a result aortic orifice becomes so small that the left ventricle needs to contract much harder to ensure that an adequate volume of blood passes through the critical bottleneck. Currently, the main cause of aortic stenosis is senile (senile) valve damage in the elderly.

Microscopic changes in myocardial hypertrophy consist in thickening of the heart fibers, in some proliferation of connective tissue. At first this is compensatory, but with long-term increased afterload (for example, after many years of untreated hypertension), hypertrophied fibers undergo dystrophic changes, the architectonics of myocardial syncytium is disturbed, sclerotic processes in the myocardium are predominant. As a result, hypertrophy turns from a compensation phenomenon into a mechanism for the manifestation of heart failure - the heart muscle cannot work with tension for an infinitely long time without consequences.

2. Congenital cause of LVH: hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is a genetically determined disease characterized by the appearance of unmotivated LVMH. The manifestation of hypertrophy occurs after birth: as a rule, in childhood or adolescence, less often in adults, but in any case not later than 35-40 years. Thus, in hypertrophic cardiomyopathy, LVMH occurs against the background of complete well-being. This disease is not a rarity: according to statistics, 1 out of 500 people suffer from it. clinical practice I see 2-3 patients with hypertrophic cardiomyopathy every year.

Unlike hypertensive heart in hypertrophic cardiomyopathy, LVMH can be very pronounced (severe) and often asymmetric (more on this in PSRёP¶Рµ). Only with hypertrophic cardiomyopathy, the wall thickness of the left ventricle sometimes reaches "outrageous" values of 2.5-3 cm or more. Microscopically, the architectonics of cardiac fibers is grossly disturbed.

3. LVMH as a manifestation of systemic pathological processes.

— Obesity. Excess body weight is not only a cosmetic problem. This is a deep pathophysiological process affecting all organs and systems, in which biochemical processes, psychodynamics of thinking, human self, etc. In case of obesity adipose tissue in excess is deposited not only under the skin, but also in almost all organs. The heart is compelled to provide blood to "the body with all its excess mass." Such increased load cannot but affect cardiac functionality - it certainly increases: the heart contracts more often and stronger. Thus, in obesity, LVMH can develop in the absence of persistent arterial hypertension.

With obesity, the myocardium thickens not only due to the growth of cardiac fibers and connective tissue, but also due to the deposition of excess fat.

— Amyloidosis(primary or secondary) - a pathology in which a special amyloid protein is deposited in the internal organs, leading to the development of diffuse sclerosis and organ failure. With all the possibility of developing LVH due to amyloidosis, it rarely comes to the fore in the clinic of the disease: other organs (for example, the kidneys) are more significantly affected, which will determine the specific picture of the disease.

4. Relatively natural causes of LVMH.

— Elderly age. Senile age characterized by slow but steadily progressive degradation (dystrophy) of all organs and systems. Decreases specific gravity water and parenchymal components in organs; on the contrary, sclerotic processes intensify. The heart of an old man is no exception: muscle fibers become thinner, loosen, at the same time, connective tissue develops powerfully, due to which LVMH occurs mainly in old age. What is important to know is that senile LVMH, in the absence of other causes, never reaches significant values. It does not exceed the degree of "insignificant" and more often is only an age-related phenomenon, without any particular clinical significance.

— Athlete's heart. We are talking about people who have been engaged for a long time professional sports. LVMH in such subjects can be called in pure form compensatory (working), as well as concomitant hypertrophy of skeletal muscles. After the end of a sports career, LVMH undergoes complete or partial regression.

The following diseases (conditions) lead to concentric LVMH:

S-hypertrophy has no particular clinical significance, being more often a marker of an "age" heart. Occasionally, this type of hypertrophy occurs in middle-aged people.

Clinical significance of LVH. Diseases leading to the development of LVMH can be asymptomatic for a long time (years, decades) or have nonspecific manifestations: for example, headache in arterial hypertension. by the most early symptom LVMH (which, by the way, may appear after years of hypertrophy) is dyspnea with the usual physical activity: walking, climbing stairs. Mechanism of breathlessness: РґРёР°СЃС‚РѕР»РёС‡РµСЃРєР°СЏ СЃРµСЂРґРµС‡РЅР°СЏ РЅРµРґРѕСЃС‚Р°С‚РѕС‡РЅРѕСЃС‚СЊ. It is known that the blood filling of the heart occurs during diastole (relaxation): blood moves along the concentration gradient from the atria to the ventricles. With hypertrophy, the left ventricle becomes thicker, stiffer, denser - this leads to the fact that the process of relaxation, stretching of the heart becomes difficult, becomes inferior; accordingly, the blood filling of such a ventricle is disturbed (decreases). Clinically, this phenomenon is manifested by shortness of breath. Symptoms of diastolic heart failure in the form of shortness of breath and weakness may be the only manifestation of LVMH for many years. However, in the absence of adequate treatment of the underlying disease, the symptoms will gradually increase, which will lead to a progressive decrease in exercise tolerance. The final stage of advanced diastolic heart failure will be the development of systolic heart failure, the treatment of which is even more difficult. So, LVMH is a direct path to heart failure, and therefore to high risk early cardiac death.

The next most common complication of LVH is development of paroxysmal atrial fibrillation (atrial fibrillation). Violation of the relaxation (diastole) of the hypertrophied left ventricle inevitably entails an increase in it blood pressure; this, in turn, causes the left atrium to contract more strongly in order to "push" the required volume of blood into the "reservoir" with high blood pressure. However, the left atrium is a thin-walled cardiac chamber that cannot operate in super mode for a long time; eventually, the left atrium dilates (expands) to accommodate the excess blood. Dilatation of the left atrium is one critical factors risk of developing atrial fibrillation. As a rule, damage to the left atrium for a long time is manifested only by atrial extrasystole; subsequently, when the atrium "dilates enough" to "support" fibrillation, atrial fibrillation occurs: first paroxysmal, then constant. The risks that atrial fibrillation brings to the patient's life are described in detail in a separate chapter.

Obstructive syncope. A rare variant of the course of LVH. It is almost always a complication of an asymmetric variant of hypertrophic cardiomyopathy, when the thickness of the interventricular septum is so great that there is a threat of transient obstruction (overlap) of blood flow in the area of the outflow tract of the left ventricle. Paroxysmal obstruction (cessation) of blood flow in this "critical place" will inevitably lead to fainting. As a rule, the risk of obstruction occurs when the thickness of the interventricular septum exceeds 2 cm.

Ventricular extrasystole is another possible satellite in LVH. It is known that any micro- and macroscopic changes in the heart muscle can theoretically be complicated by extrasystole. The hypertrophied myocardium is an ideal arrhythmogenic substrate. Clinical course ventricular extrasystole against the background of LVMH is variable: more often, its role is limited to a "cosmetic arrhythmic defect". However, if the disease that led to LVMH is not treated (ignored), the regimen for limiting intense physical activity is not observed, life-threatening ventricular arrhythmias triggered by extrasystoles may develop.

Sudden cardiac death. The most severe complication of LVH. Most often, LVMH leads to such a ending against the background of hypertrophic cardiomyopathy. There are two reasons. First, in this disease, LVMH can be especially massive, making the myocardium extremely arrhythmogenic. Secondly, hypertrophic cardiomyopathy very often has an asymptomatic course, which does not allow patients to take preventive measures. preventive measures in the form of limiting intense physical activity. Sudden cardiac death in other nosologies complicated by LVMH is a rare phenomenon, if only because the manifestation of these diseases begins with symptoms of heart failure, which in itself makes the patient see a doctor, and therefore there is real opportunity bring the disease under control.

Possibility of regression of LVH. The probability of a decrease in the mass (thickness) of the left ventricular myocardium during treatment depends on the cause of hypertrophy and its degree. A classic example is the athletic heart, whose walls can shrink back to normal thickness after the end of an athletic career.

LVMH due to arterial hypertension or aortic stenosis can successfully regress with timely, complete and long-term control of these diseases. However, it is considered as follows: only mild hypertrophy undergoes absolute regression; in the treatment of moderate hypertrophy, there is a chance of reducing it to mild; and heavy can "become medium". In other words, the more running the process, the less likely it is to return everything completely to the original. However, any degree of LVMH regression automatically means the correctness in the treatment of the underlying disease, which in itself reduces the risks that hypertrophy brings to the life of the subject.

With hypertrophic cardiomyopathy, any attempts at drug correction of the process are meaningless. There are surgical approaches in the treatment of massive ventricular septal hypertrophy, which is complicated by obstruction of the outflow tract of the left ventricle.

The likelihood of regression of LVMH against the background of obesity, in the elderly, with amyloidosis is practically absent.

РќР°РІРµСЂС…

Hypertrophy of the interventricular septum. What is hypertrophic cardiomyopathy? The course of hypertrophic hypertrophic cardiomyopathy

Forms

Causes

Diagnostics

Treatment of hypertrophic cardiomyopathy

Complications and consequences

Prevention of hypertrophic cardiomyopathy

Additionally

Symptoms and Causes of Hypertrophic Cardiomyopathy

Possible complications of IVS hypertrophy

Causes of left ventricular hypertrophy

Persistent arterial hypertension

​ Cardiomegaly

Athletes

valvular heart disease

Cardiac ischemia

​ Cardiomyopathy

About cardiomyopathy

Hypertrophic form

Dilated form

Types of LVH

Differences between different types of LVH

cardiomyopathy

arterial hypertension

sports heart

Complications of LVH

Diagnosis of LVH

Inspection

ECG

Ultrasound of the heart

Other methods

Treatment of left ventricular hypertrophy

Treatment is considered successful if:

Disease history

Prevalence and significance

Classification

Reasons for the appearance

Causes of damage to the left ventricle

Causes of damage to the right ventricle

Symptoms of left and right ventricular hypertrophy

How is hypertrophy of both ventricles of the heart diagnosed?

Treatment of various forms of cardiac hypertrophy

Causes

Primary or idiopathic

Secondary

The mechanism of development of pathology

Types of heart damage

Clinical picture

How to identify the disease

Additional examination methods

Treatment

Surgical methods

The course of the disease

What are the possible complications

Forecast

What is myocardial hypertrophy

Pathological myocardial hypertrophy

Myocardial hypertrophy in athletes

Myocardial hypertrophy in a child

Causes of cardiomyopathy

Hypertrophy of the left ventricle of the heart

Right atrial hypertrophy

Hypertrophy of the interventricular septum

Dilatation of the chambers of the heart

Cardiac hypertrophy - symptoms

Forms of cardiomyopathy

Myocardial hypertrophy - classification

Eccentric hypertrophy

concentric hypertrophy

Myocardial hypertrophy - degrees

Diagnosis of hypertrophic cardiomyopathy

How to treat cardiomyopathy

Cardiomyopathy - treatment with folk remedies

Cardiomegaly

Cardiomyopathy