Left ventricular hypertrophy of the heart how can be treated

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The human heart consists of four chambers (cavities), which are filled with blood into the diastole and expel it into large vessels in the systole phase. Two atria and two ventricles perform the functions assigned to them and participate, thus, in the work of the small and large circle of blood circulation. The right ventricle expels blood into the vessels of the pulmonary circulation, the left – into the vessels of the pulmonary circulation.

Such anatomical features are explained by the fact that the left ventricle has to work in conditions of high resistance, the right one – in conditions of low. Finding themselves under stress, the ventricles of the heart begin to work with greater force, pumping blood more intensively into the vessels of the small and large circle. And such moments do not take the ventricles by surprise – they know how to work under conditions of increased load.

1 Why and why

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Coronary heart disease

Before we touch on the treatment of left ventricular hypertrophy itself, it is worth talking about the causes of the disease. The entire diagnostic search for a doctor is aimed at establishing the cause of the disease. If diagnostic signs are identified that indicate left ventricular hypertrophy, further research will focus on establishing the cause. The main causes that lead to myocardial hypertrophy are as follows:

  • arterial hypertension,
  • coronary artery disease,
  • hypertrophic cardiomyopathy,
  • aortic stenosis,
  • obesity,
  • intense physical activity,
  • muscular dystrophy.

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Risk factors for cardiovascular diseases, which can affect the effectiveness of treatment and the prognosis of the disease, also occupy an important place. The following risk factors are distinguished:

  • high blood pressure;
  • age: women over 65 years old, men over 55 years old;
  • smoking;
  • lip >gipertrofija levogo geludochka kardiomiocit - Left ventricular hypertrophy of the heart how can be treated

Atypical cardiomyocytes. A – pacemaker of the sinus-atrial node; B – conduction cardiomyocyte of the atrioventricular bundle.

The term “hypertrophy” means an increase in an organ by increasing the size of its constituent cells. In the left ventricle, the muscle layer, the myocardium, undergoes hypertrophy, since pumping function is prescribed to him. The structural unit of the myocardium is cardiomyocyte – a muscle cell. Three stages are distinguished in the formation of left ventricular hypertrophy.

  1. Stage of adaptation or formation. During this period, under the influence of provoking factors that cause cardiomyocytes to work under conditions of increased load, adaptive reactions occur. The number and mass of muscle cells is increasing. LV wall thickness also increases. In the cell itself, the consumption of energy substrates increases, because you need to work harder.
  2. Stage of compensation. Over a period of time, cardiomyocytes can work in conditions of increased energy consumption. But the heart still copes with its function and regularly pumps blood, although in the cells themselves there is a depletion of energy substrates. Cell oxygen starvation may be observed.
  3. Decompensation. Disruption of the compensatory mechanisms leads to the fact that the LV works and pumps blood, but not with the same strength. He is not able to expel all the blood that came to him from the left atrium. The remaining blood in the ventricle accumulates and leads to an overload of this chamber by volume, which creates an additional load for the operation of the LV and the left atrium. Being in a state of oxygen starvation, energy formation processes are disturbed in cardiomyocytes. Harmful substances accumulate, which lead to the death of the cell, and connective tissue is formed in its place. Such a process in the myocardium is called cardiosclerosis.

3 Causes of Hypertrophy

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Single ventricle of the heart

Diseases and conditions in which the ventricular myocardium has to work under conditions of increased load can lead to the development of LV myocardial hypertrophy:

  • Congenital pathology. This group includes congenital aortic stenosis, underdevelopment of the pulmonary artery and LV, the only ventricle of the heart, the common arterial trunk, Farby’s disease, etc.
  • Valvular defects: mitral valve insufficiency (MK), aortic valve stenosis.
  • Hypertrophic cardiomyopathy.
  • Arterial hypertension.
  • Coronary heart disease (arrhythmias, myocardial infarction, atherosclerosis, etc.).
  • Diabetes.
  • Smoking, alcohol abuse.
  • Long-term sports, working hypertrophy (professional activity is associated with the performance of heavy physical exertion).
  • Muscular dystrophy.
  • Obesity.
  • Sedentary lifestyle (lack of exercise).

3 Arterial hypertension

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Being one of the most common causes of left ventricular hypertrophy, high blood pressure in a patient should not be ignored. The treatment of arterial hypertension (AH) is a whole complex of measures. Non-drug treatment. Lifestyle modification occupies a very important place in non-drug treatment of hypertension, since in some cases the elimination of risk factors allows achieving positive results without prescribing drug therapy. The main points of such treatment include the following:

  1. Decrease in overweight. To calculate the body mass index, you can use the simplest formula: body weight in kg/square of growth in m. Normal body mass index is in the range of 18,5 -24,9 kg/m2.
  2. Reducing salt intake to 5 mg per day.
  3. To give up smoking.
  4. Correction of blood sugar.
  5. Increased level of physical activity. Regular 30-40 minute physical activity with a minimum frequency of 4 times a week has a positive effect on lowering blood pressure.
  6. Limiting alcohol consumption, but rather a complete rejection of it. Do not forget that drinking beer is also a risk factor.
  7. Compliance with a diet rich in vegetables and fruits, low-fat meat and dairy products with low fat content, cereal products. Cooking mainly in boiled and baked form.

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Drug therapy. In each specific situation, the doctor decides what treatment tactics to choose. Someone needs to seriously take on lifestyle changes and wait for the prescription of drugs. Another category of persons requires complex treatment with the obligatory prescription of drugs.

The drugs from the group of ACE inhibitors are credited with the property of positively affecting the processes of left ventricular hypertrophy, causing its partially reverse development. To correct lipid imbalance, drugs from the group of lipid-lowering drugs – statins, are prescribed. Also in the treatment of hypertension can be used acetylsalicylic acid (ASA), sugar-lowering drugs.

4 Types of Hypertrophy

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Left ventricular hypertrophy

The left ventricle in its structure has walls and departments, so myocardial hypertrophy can occur in different ways. It can be divided into symmetric or concentric and asymmetric.

Asymmetric LV myocardial hypertrophy is most common. With this type of hypertrophy, the upper, middle or lower ventricle can thicken. The interventricular septum may also hypertrophy.

Symmetric or concentric hypertrophy is characterized by a thickening of the entire mass of the left ventricular myocardium, which entails a decrease in its cavity and a violation of the function of filling the ventricle.

Signs of LVH in the heart

Headaches and dizziness

When LVH is in the phase of compensation, complaints from the patient or the patient himself can be seen or heard rarely. When tension and the breakdown of compensatory mechanisms are observed, the condition of the patients worsens, the first complaints appear. Patients with left ventricular myocardial hypertrophy (LV) may complain of headaches and dizziness, visual impairment – darkening in the eyes, muscle weakness, shortness of breath, heart failure. The sad thing is that the first symptoms of the disease appear much later after LVH has formed.

In the stage of LVH decompensation, signs of heart failure (HF) come to the fore. Symptoms of LV hypertrophy in the stage of decompensation are nonspecific. Patients may indicate drowsiness and fatigue, general weakness, decreased exercise tolerance. Some may not pay such attention to such manifestations.

They may be disturbed by headaches, changes in blood pressure, interruptions in the work of the heart, palpitations, pain in the heart or behind the sternum, shortness of breath. Swelling of the legs may occur, which grows in the evening, dry cough, sudden (paroxysmal) attacks of suffocation at night, disruption of the rhythm.

The problem with hypertrophy is that it has no symptoms. Doctors may suspect an ailment by the following manifestations:

  • feeling of suffocation;
  • fainting;
  • dizziness;
  • insomnia;
  • trembling heart syndrome;
  • pain in the left side of the chest – pinching, squeezing, squeezing, etc .;
  • fatigue with previous active physical exertion;
  • pressure drops;
  • migraine;
  • fluid accumulation in the lower extremities (swelling);
  • dyspnea.

Indirect signs of LVH of the heart are those indicators that are visible with instrumental research methods with ECG. These include: violation of intraventricular conduction, repolarization phase, decrease in the amplitude of the T wave.

About cardiomyopathies

This disease refers to idiopathic diseases when the cause of the disease cannot be established. Treatment is for symptoms. The main non-drug measure is the elimination of intense FN, which contribute to the progression of left ventricular hypertrophy. The main groups of drugs for hypertrophic cardiomyopathy are beta-blockers, verapamil from the group of calcium channel blockers, antiarrhythmics can be used.

Pathological processes in myocardial cells are based on a hereditary predisposition (idiopathic cardiopathy) or dystrophy and sclerosis. Myocarditis, allergies and toxic damage to heart cells, endocrine pathologies (excess of catecholamines and growth hormone), immune malfunctions lead to the latter.

6Diagnostics

Diagnosis is based on a comprehensive identification of signs responsible for left ventricular hypertrophy. The first and important step is to collect complaints and medical history. At the stage of palpation of the heart region, the doctor can already notice a change in the normal characteristics of the apical bundle, which becomes diffuse, its localization is shifted due to an increase in the size of the left ventricle. Physical examination is supplemented by percussion and auscultation.

An important diagnostic step is the conduct of instrumental studies that allow you to make a final diagnosis and determine the treatment tactics. Of the instrumental methods of research, electrocardiography (ECG), chest x-ray (OGC X-ray), echocardiographic examination of the heart (Echocardiography, ultrasound of the heart), MRI, etc. are used.

6 Aortic stenosis

The main treatment for aortic stenosis is the surgical treatment. No one has yet come up with such a wonderful pill that would make the valve straighten and work as before. The main method of surgical correction of aortic stenosis is aortic valve replacement. Untreated aortic stenosis creates the conditions for constant overload of the left ventricle.

7 Treatment

Getting rid of extra pounds

Left ventricular hypertrophy (LVH) is not an independent disease, but only indicates its presence. Therefore, all therapy is aimed specifically at the underlying disease. An important and necessary place in the treatment of a patient with hypertrophy is the elimination of risk factors and lifestyle changes in a non-drug way. The following recommendations are given to patients:

  • diet correction
  • normalization of body weight, getting rid of extra pounds,
  • rejection of bad habits,
  • elimination of stress factors,
  • blood pressure control
  • compliance with the required level of physical activity.

In each case, the list may be longer or shorter. Next, preference should be given to medical treatment, which is also aimed at the underlying disease. Inhibitors of angiotensin-converting enzyme play an important role in the treatment of hypertrophy. The drugs of this group are able not only to stop the progression of the processes of hypertrophy, but also cause its reverse development.

In addition to these drugs, beta-blockers (BAB), calcium channel blockers (CCBs), angiotensin receptor blockers, antiarrhythmic drugs, diuretics can be used. In addition to drug treatment, the option of surgical treatment of left ventricular myocardial hypertrophy (LV) can be considered. This option is indicated when the patient develops an obstructive form of LVH, with heart defects, etc.

7 Obesity

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Follow the doctor’s recommendations

Obesity should be treated to reduce the risk of cardiovascular complications. If the patient has a body mass index greater than 25 kg/m2, it is necessary to deal with weight loss. If the body mass index is greater than 30, medications may be prescribed. Very often, obese people have elevated blood glucose and impaired lipid metabolism.

8 Physical loads

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Persons professionally involved in sports, as well as those people who, due to their profession, have to perform intense physical activity, stand as candidates for acquiring working left ventricular hypertrophy. At first glance, it seems that there is nothing wrong with such a thickening of the wall of the left ventricle. Who will be prevented by a “pumped-up” heart that can pump more oxygen, withstand intense physical exertion, etc.?

In the matter of working left ventricular hypertrophy, it is important to remember that a person should have a sense of proportion. What distinguishes an athletic heart or working hypertrophy from a pathological one is that with a thickening of the heart muscle (myocardium), the capillary network also grows, which ensures balanced myocardial function.

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Overwork when playing sports

For people involved in sports, it is important not to over-train themselves, to observe a minimum level of physical activity, and not to quit sharply training. It is also important to avoid overtraining, which can lead to the following points: insufficient recovery between workouts, a sharp increase in loads, an increase in the duration of loads.

If any deviations are detected, people with working hypertrophy of the left ventricle should be suspended from performing physical exertion for a certain period of time to fully restore the body’s strength. After completing a sports career, you should not be tied to physical activity. There are times when professional athletes after leaving sports start complaining about an increase in blood pressure. In such cases, it is important to maintain a minimum level of physical activity, allowing you to keep your body in good shape.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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