Right atrial hypertrophy

The term hypertrophy was introduced to denote a compensatory enlargement resulting from some insufficiency or deficiency. Hypertrophy of the right atrium is less common than that of the left, since the latter experiences comparatively greater functional loads.

The heart has four sections that can increase in volume due to negative factors. An exception and physiological norm is the growth of cardiac volume due to regular aerobic training in professional athletes and people leading an active lifestyle. Pathological proliferation of cardiac tissue cells (cardiomyocytes) often entails concomitant diseases. Hypertrophy of one of the cardiac chambers is characterized by its own features and has symptoms peculiar only to it. It should be noted that hypertrophy does not refer to independent diseases, but is a syndrome of a set of disorders that have led to an unfavorable condition.

Right atrium hypertrophy, as a result of changes in the pulmonary circulation, occurs with respiratory disorders, is caused by pathology of the tricuspid valve or vessels, and is often a consequence of congenital heart defects. The listed diseases lead to hypertension of the pulmonary artery and significant cardiac overloads, increasing the right atrium and causing its failure.

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Causes of Right Atrium Hypertrophy

Right atrial hypertrophy can be caused by increased body weight or obesity, rib deformation, strong emotional outburst, various addictions (for example, to alcohol).

Types of hypertrophy are divided depending on the factors affecting the functioning of the heart:

• myofibrillar or working - develops against the background of intense loads or constant overstrain of a healthy organism;
• substitution - the result of the heart's adaptation to a normal regime in various painful conditions;
• regenerative - after a heart attack, a scar is formed in its place, and the cardiomyocytes located around it grow, taking over the functions of the lost zone.

The following causes of right atrial hypertrophy are identified:

• pulmonary pathologies - bronchitis or chronic obstructive pulmonary disease can increase blood pressure in the pulmonary artery, which receives blood from the right ventricle;
• pulmonary artery embolism - the lungs communicate with the right ventricle via an artery that carries blood for purification with subsequent oxygen saturation. The formation of a thrombus in the pulmonary artery prevents free blood flow, which causes an increase in the load on the heart muscle, which strives to resume the anatomically correct blood flow. Moreover, the maximum effort is observed in the right heart chambers;
• tricuspid stenosis - a septum located between the atrium and the ventricle on the right helps blood circulate normally from the right atrium to the right ventricle. A decrease in the lumen of the valve (stenosis) reduces the amount of blood flowing. To get rid of stagnation, the pressure in the right atrium chamber increases, but functioning in an increased mode leads to dilation and hypertrophy;
• tricuspid valve insufficiency – changes in the tricuspid valve caused by the inability to close completely and the backflow of blood from the ventricle to the atrium;
• often hypertrophy of the right atrium is a consequence of an enlargement of the right ventricle;
• congenital heart defects – such diseases are characterized by problems with the tricuspid, mitral or pulmonary artery valve. Any change in the structure of the heart leads to dysfunction of blood flow and subsequently to hypertrophy.

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Signs of right atrial hypertrophy

Right atrial hypertrophy is expressed by chest pain, respiratory problems, and fatigue. Often, unfavorable symptoms are preceded by: previous pneumonia, exacerbation of bronchial asthma, pulmonary artery embolism, etc. After treatment of the underlying disease, alarming symptoms may subside and even disappear completely. In addition to clinical manifestations of pulmonary problems, signs of venous congestion are possible with hypertrophy. Alarming signs of right atrial hypertrophy are characterized by:

• cough, shortness of breath, deterioration of respiratory function;
• swelling;
• pallor of the skin, cyanosis;
• dulling of attention;
• slight tingling, discomfort in the heart area;
• pathology of the heart rhythm.

In most cases, hypertrophy is asymptomatic, and clinical symptoms are observed only at an advanced stage. Consult a doctor immediately if you notice rapid heartbeat, dizziness (loss of consciousness), swelling of the lower extremities.

Right atrial hypertrophy during pregnancy

Cardiovascular pathologies are considered to be rather complex extragenital diseases during pregnancy. Any pregnancy is characterized by the dynamics of a gradual, constant, sometimes sudden type with obvious physiological and hormonal changes. The cardiovascular system undergoes enormous stress during pregnancy, for this reason it is important to establish the correct diagnosis in a timely manner, as well as to assess the woman's ability to bear and give birth. The ideal option would be to decide on the admissibility of pregnancy before conception in order to prevent health risks and threats to the life of the mother and baby.

It is known that right atrial hypertrophy during pregnancy is not an independent disorder. The disease can be caused by both congenital and acquired pathologies, including those during the period of gestation. In order to monitor the condition, pregnant women with heart problems are recommended to be hospitalized three times during the entire period. The first hospitalization is necessary for a thorough examination of the defect, determining the activity of the pathological process and the functioning of the circulatory system with consideration of the issue of possible termination of pregnancy. Repeated hospitalization is required due to the peak of physiological stress to maintain the performance of the heart. Staying in the hospital for the third time helps specialists determine the method of delivery.

Consequences of right atrial hypertrophy

Chronic lung pathologies have a negative effect on the pulmonary circulation and form an excessive amount of connective tissue, reduce the area of gas exchange and the volume of microcirculation. Such disorders create excess pressure in the pulmonary vessels, which in turn entail an active contraction of the right cardiac cavities, which over time hypertrophy.

The following consequences of right atrial hypertrophy are distinguished:

• inevitable dilation (expansion) of the cardiac section;
• insufficient blood flow in both circles;
• the appearance of pulmonary heart disease;
• venous congestion;
• development of edema;
• detection of cyanosis of the skin;
• dyspnea.

The progression of the disease causes disruptions in the functioning of other internal organs.

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Diagnosis of right atrial hypertrophy

As practice shows, already at the stage of physical examination the doctor establishes myocardial hypertrophy. The specialist is armed with the technique of auscultation - assessment of the state of internal organs by listening. Examination of the patient with a stethoscope allows to detect noises in the cardiac zone, indicating dysfunction of the valves and the presence of disease. An electrocardiogram is necessary in order to find disturbances and deviations in the functioning of the heart, as evidenced by the increased amplitude and sharpening of the teeth.

A more accurate diagnosis of right atrial hypertrophy is echocardiography, which is performed using ultrasound. The method gives an idea of the size and thickness of the walls of the heart chambers, helps to get a complete picture of the blood flow with a detailed state of the valves and tissues of the organ.

It is possible to characterize the size of the atria and ventricles, as well as identify pulmonary pathologies, which is especially important in case of congenital defects, using radiography.

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Right atrial hypertrophy on ECG

Excessive overload of the right atrium is expressed by the deviation of the electrical axis to the right, forward and downward. Chest leads are normal - a two-phase P wave in the positive phase reflects excitation of the right atrium, and the negative - the left. The appearance of hypertrophy of the atrium on the right is characterized by an increase in the positive phase of the wave, which sharpens and increases in height.

Right atrial hypertrophy on the ECG is differentiated by a set of signs designated by P-pulmonale and characteristic of pulmonary pathology, including chronic pulmonary heart disease and pulmonary hypertension, and disorders of the pulmonary circulation. Right atrial hypertrophy is assessed by the following signs: •

High amplitude of the P wave and sharpening of the apex with leads I, III, aVF (P value more than 2.5 mm); •

The first positive phase, prevailing over the negative one, is determined by the high and pointed form of Pv1,2; •

P wave widening or duration greater than 0.1 s.

If there are difficulties in differentiating hypertrophy, the Macruz index is used - the ratio of the P value and the PQ segment. Pathology of the right atrium gives an index of less than 1.1.

Treatment of right atrial hypertrophy

As is known, right atrial hypertrophy is a secondary problem. It is possible to normalize the atrium size, improve the body's oxygen supply due to healthy heart function, by treating the underlying cause. Thus, treatment of right atrial hypertrophy is based on a comprehensive approach to treating the underlying pathology. Doctors perform drug correction of the condition, and the patient himself is often required to change his usual way of life. Without proper treatment of his own body, the efforts of specialists can be futile. Refusal of addictions, reasonable restrictions in the daily diet (reducing the consumption of salt, water, foods with cholesterol, etc.), normalization of body weight, but at the same time moderate physical activity. All of the above will speed up the recovery and restoration processes, prevent the possibility of relapse.

When diagnosing pulmonary heart disease, which is a consequence of pulmonary problems, they work on compensating the pulmonary function using anti-inflammatory measures, bronchodilators and other necessary medications. Valve defects in most situations require surgical treatment. To eliminate the symptoms of myocardial diseases, antiarrhythmic therapy is prescribed, including cardiac glycosides and drugs that stimulate metabolic processes in muscle structures (for example, riboxin).

Timely diagnosis of acquired right atrial hypertrophy provides a high chance of full recovery and a long, full life.

Prevention of right atrial hypertrophy

Prevention of right atrial hypertrophy begins with a healthy lifestyle, proper daily routine, and balanced nutrition. If your profession is not related to professional sports, you should not exhaust yourself with physical exercises and colossal loads. To maintain a great mood and create a great physical shape, daily walks, swimming, cycling, or moderate jogging are enough.

Today, more and more specialists are inclined to believe that the body has difficulty withstanding extreme loads that increase pressure in the circulatory system and cause hypertrophy. The next colossal problem that hits the heart muscle is nervous overstrain. Of course, it is impossible to put yourself under a cap in a complete vacuum, but you should do everything to prevent heart wear. Maybe that is why the number of people keen on yoga, meditation, and relaxation practices is steadily growing? The ability to think about the good, notice the pleasant, and be inspired by the world around you is becoming a necessary skill for every resident of a huge metropolis.

Timely visits to a doctor regarding diseases that can cause complications in the circulatory system, proper health maintenance in the presence of congenital heart defects are no less important prevention of right atrial hypertrophy.

Prognosis of right atrial hypertrophy

Based on the fact that right atrium hypertrophy is a consequence of some disease or defect, a favorable medical conclusion is based on successful treatment and the characteristics of the primary pathology. The degree of irreversible changes in the tissues and functioning of the heart plays a huge role. If the preceding disease is a congenital defect, for example, pulmonary artery stenosis, which led to dilation and hypertrophy first of the ventricle and then of the atrium on the right, then surgical intervention is required.

Acquired defects, which are formed due to a previous disease, often of an infectious nature, respond well to complex therapy in the early stages. The prognosis of right atrial hypertrophy is largely determined by the severity of the defect, the presence of concomitant pathologies and the patient's condition (for example, during pregnancy the clinical picture may worsen), and the severity of hemodynamic disorders.

Provided that it is diagnosed early, treated correctly and all medical recommendations are followed, right atrial hypertrophy is not considered a death sentence for the patient. In this regard, it is very important to listen to the signals of your own body and seek medical help in time.