Treatment of myocardial hypertrophy
Author Ольга Кияница
- 1 Description of myocardial hypertrophy
- 2 General principles of treatment of myocardial hypertrophy
- 3 Treatment of myocardial hypertrophy of the left ventricle
- 4 Treatment of concentric hypertrophy of the left ventricular myocardium
- 5 Complications of myocardial hypertrophy
- 6 Prevention
Hypertrophy of the myocardium (GM) is an increase and thickening of the heart muscle, which can overcome the pathway for blood flow, which makes the heart work harder. Most people have no symptoms, and at the same time, their habitual life is practically not disturbed. In some cases, signs of heart failure and potentially serious complications may develop.
According to US statistics, one out of 500 suffers from hypertrophy of the myocardium, whereas multiple sclerosis is detected in one person out of 700 examined.
Before the appointment of the treatment of myocardial hypertrophy, a complete examination of the patient is mandatory. In particular, electrocardiography, echocardiography and other studies are performed. It is important to set the stage of the disease.
Video: Hypertrophic Cardiomyopathy (HCM) Mechanism of Disease Video
Description of myocardial hypertrophy
The disease may develop for a long time without any manifestations, although in some cases a rather rapid progression of the clinical picture can be determined. Most often, with hyperthrophy of the myocardium, the following symptoms are determined:
- Sweat at physical activity (sometimes at rest or after eating).
- Pain in the chest.
- Dizziness and fainting, especially after intense workout.
- Feeling of a rapid heartbeat or tremor of the heart.
All of these manifestations are often associated with developing cardiac insufficiency and a decrease in the compensatory capacity of the heart.
Most cases of hypertrophy of the myocardium are associated with an adverse heredity that is caused by anomalies in one gene or another. There are also risk factors that contribute to the expansion of the heart muscle.
The most common risk factors:
- Genetics. If the parent is diagnosed with hypertrophy of the myocardium, the child has a 50% probability of developing the disease.
- Hypertension (high blood pressure).
- Aortic valve stenosis (narrowing the valve through which blood passes when it leaves the heart and passes into a large circle of blood circulation).
- Obstructive cardiomyopathy (a hereditary type of GM that slows the flow of blood to the aorta due to the overheated heart muscle).
- Extreme intensive sports training. Intense, long-term workouts for endurance and strength can make the heart adapt to the extra load. It is unclear whether this athletic type of myocardial hypertrophy can lead to heart muscle and disease.
- Congenital heart disease.
- Teenage age . The GM may develop during the growth of the child's body and usually manifests at the end of adolescence or in the early twenties.
Although myocardial hypertrophy is often found in children, this condition can affect people of all ages.
If a GM is suspected, physical examination is first performed and questions about the symptoms and the presence of cardiovascular diseases from close relatives (parents, children, brothers, sisters) are asked. Then, advanced diagnostic studies and technologies are used for effective examination of the patient. The collected information is analyzed and then the treatment is made taking into account individual peculiarities of a person.
Depending on the readings, the following diagnostic procedures are performed:
- Catheterization of the heart . When it is performed through a blood vessel in the hand or groin, a long, thin flexible tube is directed to the heart. The contrast agent is injected through the tube, after which X-ray video is recorded. It evaluates the functional properties of the heart. Heart block is also defined.
- Magnetic resonance imaging (MRI). To obtain images of the heart and blood vessels, a large magnet, radio waves and a computer device are used.
- Echocardiography. This ultrasound study uses sound waves to capture moving heart chambers and valves.
- Electrocardiography (ECG) . This test measures the electrical activity of the heart and can help determine the enlarged parts of the heart, whether it works normally or is damaged. Electric currents of the heart are recorded using 12-15 electrodes, which are attached to the arms, legs and chest using a duct tape.
- Genetic testing or screening : Some types of myocardial hypertrophy are transmitted by heredity. The genetic test can identify the status of other family members, determine the chances of the parent to pass on the gene to the child and identify hereditary cardiomyopathy until symptoms appear.
- Holter monitoring. To carry it out, a portable ECG device is used that constantly records heart rhythms. It should be worn from 24 to 48 hours without changing daily activity.
- Stress test . Conducted during physical training. If a person can not practice physical activity, prescribe medications to increase the frequency of heart rate. The test is used together with the ECG, so it can show changes in heartbeat, rhythm or electrical activity, as well as blood pressure.
The prognosis for people with myocardial hypertrophy depends on the general condition of the person. Most people with HM symptoms are defined as lungs or they are absent at all. In such cases, a person leads a normal, active life. Some patients experience more severe, progressive symptoms that require medication and / or even surgical treatment. A small proportion of patients have an increased risk of sudden death, often at a young age or during active sports activities.
General principles of treatment of myocardial hypertrophy
In the treatment of hypertrophy of the myocardium, the following methods of exposure are used:
- Changing lifestyle
- Use of medicines.
- Surgical treatment.
It is important to know that in determining the hypertrophy of myocardium in athletes , which, according to the results of the research, does not present any health or life threats, does not require treatment.
Patients with hypertrophy of the myocardium can relieve their symptoms by the following changes in lifestyle and diet:
- quit smoking;
- maintain healthy weight;
- regularly monitor blood pressure;
- be physically active for most of the time;
- limit alcohol and caffeine consumption;
- increase fruit and vegetable consumption;
- replace products made from purified grains such as white bread and pasta, whole-grain products;
- eliminate processed foods with high sugar and fat content;
- consume no more than 1500 milligrams of salt per day;
- sleep 7-9 hours a day.
The implementation of such recommendations will improve general well-being and prevent the emergence of life-threatening complications. If necessary, you can apply for help in getting rid of alcoholism and drug addiction.
The main purpose of using drugs is to alleviate symptoms such as chest pain, shortness of breath, and palpitations.
Beta-blockers are considered first-line drugs, since they can slow heart beat and reduce the likelihood of extraordinary contractions.
Patients who can not tolerate beta-blockers are more likely to be prescribed by non-dihydropyridine calcium channel blockers , such as verapamil. They are potentially dangerous for people who are additionally afflicted with low blood pressure or have severe shortness of breath at rest. These drugs also reduce the frequency of heart attacks, although they should be used with caution in patients with severe outflow obstruction, elevated pulmonary arterial pressure and low blood pressure. Dihydropyridine calcium channel blockers should be avoided in people with signs of obstruction.
Patients whose symptoms are not facilitated by the aforementioned drugs may be considered the use of disopyramide .Also often prescribed diuretics , which are shown to people with signs of over-saturation of the body fluid. At the same time, such drugs are used with caution in those cases where signs of obstruction are determined.
In the presence of symptoms, in spite of drug therapy, more radical methods of exposure may be considered. In particular, the method of intravenous administration of phenylephrine (or other vasoconstrictor), shown in acute states accompanied by low blood pressure in patients with obstructive hypertrophic cardiomyopathy, is often used.
Additionally, the doctor may prescribe medications for monitoring blood pressure or treating diabetes, as well as another major condition.
There are several types of procedures that can be used to treat myocardial hypertrophy, including implantation of a cardioverter defibrillator, ablation of the septal, septal myectomy.
- Implantation of Cardioverter Defibrillator (ICD)
During the IC, the device is inserted under the skin, just below the clavicle. From him conducting thin wiring to the heart.The device controls the heart rate and, if necessary, generates electrical signals that can eliminate abnormal heart rhythms.
- Ablation of the partition
During this procedure, the interventional cardiologist inserts a small amount of pure alcohol directly into the heart muscle. This leads to a reduction in the affected part of the myocardium, which allows the blood to flow more freely.
Alcoholic ablation of the septum was first used in 1994 by Ulrich Sigvart, a German cardiologist and surgeon.
During the procedure, the patient is awake, but doctors use medications to anesthetize the skin around the area of the cut so as not to feel pain. A small needle is inserted into the vein, catheters (thin tubes) are also used, which makes access to the arteries near the heart.
Using a special dye, visible arteries are controlled by equipment for visualization, such as an echocardiograph. The blood vessel, a blood supplying enlarged area of the myocardium, is detected. By arteries, a catheter with a balloon is being promoted to this site. The balloon is then inflated to temporarily block the artery and make sure that the alcohol remains in the desired area. Finally, a small amount of pure alcohol is added and is expected to last for 5-10 minutes.This prevents unwanted leakage of matter into other parts of the heart.
As soon as the procedure is completed, the catheter is removed. After a while, the patient may feel better. Next, you will need to monitor your heart for the next few days with a temporary pacemaker. Sometimes you need to stay in the hospital during this time.
- Septic myectomy
This surgical procedure is performed to reduce the size of the thickened muscle in patients with hypertrophic cardiomyopathy. Septic myectomy is one of the treatments for GM where the symptoms persist despite medication being treated, or if the obstruction seriously restricts the release of blood from the heart.
During a septal myectomy, the surgeon removes a small amount of thickened partition myocardium, which allows you to expand the outflow from the left ventricle to the aorta. This eliminates the obstruction and regurgitation of the mitral valve that occurs in this condition. After the procedure, patients often experience rapid relief.
Treatment of myocardial hypertrophy of the left ventricle
First of all, the treatment is directed at the underlying disease (hypertension, diabetes mellitus, heart malformation). At the beginning, medicines are used. In the event of their ineffectiveness, a decision is made on surgical intervention.
Strategies for treating the underlying causes of the GM left ventricle
- Blood pressure monitoring
With the development of GM in the background of hypertension, medical recommendations are based on maintaining sufficient physical activity, refusing to smoke and drinking alcohol. Of great importance is dietary nutrition with a predominance in the diet of vegetables, fruits, whole-grain bakery products, etc.
It is imperative to prescribe antihypertensive drugs and antiarrhythmics, which should be taken in the dosage indicated by the doctor. When diarrhea is present, swabs may be used.
- Sleep apnea treatment
Sometimes during a sleep, a person stops breathing for a short time and then speaks of sleep apnea. Such a disease often develops against a background of hypertension and can provoke development of hypertrophy of a myocardium.
Today, CPAP equipment is used to eliminate this problem, which creates a constant positive pressure in the respiratory tract, which in turn prevents overlapping breathing. As a result, a constant supply of oxygen is provided and the blood pressure is normalized.
- Treatment of heart defects
The left ventricular myocardial hypertrophy often occurs due to the aortic valve stenosis. In such cases, medication therapy is ineffective, as well as folk remedies. The defect is eliminated only by a surgical procedure, when either the plastic valve of the valve occurs or an artificial valve is implanted. Today, tissue valve implantation is also possible, but the final choice depends on the indications.
Treatment of concentric hypertrophy of the left ventricular myocardium
Concentric hypertrophy of the left ventricle leads to a deterioration of the systolic function of the heart, as well as the longitudinal, peripheral and radial deformation of the myocardium. It is most commonly encountered in patients with hypertension and is usually followed by the preservation of the function of the left ventricle.
In concentric GM patients, patients often feel well, whereas pathological changes are mostly found on control echocardiography. Nevertheless, in order to prevent further thickening of the walls of the myocardium, it is recommended to undergo appropriate treatment.
Main directions of therapy at concentric GM:
- Maintaining a healthy lifestyle.
- Dietary nutrition with reduced salt intake.
- Antihypertensive treatment, with the maintenance of systolic blood pressure no higher than 140 mm Hg. Art., and better 130 mm Hg. Art.
- Use of antiarrhythmics, such as ACE inhibitors (ramipril).
- In some cases, with a high probability of progression of the disease, EECP can be used.
UNPP is an intensified external counterpulsation that is carried out as a non-invasive treatment to reduce the amount and intensity of angina attacks. The treatment is carried out through three pairs of external inflatable cuffs, which are superimposed on the legs, hips and buttocks. These cuffs are pumped and blown at a certain frequency (between periods of the palpitation), which allows you to increase the flow of blood to the heart.
- Increase oxygen supply to the heart.
- Reduce chest pain.
- Improve ECG response to physical exercises.
- Reduce the use of nitroglycerin.
- Increase vigor.
- Increase the duration of exercises.
- Get long-term results of up to 2 years.
With hypertrophic cardiomyopathy and enlarged heart, EECP is not recommended, but with concentric GM, this method of treatment can be used.
Complications of myocardial hypertrophy
Complications of GM may include:
- Blood clot formation . This is caused by ineffective blood transfusion. As a result, blood clots (thrombi) can form in the heart cavities, which can penetrate the general blood flow and block the blood flow to other organs.
- Stopping heart and sudden death . Hypertrophy of the myocardium can lead to arrhythmias, which often cause a fainting or even heart failure.
- Heart failure . Hypertrophy of the myocardium can weaken the heart and cause it to not be able to efficiently pump oxygen-enriched blood to all parts of the body.
- Valvular vices . If the heart is enlarged, the valves may not close properly, which affects the flow of blood through the chambers of the heart and its entry to the rest of the body.
It is important to know that people with HM are at increased risk of premature death, which can occur without warning at any age.
Although it is virtually impossible to prevent hereditary types of hypertrophic cardiomyopathy, there are ways to prevent a number of serious complications. In particular, it is necessary:
- Monitor high blood pressure and cholesterol levels.
- Quit smoking, observe the principles of healthy eating, engage in unprofessional sports.
- Regular examinations, especially if new signs or new symptoms have changed. In such cases, you should immediately contact your doctor.
- Take medication as prescribed by your doctor. If a medicine is prescribed from myocardial hypertrophy or high blood pressure, you must take it at the specified dose.
Treatment of myocardial hypertrophy in many respects depends on the course and peculiarities of the underlying disease. But in all cases, dietary nutrition, rejection of bad habits and sufficient physical activity are important. If necessary, surgical intervention is performed on the type of septal myectomy, alcohol ablation of the septum, or the implantation of the valve (artificial or tissue).
Video: Medical Treatment of Hypertrophic Cardiomyopathy - Andrew Wang, MD
Increased load can lead to thickening of the muscles not only of the arms and legs, but also of the heart. In this case, they say about myocardial hypertrophy and a similar condition is a pathology, since it can lead to serious consequences. Treatment of the disease can improve the condition of the patient and maintain its performance over a long time.
An increase in the heart size and weight in the medical language is indicated as hypertrophy of the myocardium. The development of a pathological condition is often associated with other cardiovascular, endocrine and somatic diseases, and therefore it is considered a complication.
A number of heart diseases are often complicated by hypertrophy of the left ventricular myocardium, which means a similar definition? This is a pathological condition, which sometimes does not foretell anything bad. In other cases, an urgent surgical intervention is required.