Left atrial hypertrophy

Strictly speaking, cardiac hypertrophy is not a disease, but a very alarming symptom that may indicate the development of various cardiovascular diseases. The increase in cardiac tissue cells most often affects the left side of the heart. And, probably, many have personally encountered or heard from friends about a diagnosed condition such as left atrium hypertrophy. What is it? How dangerous is it, because it is known that from the lungs, blood enriched with oxygen goes directly to the left atrium?

What steps should be taken if you encounter such a diagnosis during a routine ECG?

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes of left atrial hypertrophy

In general, the causes of left atrial hypertrophy are quite varied. They may include heredity, extreme excess weight, and high blood pressure.

Sadly, heart problems have long ceased to be the prerogative of older people. The age of patients in cardiology departments is rapidly decreasing, and one of the most common causes of this pathology is obesity - and especially in young people and even children.

Hypertensive patients are also susceptible to left atrial hypertrophy: high blood pressure naturally leads to increased stress on the heart in conditions of impaired normal blood flow.

It causes hypertrophy of the left atrium and narrowing of the opening that regulates blood flow between the left atrium and ventricle (the scientific name for this phenomenon is mitral valve stenosis), as a result of which the load on the atrium increases, since normal blood flow is disrupted, and excess blood is retained in the atrium. This is why hypertrophy of the left atrium occurs. However, stenosis of the aortic valve, which is responsible for blood circulation from the left ventricle to the aorta, can also cause an increase in this part of the heart. Less and less blood leaves the heart, the load on the heart muscle increases, and problems with the left atrium arise.

In addition to the aforementioned mitral and aortic stenosis, left atrium hypertrophy can also be caused by mitral or aortic valve insufficiency. In this case, we are not talking about the narrowing of one of them, but about their incorrect operation, when the corresponding valve is unable to close tightly. As a result, blood flows in the opposite direction, and, if we are talking about, say, the mitral valve, inflammation of the left atrium occurs, which leads to its hypertrophy.

Myocarditis, when the contractile function of the heart suffers due to inflammation, and kidney diseases, which cause increased pressure, also lead to hypertrophic changes in the heart muscle. The occurrence of left atrium hypertrophy is also associated with various infectious diseases of the respiratory tract, which impede the functioning of the lungs and, as a consequence, the work of the left atrium.

If we look for the causes of left atrial hypertrophy in heredity, then, first of all, we can name hypertrophic cardiomyopathy. With this disease, overloads in the work of the heart occur due to pathological thickening of the ventricles. The lower chambers of the heart have to work in an enhanced mode to ensure the flow of blood to all organs and parts of the body, which, in turn, leads to an increase in the heart muscle.

And, of course, a rare heart disease or pathology is not related to stress. Constant nervous tension cannot but affect the blood pressure level, and from here - a direct path to left atrial hypertrophy.

[ 7 ], [ 8 ], [ 9 ], [ 10 ]

Symptoms of left atrial hypertrophy

Symptoms of left atrial hypertrophy are not always obvious. If the process of enlargement of the heart muscle has not gone too far, then a person can live for a long time without experiencing any particular health problems and not even suspecting that he has left atrial hypertrophy.

Problems begin when the heart tissue is seriously affected. Then even the most everyday activities can be overshadowed by unexpected and unpleasant manifestations of this pathology. For example, during a morning jog, swimming, cycling, fitness classes, such symptoms of left atrial hypertrophy as chest pain or a sudden increase in heart rate may suddenly appear. Many previously routine activities become more difficult due to increased fatigue.

Also, with left atrial hypertrophy, breathing difficulties often occur. Moreover, with such a pathology, it is recommended to avoid overexertion, since there is a high probability of shortness of breath.

Depending on what causes left atrial hypertrophy, the general symptoms listed above may vary. With mitral stenosis, for example, shortness of breath may be accompanied by hemoptysis and coughing, the patient may also suffer from swelling of the extremities, interruptions in the heart's work. Shortness of breath, general weakness and rapid heartbeat are symptoms of mitral valve insufficiency, and pallor, shortness of breath and pain during physical exertion indicate insufficiency of the aortic valves.

All the symptoms listed above should be taken very seriously, because, as has been said many times, left atrial hypertrophy is not a disease in itself, it accompanies various heart diseases. The latter are dangerous to the patient's life and health.

Diagnosis of left atrial hypertrophy

Although, as is known, at the initial stage, changes in cardiac tissue are asymptomatic, there are ways to diagnose left atrial hypertrophy.

Firstly, this pathology can be detected by auscultation of the heart. Auscultation is a special diagnostic method based on listening and evaluating sounds that occur during the work of various organs. In the case of cardiovascular diseases and pathologies, in particular with left atrial hypertrophy, two types of sounds are listened to with a stethoscope - tones (short, sharp sounds) and noises (prolonged sounds). The appearance of noises indicates problems in the work of the heart valves, and therefore the presence of pathology.

Secondly, left atrial hypertrophy can be diagnosed by ultrasound, specifically echocardiography, the purpose of which is to study changes in the heart and its valve apparatus. Thanks to the image obtained using reflected ultrasound signals, the doctor can identify the true state of the heart tissue and valves, determine the size of the heart chambers and the thickness of the heart walls, observe the speed of blood flow in the atria and ventricles and make the most accurate diagnosis of left atrial hypertrophy.

The third way to detect left atrial hypertrophy, especially in congenital heart defects, is an X-ray examination, with which the doctor can assess the condition of the lungs and reliably determine the size of the heart and its parts.

And finally, fourthly, left atrial hypertrophy can be detected by performing an electrocardiogram, which reveals abnormalities in heart contractions.

As a rule, the matter is not limited to just one of the listed methods, because a comprehensive approach to examining a person with suspected left atrial hypertrophy allows one to obtain the most complete picture of the condition and functioning of the heart in general and the left atrium in particular.

[ 11 ], [ 12 ], [ 13 ]

Left atrial hypertrophy on ECG

One of the methods for diagnosing left atrial hypertrophy, as mentioned above, is electrocardiography. This is a well-known, inexpensive, but reliable method for detecting cardiac pathologies. Its essence lies in the study of electrical fields recorded with a special device, which are formed during the work of the heart and are recorded on the ECG. As a rule, the ECG distinguishes the P, Q, R, S, T waves: the QRS complex displays the contraction of the ventricular heart muscle, the T wave and the ST segment - the repolarization of their myocardium, and P - the coverage of the excitation of the atrial myocardium.

The P wave is of particular importance for detecting left atrial hypertrophy on the ECG. When this part of the heart increases with excitation of the left atrium, the EMF increases, which, accordingly, leads to an increase in the excitation vector of this chamber of the heart, and the excitation itself lasts longer. Nothing like this is observed in the right atrium, therefore, the first part of the P wave on the ECG, reflecting excitation of the right atrium, corresponds to the norm. However, the second part of the wave, reflecting excitation of the hypertrophied left atrium, is increased in amplitude and duration. As a result, the ECG shows P-mitrale (a bifurcated elongated P wave in leads I, II, aVL, V5, V6), and the total width of this wave exceeds 0.10-0.12 s, and its second peak is larger in amplitude than the first.

Treatment of left atrial hypertrophy

Since this pathology is not an independent disease, the treatment of left atrial hypertrophy involves, first of all, the treatment of the underlying disease. Consequently, the effectiveness of the treatment of hypertrophic changes in the heart muscle depends on how correctly the underlying disease that led to left atrial hypertrophy is identified, how possible and effective its treatment is.

If the cause of left atrial hypertrophy is an infectious respiratory disease, then treatment is carried out depending on the symptoms observed in the patient. Antiviral drugs are used if left atrial hypertrophy is caused by a viral infection, antibiotics - if the infection is bacterial.

If the enlargement of the left atrium is associated with high blood pressure, the doctor prescribes a course of appropriate antihypertensive drugs to reduce the pressure (for example, carvedilol, metoprolol, etc.).

When the cause of left atrial hypertrophy is mitral valve insufficiency, the cause is most often rheumatism. In this case, it is necessary to detect and eliminate the streptococcal infection as quickly and efficiently as possible, for which the patient may be prescribed bicillin monthly for a year.

However, it is not always possible to limit oneself to therapy. It may even come to surgical intervention – when left atrium hypertrophy is associated with mitral stenosis at the second or third stage of development. One of the possible options for action in such circumstances is valvuloplasty – an operation during which the surgeon restores the valve function. When the valve is very badly damaged and cannot be restored, it is replaced.

However, each case is strictly individual, therefore treatment of left atrial hypertrophy, including diet, lifestyle, medications and their dosage, should be prescribed by a doctor after a complete and comprehensive examination, based on the underlying cause of the disease, the condition of the heart and the degree of its damage.

Prevention of left atrial hypertrophy

In general, advice on preventing left atrial hypertrophy is well known to everyone. The main one is a healthy lifestyle, no matter how trivial it may sound. Normal eight-hour sleep, healthy nutrition without extreme diets and overeating, regular but not excessive physical activity are quite capable of preventing the development of dangerous pathologies, and most importantly - the diseases hidden behind them.

Do not think that by exhausting yourself on exercise machines you can avoid health problems. On the contrary, the athlete's heart is forced to work at the limit of its capabilities due to heavy loads, so thickening of the heart tissue can be considered a common occurrence for a sports fan rather than an exception. And for those who simply want to avoid left atrial hypertrophy, it is enough to take a quiet walk before bed, swim, ride a bike or go skiing. Active games are also very beneficial: you can play badminton with friends or ball with your child - and then good health and a great mood will be ensured.

It is also important to avoid stress or at least deal with it in a timely manner. On the contrary, positive emotions have the most beneficial effect on the patient's health, including in terms of preventing the development of left atrial hypertrophy.

In order to prevent left atrial hypertrophy, it is important to treat diseases that can lead to the development of this pathology in a timely and complete manner. If left atrial hypertrophy has already been diagnosed, then immediately initiated treatment will help to avoid extremely unpleasant complications, including the need for surgical intervention.

Prognosis of left atrial hypertrophy

Like treatment, the prognosis for left atrial hypertrophy depends largely on what caused the pathology and how much the heart is affected.

With early diagnosis, timely treatment, and proper prevention, in most cases left atrial hypertrophy can be avoided or the harm from it can be reduced to a minimum, and the patient can calmly enjoy a full life and not be afraid of sad consequences for themselves.

But we must not forget that left atrium hypertrophy can serve as a signal for the onset of more dangerous cardiac pathologies and provoke hypertrophic changes in other parts of the heart. Thus, with problems with the left atrium, there is a high probability of increased pressure in the left ventricle, and, as a result, its hypertrophy can gradually develop. With mitral valve insufficiency, an increase in pressure in the left atrium is followed by an increase in pressure in the pulmonary artery and - often - hypertrophy of the right ventricle.

Left atrial hypertrophy should be taken very seriously, because without appropriate treatment the prognosis worsens significantly: this pathology can not only disrupt the usual way of life, lead to complications and health problems, but also become a real threat to life. Thus, with advanced changes in the heart muscle, pulmonary edema can develop, attacks of cardiac asthma can begin. In the worst case scenario, increasing problems with blood circulation can lead to disability or even death.

But do not think that left atrial hypertrophy has a clearly negative prognosis. Even with congenital heart defects, even if surgery is necessary, patients can easily return to a full life, without limiting themselves due to health problems. The main thing is not to delay a visit to the doctor, not to ignore unfavorable symptoms, especially if there is a genetic predisposition to left atrial hypertrophy, strictly follow the advice of doctors and undergo a full course of treatment, and often it is enough to simply lead an active and healthy lifestyle, and then the prognosis for left atrial hypertrophy will be the most favorable.