Hypertrophy of the left ventricular myocardium
Left ventricle (LV) plays a significant role in the organization of the bloodstream. It is from here starts the systemic circulation. Blood rich in oxygen and nutrients, is thrown from it into the aorta, a powerful arterial highway feeding the entire body.
If the load on the heart muscle for any reason, constantly elevated, may lead to left ventricular hypertrophy (Cardiomyopathy). Pathology is expressed in the thickening and densification of the LV walls.
The appearance of hypertrophy
The walls of the ventricular chambers consist of three layers:
- Endocardium — inner shell with a smooth surface that facilitates blood flow.
- Myocardium — the muscle tissue, the most powerful part of the wall.
- Epicardium — outer layer, protects the muscle.
Since the LV bear the main responsibility for pumping the blood, nature has provided for him a certain margin of safety. Left camera is bigger than my right (the value of LV is one third of the total volume of the heart chambers), her muscle tissue is much more powerful. The average thickness of the myocardium in different parts of the LV ranges from 9 to 14 mm.
If the muscles of the camera undergo increased load (increased pressure, or a significant amount of blood), the body is forced to adapt to these conditions. Compensatory response of the LV is the proliferation of cardiomyocytes (heart muscle cells). The walls of the LV thicken and progressively lose their elasticity.
The risk of left ventricular hypertrophy in the change in the normal process of muscle contraction. The result is inadequate blood flow to internal organs. Growing threat of CHD, stroke, myocardial infarction.
Types of hypertrophy
The proliferation of cardiomyocytes can spread to the whole cell and can be localized in different places. This is mainly interventricular septum, crossing the atrium to the left ventricle, the aortic opening. Depending on the places where there was the seal of the muscular layer, there are several types of anomaly:
Concentric hypertrophy of the left ventricular myocardium
The main reason is overloading the camera with blood pressure. If hypertension, or narrowing of the aortic valve myocardium thickens evenly, sometimes thereby reducing the cavity of the LV. The muscular layer of the ventricle gradually increases to be able to push the entire volume of blood in the tiny hole in the main artery, and hypertension — in a short spasm of vascular.
Eccentric left ventricular hypertrophy
The main role here plays the chamber is overloaded ventricle blood. In the result of insufficiency of the heart valves volumerelease into the aortic opening is reduced. The chamber fills up with blood, stretching the walls, making the total mass of the LV increases.
Obstruction is bulging already increased wall into the lumen of the chamber. Ventricle is often divided into two parts, like an hourglass. If the area of the ejection of blood into the aorta, the myocardium is also increased, the uniformity of systemic blood flow is disturbed even more.
The severity of the pathology is determined by the thickness of the overgrown tissue:
- Severe LV hypertrophy was more than 25 mm.
- The average is from 21 mm to 25 mm.
- Moderate (11 to 21 mm.
Moderate hypertrophy of the left ventricle for the life of the harmless. Seen in athletes and manual workers experiencing high load.
Factors of the disease
The excessive load on the left ventricle is a congenital or acquired heart disease.
To hereditary anomalies include:
- Genetic defects. Arise from mutation of one of the genes responsible for the synthesis of proteins of the heart. Just in these genes was found about 70 persistent changes that cause overgrowth of the myocardium of the LV.
- Birth defects: reducing the diameter of the aorta (coarctation), ventricular septal defect, atresia or absence of the pulmonary artery. With hereditary defects of the heart muscle associated left ventricular hypertrophy in children. Here, the main therapy is surgical intervention.
- Congenital narrowing of the aortic valve (the outlet of the left ventricle, through which blood is ejected into the artery). The normal valve area is 3-4 sq cm stenosis it is narrowed to 1 square centimeter
- Mitral insufficiency. The defect is the valve leaflets causes reverse blood flow in the atrium. Each time during the relaxation phase of the ventricle is overfilled with blood (volume overload).
Acquired hypertrophy of the left ventricular myocardium can develop under the influence of certain diseases and factors:
- Hypertension. Holds the first place among pathologies that cause compaction of the myocardium (90%). Muscle tissue grows due to the fact that the body works all the time under overload pressure;
- Atherosclerosis of the aorta. On the walls of the aorta and its valve deposited cholesterol plaques that later investsource. The walls of the main arteries lose their elasticity, which interferes with the free current blood. The muscle tissue of the left ventricle, feeling the increasing voltage begins to increase its volume;
- Coronary heart disease;
- Diabetes mellitus;
- Overeating, largeweight, obesity;
- Prolonged stress;
- Alcoholism and Smoking;
- Insomnia, emotional instability;
- Heavy physical activity.
All of these causes of left ventricular hypertrophy makes the heart work harder. The reason for this is the thickening of the myocardium.
Signs of the disease
Heart condition for a long time does not manifest itself. But over time, increased muscle mass is starting to have an effect on the blood system. The first signs of illness. They are usually associated with great physical exercise. With the development of disease symptoms bothering the patient and alone.
The symptoms of hypertrophy of the left ventricle:
- Shortness of breath, interruptions in heart, shortness of breath.
- Dizziness, or fainting.
- Angina (squeezing, pressure) pain behind the breastbone.
- The AP difference.
- High blood pressure, poorly amenable to therapeutic measures.
- Swelling of limbs and face in the evening.
- Asthma, no cough in the supine position.
- Cyanosis of the nails, nasolabial triangle.
- Drowsiness, headaches, unclear nature, weakness.
Noticing such signs, it is necessary to hurry to the cardiologist.
Diagnosis of LV hypertrophy
On the first visit, the doctor collects the medical history of the patient's complaints, information about the family disease). If the family was endocrine disease, hypertension, valvular heart disease, hypertrophy of the left ventricular wall is more than probable.
To confirm the diagnosis, prescribe the following procedures:
- Chest x-ray. On the radiograph will be visible increased shadow hearts and shadow of the aorta;
- Daily monitoring of the ECG;
- Stress-echocardiography (an ultrasound of the heart before exercise and after it);
- Doppler test (to check heart blood flow also using load);
- A laboratory study of the blood;
- A blood test for hormones;
- The analysis of urine.
Identifying the extent of the disease, the doctor will prescribe the CAG (x-ray examination with the introduction of contrast fluid in the supply blood to the heart). So determine how free the lumen of the coronary arteries.
For precise visualization of intracardiac pathologies MRI of the heart.
Forms of treatment
Eccentric, obstructive and concentric left ventricular hypertrophy is poorly amenable to therapeutic intervention. But modern medical technology can significantly stabilize the patient's condition. Treatment is mainly integrated.
To restore the natural rhythm of the heart muscle are assigned beta-blockers (Propranolol, Inderal, Metaprolol, Atenolol).
Calcium channel blockers (Verapamil, Procardia) adjust blood flow to the heart and Central body systems that have a vasodilator effect.
ACE inhibitors — Capoten, Zestril, enalapril. Lower blood pressure.
Anticoagulants (Warfarin derivatives Indandiona) to prevent the formation of thrombi in the ventricle.
Sartana (Lorista, Valsartan) are first-line drugs in the treatment of hypertension and prevention of strokes in the brain.
Diuretics (Indal, Navidrex) are used in combination with the above means, if the hypertrophy of LV myocardium is pronounced.
If drug therapy is ineffective, used surgical techniques. Shown the following interventions:
- Operation morrow piecemeal destruction of the myocardium in the area of the interventricular septum;
- Mitral valve replacement;
- Replacement or transplantation of the aortic valve;
- Comissurotomy — division of adhesions at the mouth of the main artery, spliced as a result of stenosis (narrowing);
- Coronary stenting (the insertion of the implant-expander into the lumen of the artery).
In cases where the treatment of left ventricular hypertrophy does not give the expected results, is inserted cardioverter-defibrillator or pacemaker. The devices are designed to restore proper heart rhythm.
If the cardiologist approves, you can use the following tools:
- Infusions of flowers of cornflower, Lily of the valley, hawthorn;
- Infusion of Hypericum with honey;
- The mixture of garlic and honey in equal parts;
- Mixed decoction of Ledum, motherwort and cottonweed;
- Decoction of parsley in red wine.
Good effect gives long-term use of baked milk with strawberry jam, grated cranberries with sugar, dried fruits, raisins, dried apricots.
Increasingly, LV hypertrophy find in people under the age of 35 years. Hoping for the compensatory potential of the young organism, patients avoid going to the clinic.
But heart disease is dangerous, that without medical treatment and monitoring they are making steady progress.
Only 5-10% of cases reverse the development of cardiomyopathy. The rest fall into the high risk group. Only persistent treatment and the implementation of the recommendations of the cardiologist will allow the person not to change the rhythm of life.