Hypertrophy of the basal part of the interventricular septum. Hypertrophic cardiomyopathy diagnosis and treatment. Destruction of the interventricular septum with ethanol

Hypertrophic cardiomyopathy (HCM) is an isolated lesion (deformation) of the heart muscle, in particular, thickening of the wall of the ventricle (usually the left one). At the same time, the volume of its cavity remains normal (less often, it decreases), but diastolic function, that is, the flow of blood into the heart, deteriorates significantly. Why does arrhythmia occur? The disease is primary in nature.

Hypertrophic cardiomyopathy causes heart damage

HCM is an inherited cardiovascular disease. Occurs in 1 case out of 500, more often among the working population. However, spontaneous mutations in old age (non-classical Fabry disease) and early manifestation in children are possible.

Causes of pathology

The development of the disease is associated with an abnormal arrangement of muscle fibers, which is caused by gene mutations (changes in the cells responsible for contractile proteins). This is an autosomal dominant pathology, often with asymmetric manifestations. In 60% of cases, hypertrophy of the interventricular septum (IVS) is observed, less often of the apex of the organ, and sometimes of the middle segments.

Currently, clinical medicine has identified more than 400 possible mutations - causes among genes:

β-myosin, protein C, β light and heavy chains;

Hypertrophy of the interventricular septum is a fairly common pathology.

troponin T, C, I;
potassium channels;
α-actin;
protein kinase type A;
titin.

The genes of healthy parents can mutate during pregnancy or in the child’s later life under the influence of negative factors: radiation, ionization, infections, bad habits (smoking, alcohol, use of other surfactants).

Smoking and alcoholism in pregnant women can provoke gene mutations in the child

Classification of the disease

Hypertrophic cardiomyopathies are divided according to several criteria. All of them are reflected in the table.

Type	Description (indicators)
According to hemodynamics
Non-obstructive	Systolic gradient is normal
Obstructive (subaortic stenosis)	Present (promoted)
By type of obstruction (systolic pressure gradient)
Basal	≥30 mmHg Art.
Labile	Sharp and large fluctuations
Latent
By stages of obstruction
I
II
III
IV	>25 mmHg Art.
By location
Left ventricle (LV)	Asymmetric (basal sections of the IVS, the entire IVS, the entire IVS and the free wall of the LV, the apex of the heart including the septum and LV) and symmetrical (the entire ventricular cavity).
Right ventricle (RV)	The same changes in the right ventricle (moderate, medium, sharp).
According to the stages of the disease
Compensatory	Slight valve insufficiency (20-25%), hypertrophy and dilatation of the atrium.
Subcompensatory	Significant failure (25-50%), blood stasis, biventricular overload, pulmonary hypertension
Decompensatory	Severe obstruction (blood return - 50-90%), total heart failure.

Hypertrophic obstructive cardiomyopathy affects the aorta, organ cavity and walls, and mitral valve. Malfunctions of these elements are reflected by a number of signs.

Cardiomyopathy can affect different areas and areas of the heart

Characteristic symptoms

Common clinical signs include:

Manifestations of heart failure (90% of cases): shortness of breath, increased fatigue, night attacks of asphyxia. chest pain (pressing, squeezing) that does not go away after taking painkillers. Provoked by an increase in systolic pressure.
Obvious, noticeable disruptions in the functioning of the heart (frequent and excessive or, on the contrary, rare contractions, interruptions. 70% of cases).
Dizziness, fainting and presyncope (small output syndrome. Frequency 20-25%).
Ischemia caused by oxygen starvation due to deformation of blood vessels, impaired circulation, constant tension in the muscles, walls of capillaries and ventricles.
In 30% of cases, sudden death (loss of consciousness for more than an hour) is the only sign of an ongoing illness.

With this pathology, dizziness and fainting are often observed.

Symptoms can intensify with physical activity, tension (the moment of defecation), and a sudden change in position to vertical (bending). Hypertrophic cardiomyopathy has a number of risks and complications.

Possible complications

IVS hypertrophy and obstruction of the ventricular outflow tract (35-50% of cases) are dangerous due to the occurrence of life-threatening arrhythmias and arterial hypotension. Due to the enlarged septum, the valve rises to the surface and, at the moment of contraction of the ventricles, is attracted by the blood flow, which interferes with the normal circulation of the latter.

This disease can cause symptoms of hypotension when blood pressure drops to a critically low level.

People who work hard and professional athletes are most susceptible to SCD (sudden cardiac death). The risk group includes people suffering from obesity and other diseases, such as ischemia.

Diagnosis of the disease

During diagnostic procedures, HCM is characterized by thickening of the wall of one or both ventricles of 1.5 cm or more, and impaired diastole. In addition, there is a replacement of muscle tissue with fibrous tissue, abnormalities in the vessels and the entire myocardium. Diagnosis and treatment of hypertrophic cardiomyopathy is carried out in several stages.

Initial examination (available at home):

Studying the anamnesis: the nature of the disease, the first manifestation, what is associated with the increase in symptoms, whether anyone in the family suffers from this, whether any deaths have been recorded.
Visually inspect the skin for painful whiteness or bluish discoloration.

At the appointment, the doctor must listen to the patient for the presence of systolic heart murmurs

Heart tapping (determining changes in value), auscultation (determining systolic murmurs), measuring pressure.

Secondary examination (in a hospital setting):

General and chemical analysis of blood, urine, feces, coagulogram (study of coagulation and blood clots). They allow you to determine the presence of adjacent inflammations and the general condition of the body.
Echocardiography (EchoCG). Detects murmurs; in HCM, systolic murmurs are noted over the aorta. Determines heart defects, cavity sizes and wall thickness (a decrease in the ventricular cavity in combination with compaction of the IVS and wall is noted). If it is impossible to use the method (for example, the patient is obese), radionuclide ventriculography is performed (injection of contrast into the blood).
Electrocardiography (ECG). Shows heart rhythm, electrical conductivity and ventricular size.

To make an accurate diagnosis, it is necessary to undergo an ECG

Daily ECG monitoring. Helps track the dynamics of the disease and the effectiveness of treatment.
Load tests are specially organized laboratory experiments on simulators to identify the characteristics of hypertrophy and endurance of the body. Help make recommendations for rehabilitation.
MRI (magnetic resonance imaging). Shows in detail the condition of all internal organs.
X-ray. Determines the size of the heart (in case of HCM – normal or slightly enlarged) and the presence of blood congestion. Additionally, it excludes other inflammations and diseases.
Gene testing. Identifies a mutated gene and is carried out with the participation of the patient’s relatives.

If after this complex the diagnosis is still inaccurate, then a biopsy (sampling of muscle tissue) and catheterization (measuring pressure from the inside through tubes) are performed.

In some cases, a heart biopsy is necessary

Considering the fact that there may be no other manifestations before sudden death, it is recommended to undergo routine examinations with a cardiologist or cardiac surgeon or therapist. In 0.5% of cases, the pathology in question is identified during the process.

Treatment methods

If there is an identified risk of SCD (arrhythmias of various kinds), surgical insertion of an implant (an electrical device that monitors the heartbeat, which, when weakened, sends an impulse) For reduced obstruction, a two-chamber pacemaker; for ventricular tachycardia, a cardioverter-defibrillator. Surgical treatment includes myectomy (removal of part of the septum from the inside), ethanol ablation (injection of an alcohol solution into the septum with a syringe without cutting the chest; the cells die, the IVS decreases, and blood flow is restored).

Treatment involves the use of a whole range of drugs

With a progressive and complex course - a complex of medications. Taking into account the specifics of the disease, it is carried out in three directions: eliminating symptoms and preventing the development of secondary pathologies, preventing SCD, regulating and maintaining the neurohumoral system:

Drugs that restore rhythm. To eliminate ventricular tachycardia and atrial fibrillation - Amiodarone or Disopyramide. Supplement with inhibitors and diuretics. If there is more than one risk indicator for SCD, it is not prescribed.
Adrenergic blockers (Metoprolol, Nadolol, Propranolol). They are used for obstructive or non-obstructive forms. Effective at 30-60%. They suppress the activity of the sympathoadrenal system, which reduces the need for oxygen in the heart muscle. Eliminate symptoms and cause regression of hypertrophy. The approximate dose is 20 mg three times a day, varies depending on the dynamics of pressure, frequency of contractions and manifestations of insufficiency. To prevent blood clots, anticoagulants are prescribed.

Metoprolol helps reduce the manifestations of hypertrophy

Calcium channel blockers (Verapamil, Disopyramide). Suppress hypertrophy and eliminate symptoms. The functions are similar to the previous group; effectiveness was confirmed in 60-80% of cases. Dangerous due to increased gradient. The method of application is the same. Under the supervision of a doctor, the dose is increased.

Any treatment is carried out strictly in a medical facility and under constant supervision.

This video will tell you about the features of hypertrophic cardiomyopathy and its dangers:

Myocardial hypertrophy (hypertrophic cardiomyopathy) is a significant thickening and enlargement of the walls of the left ventricle of the heart. Its cavity inside is not expanded. In most all cases, thickening of the interventricular septa is also possible.

Due to thickening, the heart muscle becomes less extensible. The myocardium can be thickened over the entire surface or in some areas, it all depends on the course of the disease:

If the myocardium hypertrophies primarily under the aortic outlet, narrowing of the left ventricular outlet may occur. In this case, the inner lining of the heart thickens and the functioning of the valves is disrupted. In most cases, this occurs due to uneven thickening.
Asymmetrical thickening of the septum is possible without disruption of the valve apparatus and a decrease in output from the left ventricle.
Apical hypertrophic cardiomyopathy occurs as a result of enlargement of the muscle at the apex of the heart.
Myocardial hypertrophy with symmetrical circular hypertrophy of the left ventricle.

Disease history

Hypertrophic cardiomyopathy has been known since the mid-19th century. It was described in detail only in 1958 by the English scientist R. Teare.

Significant progress in the study of the disease was the introduction of some non-invasive research methods, when they learned about the existence of obstructions of the outflow tract and disorders of dystolic function.

This is reflected in the corresponding names of the disease: “idiopathic hypertrophic subaortic stenosis”, “muscular subaortic stenosis”, “hypertrophic obstructive cardiomyopathy”. Today, the term “hypertrophic cardiomyopathy” is universal and generally accepted.

With the widespread introduction of echocardiography studies, it was revealed that the number of patients with myocardial hypertrophy is much greater than was thought in the 70s. Every year, 3-8% of patients with this disease die. And every year the mortality rate is growing.

Prevalence and significance

Most often, people aged 20-40 suffer from myocardial hypertrophy; men are about twice as likely. Although it has a very varied course and progresses, the disease does not always manifest itself immediately. In rare cases, from the very beginning of the disease, the patient's condition is serious and the risk of sudden death is quite high.

The incidence of hypertrophic cardiomyopathy is about 0.2%. The mortality rate ranges from 2 to 8%. The leading cause of death is sudden cardiac death and life-threatening cardiac arrhythmias. The main reason is hereditary predisposition. If relatives did not suffer from this disease, it is believed that a mutation of the heart muscle protein genes occurred.

The disease can be diagnosed at any age: from birth to old age, but most often patients are young people of working age. The prevalence of myocardial hypertrophy does not depend on gender or race.

In 5-10% of all registered patients, with a long course of the disease, a transition to heart failure is possible. In some cases, in the same number of patients, an independent regression of hypertrophy, a transition from the hypertrophic to the dilated form, is possible. The same number of cases occur due to complications arising in the form of infective endocarditis.

Without appropriate treatment, mortality is up to 8%. In half of the cases, death occurs as a result of acute infarction, ventricular fibrillation and complete atrioventricular heart block.

Classification

In accordance with the location of hypertrophy, myocardial hypertrophy is distinguished:

left ventricle (asymmetric and symmetric hypertrophy);
right ventricle.

Basically, asymmetric hypertrophy of the interventricular septum is detected on the entire surface or in some of its parts. Less commonly, hypertrophy of the apex of the heart, anterolateral or posterior wall can be found. In 30% of cases, the share is symmetrical hypertrophy.

Taking into account the systolic pressure gradient in the left ventricle, hypertrophic cardiomyopathy is distinguished:

obstructive;
non-obstructive.

The non-obstructive form of myocardial hypertrophy usually includes symmetrical hypertrophy of the left ventricle.

Asymmetric hypertrophy can refer to both obstructive and non-obstructive forms. Apical hypertrophy mainly refers to the non-obstructive variant.

Depending on the degree of thickening of the heart muscle, hypertrophy is distinguished:

moderate (up to 20 mm);
medium (21-25 mm);
pronounced (more than 25 mm).

Based on clinical and physiological classifications, 4 stages of myocardial hypertrophy are distinguished:

I - pressure gradient at the outlet of the left ventricle is not more than 25 mm Hg. Art. (no complaints);
II - the gradient increases to 36 mm Hg. Art. (appearance of complaints during physical exertion);
III - the gradient increases to 44 mm Hg. Art. (shortness of breath and angina pectoris appear);
IV - gradient above 80 mm Hg. Art. (hemodynamic impairment, sudden death is possible).

Left atrial hypertrophy is a disease in which the left ventricle of the heart thickens, causing the surface to lose its elasticity.

If the compaction of the heart septum occurs unevenly, disturbances in the functioning of the aortic and mitral valves of the heart may additionally occur.

Today, the criterion for hypertrophy is myocardial thickening of 1.5 cm or more. This disease is currently the main cause of early death among young athletes.

Comments

Left ventricular hypertrophy or cardiomyopathy is a very common heart disorder in patients diagnosed with hypertension. This is a rather dangerous disease, since its final stage is often death in 4% of all cases.

What it is?

Hypertrophy implies thickening of the walls of the left ventricle and this does not occur due to the characteristics of the internal space. The septum between the ventricles changes, and tissue elasticity is lost.

Comments

Prevalence and causes of hypertrophy

The reason that leads to hypertrophy of the interventricular septum (IVS) is a genetic defect. This defect can occur in one of ten genes, each of which is involved in encoding information regarding the functioning of the contractile protein in the muscle fibers of the heart. To date, about two hundred such mutations are known, as a result of which hypertrophic cardiomyopathy develops.

2 Pathogenesis

What happens with hypertrophy of the interventricular septum? There are several interrelated pathological changes that occur during myocardial hypertrophy. First, thickening of the myocardium occurs in the specified area separating the right and left ventricles. The thickening of the interventricular septum is not symmetrical, so such changes can occur at any site. The most unfavorable option is thickening of the septum in the outflow tract of the left ventricle.

This causes one of the leaflets of the mitral valve, which separates the left atrium and ventricle, to come into contact with the thickened IVS. As a result, the pressure in this area (outflow section) increases. At the moment of contraction, the myocardium of the left ventricle has to work with greater force so that blood from this chamber enters the aorta. Under conditions of continued increased pressure in the outflow tract and in the presence of hypertrophy of the IVS of the heart, the myocardium of the left ventricle loses its former elasticity and becomes stiff or rigid.

Losing the ability to adequately relax during diastole or filling, the left ventricle begins to perform its diastolic function worse. The chain of pathological changes does not end here; diastolic dysfunction entails a deterioration in the blood supply to the myocardium. Ischemia (oxygen starvation) of the myocardium occurs, which is subsequently supplemented by a decrease in the systolic function of the myocardium. In addition to the IVS, the thickness of the walls of the left ventricle may also increase.

3 Classification

Currently, a classification is used that is based on echocardiographic criteria that makes it possible to distinguish hypertrophic cardiomyopathy into the following options:

Obstructive form. The criterion for this variant of hypertrophic cardiomyopathy is the difference in pressure (pressure gradient) that occurs in the area of the left ventricular outflow tract and ranges from 30 mm Hg. and higher. This pressure gradient is created at rest.
Latent form. At rest, the pressure gradient is below 30 mm Hg. When performing a stress test, it increases and is more than 30 mm Hg.
Non-obstructive form. The pressure gradient at rest and during a stress test does not reach 30 mmHg.

4 Symptoms

The presence of hypertrophy of the interventricular septum and left ventricle does not always have any clinical signs. Patients can live quite a long time, and only after the age of seventy do they begin to show the first signs. But this statement does not apply to everyone. After all, there are forms of IVS hypertrophy that manifest themselves only under conditions of intense physical activity. There are options that make themselves felt with minimal physical activity. And all of the above is connected with the part in which the interventricular septum is thickened. In another case, the only manifestation of the disease may be sudden cardiac death.

First of all, symptoms will appear with the obstructive form of hypertrophy. The most common complaints of patients with IVS hypertrophy in the area of the outflow tract are the following:

dyspnea,
chest pain,
dizziness,
fainting states,
weakness.

All of these symptoms tend to progress. As a rule, they first appear during physical activity. As the disease progresses, symptoms become apparent even at rest.

5 Diagnosis and treatment

Despite the fact that standard diagnosis should begin with the patient’s complaints, for the first time, hypertrophy of the IVS and left ventricle can be detected using an echocardiographic study (EchoCG, cardiac ultrasound). In addition to physical methods for diagnosing hypertrophy of the IVS and left ventricle, carried out in the doctor’s cabin, laboratory and instrumental methods are used. The following instrumental diagnostic methods are used:

Electrocardiography (ECG). The main ECG signs of myocardial hypertrophy of the interventricular septum and left ventricle are: signs of overload and enlargement of the left heart, negative T waves in the chest leads, deep atypical Q waves in leads II, III aVF; disturbance of rhythm and conduction of the heart.
X-ray of the chest organs.
24-hour Holter ECG monitoring.
Ultrasound of the heart. Today, this method is the leading one in diagnostics and represents the “gold standard”.
Magnetic resonance imaging Coronary angiography.
Genetic diagnosis uses a mapping method. DNA analysis of mutant genes is used.

All of these diagnostic methods are not only used to make a diagnosis of HCM, but to carry out differential diagnosis in relation to a number of similar diseases.

Treatment of hypertrophic cardiomyopathy has several goals: to reduce the manifestations of the disease, slow down the progression of heart failure, prevent life-threatening complications, etc. Like most, if not all cardiac diseases, HCM requires non-drug measures that contribute to the progression of the disease. The most important are normalizing body weight, giving up bad habits, and normalizing physical activity.

The main groups of drugs for the treatment of IVS and left ventricular hypertrophy are beta-blockers, calcium channel blockers (verapamil), anticoagulants, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, diuretics, class 1A antiarrhythmics (disopyramide, amiodarone). Unfortunately, HCM is difficult to treat with medication, especially if there is an obstructive form and insufficient effect of drug therapy.

Today, there are the following options for surgical correction of hypertrophy:

excision of hypertrophied cardiac muscle in the area of the IVS (myoseptectomy),
mitral valve replacement, mitral valve repair,
removal of hypertrophied papillary muscles,
alcohol septal ablation.

6 Complications

Despite the fact that this disease, hypertrophic cardiomyopathy, can be completely asymptomatic, it can have the following complications:

Heart rhythm disturbance. Non-fatal (non-fatal) rhythm disturbances such as sinus tachycardia may occur. In other situations, HCM can be complicated by more dangerous types of arrhythmias - atrial fibrillation or ventricular fibrillation. It is the last two variants of arrhythmias that occur with IVS hypertrophy.
Impaired cardiac conduction (blockade). About a third of cases of HCM can be complicated by blockades.
Sudden cardiac death.
Infectious endocarditis.
Thromboembolic complications. Blood clots formed in a certain place in the vascular bed can spread through the bloodstream and clog the lumen of the vessel. The danger of such a complication is that these microthrombi can enter the vessels of the brain and lead to impaired cerebral circulation.
Chronic heart failure. The progression of the disease steadily leads to the fact that first the diastolic and then the systolic function of the left ventricle decreases with the development of signs of heart failure.

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It is important to know! An effective means for normalization heart function and blood vessel cleansing exists! ...

Despite its prevalence (IVS hypertrophy is observed in more than 70% of people), it is most often asymptomatic and is detected only during very intense physical activity. After all, hypertrophy of the interventricular septum itself is its thickening and the resulting reduction in the useful volume of the chambers of the heart. As the thickness of the cardiac walls of the ventricles increases, the volume of the heart chambers also decreases.

In practice, this all leads to a reduction in the volume of blood that is released by the heart into the vascular bed of the body. To provide the organs with a normal amount of blood under such conditions, the heart must contract stronger and more often. And this, in turn, leads to its early wear and tear and the occurrence of diseases of the cardiovascular system.

Symptoms and causes of hypertrophic cardiomyopathy

A large number of people around the world live with undiagnosed IVS hypertrophy, and only with increased physical activity does their existence become known. As long as the heart can ensure normal blood flow to the organs and systems, everything proceeds hidden and the person will not experience any painful symptoms or other discomfort. But you should still pay attention to some symptoms and contact a cardiologist if they occur. These symptoms include:

chest pain; shortness of breath with increased physical activity (for example, climbing stairs); dizziness and fainting; increased fatigue; tachyarrhythmia that occurs for short periods of time; heart murmur on auscultation; labored breathing.

The causes of this pathology lie not only in an incorrect lifestyle. Smoking, alcohol abuse, excess weight - all this becomes a factor contributing to the increase in severe symptoms and the manifestation of negative processes in the body with an unpredictable course.

And doctors call gene mutations the reason for the development of IVS thickening. As a result of these changes at the level of the human genome, the heart muscle becomes abnormally thick in some areas.

The consequences of the development of such a deviation become dangerous.

After all, additional problems in such cases will be disturbances in the conduction system of the heart, as well as weakening of the myocardium and the associated decrease in the volume of blood ejected during cardiac contractions.

Possible complications of IVS hypertrophy

What complications are possible with the development of cardiopathy of the type under discussion? Everything will depend on the specific case and individual development of the person. After all, many will never know throughout their lives that they have this condition, and some may experience significant physical ailments. We list the most common consequences of thickening of the interventricular septum. So:

1. Heart rhythm disturbances such as tachycardia. Such common types as atrial fibrillation, ventricular fibrillation and ventricular tachycardia are directly associated with IVS hypertrophy. 2. Disorders of blood circulation in the myocardium. Symptoms that occur when the outflow of blood from the heart muscle is disrupted include chest pain, fainting and dizziness. 3. Dilated cardiomyopathy and the associated decrease in cardiac output. The walls of the heart chambers, under conditions of pathologically high load, become thinner over time, which is the cause of the appearance of this condition. 4. Heart failure. The complication is very life-threatening and in many cases ends in death. 5. Sudden cardiac arrest and death.

Of course, the last two conditions are terrifying. But, nevertheless, with a timely visit to the doctor, if any symptom of cardiac dysfunction occurs, a timely visit to the doctor will help you live a long and happy life.

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Hypertrophy of the interventricular septum is a special case of such a disease as hypertrophic cardiomyopathy. A thickened interventricular septum can obstruct blood flow from the left ventricle, making it difficult for the heart to pump.

1 Prevalence and causes of hypertrophy

Geographically, the prevalence of HCM is variable. In addition, different regions take different age categories. It is difficult to provide precise epidemiological data because a disease such as hypertrophic cardiomyopathy does not have specific clinical symptoms. It is safe to say that the disease is more often detected in men. The third part of cases is represented by a familial form, the remaining cases are related to HCM, which has no connection with a hereditary factor.
The reason that leads to hypertrophy of the interventricular septum (IVS) is a genetic defect. This defect can occur in one of ten genes, each of which is involved in encoding information regarding the functioning of the contractile protein in the muscle fibers of the heart. To date, about two hundred such mutations are known, as a result of which hypertrophic cardiomyopathy develops.

2 Pathogenesis

Changes in hypertrophy of the interventricular septum
What happens with hypertrophy of the interventricular septum? There are several interrelated pathological changes that occur during myocardial hypertrophy. First, thickening of the myocardium occurs in the specified area separating the right and left ventricles. The thickening of the interventricular septum is not symmetrical, so such changes can occur at any site. The most unfavorable option is thickening of the septum in the outflow tract of the left ventricle.
This causes one of the leaflets of the mitral valve, which separates the left atrium and ventricle, to come into contact with the thickened IVS. As a result, the pressure in this area (outflow section) increases. At the moment of contraction, the myocardium of the left ventricle has to work with greater force so that blood from this chamber enters the aorta. Under conditions of continued increased pressure in the outflow tract and in the presence of hypertrophy of the IVS of the heart, the myocardium of the left ventricle loses its former elasticity and becomes stiff or rigid.
Losing the ability to adequately relax during diastole or filling, the left ventricle begins to perform its diastolic function worse. The chain of pathological changes does not end here; diastolic dysfunction entails a deterioration in the blood supply to the myocardium. Ischemia (oxygen starvation) of the myocardium occurs, which is subsequently supplemented by a decrease in the systolic function of the myocardium. In addition to the IVS, the thickness of the walls of the left ventricle may also increase.

3 Classification

Currently, a classification is used that is based on echocardiographic criteria that makes it possible to distinguish hypertrophic cardiomyopathy into the following options:

Obstructive form. The criterion for this variant of hypertrophic cardiomyopathy is the difference in pressure (pressure gradient) that occurs in the area of the left ventricular outflow tract and ranges from 30 mm Hg. and higher. This pressure gradient is created at rest.

Latent form. At rest, the pressure gradient is below 30 mm Hg. When performing a stress test, it increases and is more than 30 mm Hg.

Non-obstructive form. The pressure gradient at rest and during a stress test does not reach 30 mmHg.

4 Symptoms

Chest pain
The presence of hypertrophy of the interventricular septum and left ventricle does not always have any clinical signs. Patients can live quite a long time, and only after the age of seventy do they begin to show the first signs. But this statement does not apply to everyone. After all, there are forms of IVS hypertrophy that manifest themselves only under conditions of intense physical activity. There are options that make themselves felt with minimal physical activity. And all of the above is connected with the part in which the interventricular septum is thickened. In another case, the only manifestation of the disease may be sudden cardiac death.
First of all, symptoms will appear with the obstructive form of hypertrophy. The most common complaints of patients with IVS hypertrophy in the area of the outflow tract are the following:

dyspnea,
chest pain,
dizziness,
fainting states,
weakness.

All of these symptoms tend to progress. As a rule, they first appear during physical activity. As the disease progresses, symptoms become apparent even at rest.

5 Diagnosis and treatment

Electrocardiography (ECG). The main ECG signs of myocardial hypertrophy of the interventricular septum and left ventricle are: signs of overload and enlargement of the left heart, negative T waves in the chest leads, deep atypical Q waves in leads II, III aVF; disturbance of rhythm and conduction of the heart.

X-ray of the chest organs.

24-hour Holter ECG monitoring.

Ultrasound of the heart. Today, this method is the leading one in diagnostics and represents the “gold standard”.

Magnetic resonance imaging Coronary angiography.

Genetic diagnosis uses a mapping method. DNA analysis of mutant genes is used.

All of these diagnostic methods are not only used to make a diagnosis of HCM, but to carry out differential diagnosis in relation to a number of similar diseases.

Normalization of body weight
Treatment of hypertrophic cardiomyopathy has several goals: to reduce the manifestations of the disease, slow down the progression of heart failure, prevent life-threatening complications, etc. Like most, if not all cardiac diseases, HCM requires non-drug measures that contribute to the progression of the disease. The most important are normalizing body weight, giving up bad habits, and normalizing physical activity.
The main groups of drugs for the treatment of IVS and left ventricular hypertrophy are beta-blockers, calcium channel blockers (verapamil), anticoagulants, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, diuretics, class 1A antiarrhythmics (disopyramide, amiodarone). Unfortunately, HCM is difficult to treat with medication, especially if there is an obstructive form and insufficient effect of drug therapy.
Today, there are the following options for surgical correction of hypertrophy:

excision of hypertrophied cardiac muscle in the area of the IVS (myoseptectomy),
mitral valve replacement, mitral valve repair,
removal of hypertrophied papillary muscles,
alcohol septal ablation.

6 Complications

Heart conduction disturbances (blocks)
Despite the fact that this disease, hypertrophic cardiomyopathy, can be completely asymptomatic, it can have the following complications:

Heart rhythm disturbance. Non-fatal (non-fatal) rhythm disturbances such as sinus tachycardia may occur. In other situations, HCM can be complicated by more dangerous types of arrhythmias - atrial fibrillation or ventricular fibrillation. It is the last two variants of arrhythmias that occur with IVS hypertrophy.

Impaired cardiac conduction (blockade). About a third of cases of HCM can be complicated by blockades.

Sudden cardiac death.

Infectious endocarditis.

Thromboembolic complications. Blood clots formed in a certain place in the vascular bed can spread through the bloodstream and clog the lumen of the vessel. The danger of such a complication is that these microthrombi can enter the vessels of the brain and lead to impaired cerebral circulation.

Chronic heart failure. The progression of the disease steadily leads to the fact that first the diastolic and then the systolic function of the left ventricle decreases with the development of signs of heart failure.

Hypertrophic cardiomyopathy - description and causes of the disease, diagnosis, treatment methods and prognosis

Thickening of the wall of the myocardium (the muscular lining of the heart) is a pathological condition. In medical practice, there are various types of cardiomyopathy. Morphological changes in the main organ of the circulatory system lead to a decrease in the contractility of the heart, and insufficient blood supply occurs.

What is hypertrophic cardiomyopathy

A disease characterized by thickening (hypertrophy) of the wall of the left (rarely right) ventricle of the heart is called hypertrophic cardiomyopathy (HCM). The muscle fibers of the myocardium are located chaotically - this is a characteristic feature of the disease. In most cases, asymmetric thickening is observed, and hypertrophy of the interventricular septum develops.
The pathology is characterized by a decrease in ventricular volume and impaired pumping function. The heart has to beat frequently to deliver enough blood to the organs. The consequence of these changes is heart rhythm disturbances and the appearance of heart failure. 30–50 years is the average age of patients diagnosed with hypertrophic cardiomyopathy. The disease is more common in men. The pathological condition is recorded in 0.2–1.1% of the population.
HCM is a hereditary disease. Occurs as a result of gene mutation. The type of transmission of altered hereditary structures is autosomal dominant. Pathology is not only congenital. In some cases, mutations occur under the influence of unfavorable environmental factors. The consequences of changing the genetic code are as follows:

the biological synthesis of myocardial contractile proteins is disrupted;
muscle fibers have an incorrect location and structure;
muscle tissue is partially replaced by connective tissue, myocardial fibrosis develops;
altered cardiomyocytes (muscular membrane cells) work uncoordinated, with increased load;
muscle fibers thicken, myocardial hypertrophy occurs.

Thickening of the muscle membrane (compensatory hypertrophy) is caused by one of two pathological processes:

Violation of diastolic myocardial function. During the period of relaxation of the heart (diastole), the ventricle is not filled with blood enough due to poor distensibility of the myocardium. This leads to an increase in diastolic pressure.

Obstruction (impaired patency) of the left ventricular outflow tract. Myocardial hypertrophy of the interventricular septum occurs. Blood flow is hampered due to impaired mobility of the mitral valve leaflet. At the moment of blood ejection, a difference in systolic pressure occurs between the cavity of the left ventricle and the initial part of the aorta. For this reason, some of the blood is retained in the heart. As a result, left ventricular end-diastolic pressure increases. Myocardial hypertrophy, dilatation (expansion) of the left atrium are consequences of compensatory hyperfunction.

Classification

The criteria underlying the classification of the disease are different. The following types of illness are distinguished:

asymmetric hypertrophy of the interventricular septum;
hypertrophic obstructive cardiomyopathy;
asymmetric hypertrophy of the apex of the heart (apical)

Right ventricular or left ventricular hypertrophy
Features of thickening formation
Asymmetrical, concentric (or symmetrical)
Hypertrophy of the interventricular septum, apex of the heart, anterolateral wall, posterior wall
The presence of a gradient (difference) of systolic pressure in the left ventricle
Degree of myocardial thickening
Moderate – 15-20 mm, average – 21-25 mm, pronounced – more than 25 mm
Taking into account the prevailing complaints of patients, nine forms of pathology are distinguished. While there are general symptoms, each variant of HCM has specific symptoms. The clinical forms are as follows:

lightning;
pseudovalvular;
arrhythmic;
cardialgic;
low-symptomatic;
vegetodistonic;
infarct-like;
decompensatory;
mixed.

The clinical and physiological classification identifies four stages of disease development. The main criterion is the difference in systolic pressure in the left ventricular outflow tract (LVOT) and in the aorta:

The first stage is a pressure indicator in the LVOT no more than 25 mm Hg. Art. The patient has no complaints about the deterioration of his condition.
The second stage is a pressure gradient of about 36 mmHg. Art. The condition worsens with physical activity.
The third stage – the pressure difference is up to 44 mm Hg. Art. Shortness of breath is observed and angina develops.
The fourth stage is a systolic pressure gradient in the LVOT of more than 88 mmHg. Art. Blood circulation is impaired and sudden death is possible.

Symptoms of hypertrophic cardiomyopathy

The disease may not manifest itself for a long time. Hypertrophic cardiomyopathy is the main cause of death among young athletes who were unaware of the presence of a hereditary disease. 30% of patients with GTCS have no complaints and do not experience a deterioration in their general condition. The symptoms of the pathology are as follows:

fainting, dizziness, shortness of breath, cardialgia, angina pectoris and other conditions associated with low blood output syndrome;
left ventricular heart failure;
heart rhythm disturbances (extrasystoles, paroxysms, arrhythmias);
sudden death (in the absence of symptoms);
the occurrence of complications - infective endocarditis, thromboembolism.

Diagnostics

The first signs of the disease appear in childhood, but in most cases it is diagnosed in adolescence or in patients 30–40 years old. Based on a physical examination (assessment of external condition), the doctor makes a primary diagnosis. The examination helps to identify the expansion of the borders of the heart, listen to the characteristic systolic murmur, if there is an obstructive form of the disease, the emphasis of the second tone may be on the pulmonary artery. When examining the jugular veins for hypertrophy, poor contractility of the right ventricle is indicated by a well-defined A wave.
Additional diagnostic methods include:

Electrocardiography. In the presence of pathology, the ECG is never normal. The study allows us to determine the enlargement of the heart chambers, disturbances in conduction and contraction frequency.
Chest X-ray. Helps identify changes in the size of the atria and ventricles.
Echocardiography. The main method for identifying the location of thickening of the heart wall, the degree of blood flow obstruction, and diastolic dysfunction.
Electrocardiogram monitoring throughout the day, with the use of physical activity. The method is important for preventing sudden death, prognosis of the disease, and identifying heart rhythm disturbances.
Radiological methods. Ventriculography (examination of the heart with the introduction of a contrast agent) and magnetic resonance imaging (MRI) are performed. They are used in complex cases to identify and accurately assess pathological changes.
Genetic diagnostics. The most important method for assessing the prognosis of the disease. Genotype analysis is carried out on the patient and his family members.

Treatment of hypertrophic cardiomyopathy

If a patient has symptoms of hypertrophic cardiomyopathy, a wide range of medications are used. If drug therapy is ineffective in the case of an obstructive form of pathology, surgical and alternative interventional methods of correction are used. A special treatment regimen is prescribed for patients with a high risk of sudden death or the last stage of the disease. The goals of therapy are:

reducing the severity of symptoms and clinical manifestations of pathology;
increasing the patient’s “quality of life”, improving functional ability;
ensuring a positive prognosis of the disease;
prevention of cases of sudden death and progression of the disease.

Drug therapy

In patients with symptoms of HCM, restriction of physical activity is recommended. This rule should be strictly followed by patients with an obstructive form of the disease. Loads provoke the development of arrhythmias, fainting, and an increase in the LVOT pressure gradient. To alleviate the condition with moderate symptoms of HCM, drugs of different pharmacological groups are prescribed:

Beta blockers (Propranolol, Metoprolol, Atenolol) or calcium channel blockers (Verapamil). They reduce heart rate, lengthen diastole (relaxation phase), improve filling of the ventricles with blood, and reduce diastolic pressure.
Calcium antagonists (Finoptin, Amiodarone, Cardil). Medicines reduce the amount of calcium in the coronary arteries, improve relaxation of structures (diastole), and stimulate myocardial contractility.
Anticoagulants (Phenindione, Heparin, Bivalirudin). Medicines reduce the risk of thromboembolism.
Diuretics (Furosemide, Indapamed), ACE inhibitors (Captopril, Ramipril, Fosinopril). The drugs are recommended for patients with heart failure.
Antiarrhythmic drugs (Disopyramide, Amiodarone).

In case of HCM, the use of cardiac glycosides, nifedipine, and nitrites is contraindicated. These drugs contribute to the development of obstruction.

Surgery

Cardiac surgical treatment is advisable in the absence of effectiveness of taking pharmacological drugs. Surgery is indicated for patients in whom the pressure difference between the left ventricle (LV) and the aorta is more than 50 mm Hg. Art. at rest and during physical activity. To alleviate the patient's condition, the following surgical techniques are used:

Transaortic septal myectomy (TSM). It is recommended for patients who experience fainting, shortness of breath, or chest pain during physical activity. The essence of the operation is to remove part of the interventricular septum. This manipulation ensures good LV contractility and free movement of blood into the aorta.
Percutaneous alcohol ablation. The operation is prescribed for patients with contraindications to EMS, elderly patients who have inadequate blood pressure under stress conditions. Sclerosing substances (for example, alcohol solutions) are injected into the hypertrophied interventricular septum.
Dual-chamber pacing. The technique is used for patients with contraindications to surgery. The manipulation improves heart function and increases cardiac output.
Implantation of an artificial mitral valve. Prosthetics are recommended for patients in whom poor blood flow is not due to thickening of the interventricular septum, but as a result of inversion of the valve into the aortic lumen.
Installation of ICD (implantable cardioverter-defibrillator). Indications for such a procedure are a high risk of sudden death, previous cardiac arrest, and persistent ventricular tachycardia. To install an ICD, an incision is made in the subclavian region, the electrodes are inserted through a vein (there can be 1-3, depending on the pacemaker model) and installed under x-ray control inside the heart.
Heart transplantation. Prescribed to patients with the last stage of heart failure, in the absence of effect from drug treatment.

Surgical operations significantly improve the condition of patients and increase tolerance to physical activity. Surgical treatment does not protect against further development of pathological thickening of the myocardium and complications. In the postoperative period, the patient must undergo regular examinations using hardware diagnostic techniques and take pharmacological medications prescribed by the doctor for life.

Hypertrophic cardiomyopathy has different development options. The non-obstructive form is stable, without pronounced symptoms. The consequence of prolonged development of the disease is heart failure. In 5–10% of cases, the thickening of the myocardial wall stops on its own; the same percentage is likely to transform hypertrophic cardiomyopathy into dilated cardiomyopathy (stretching of the heart cavities).
Mortality in the absence of treatment is observed in 3–8% of cases. In half of the patients, sudden death occurs, caused by severe ventricular arrhythmias, complete heart block, or acute myocardial infarction. In 15–25%, coronary atherosclerosis develops. Infectious endocarditis, which affects the mitral and aortic valves, occurs as a complication of the pathology in 9% of patients.

Myocardial hypertrophy - signs and symptoms. Treatment of hypertrophic cardiomyopathy of the left ventricle of the heart

If asymptomatic, this disease can result in sudden cardiac arrest. It's scary when this happens to seemingly healthy young people who play sports. What happens to the myocardium, why such consequences arise, whether hypertrophy is treated - remains to be figured out.

What is myocardial hypertrophy

This autosomal dominant disease is characterized by hereditary traits of gene mutation and affects the heart. It is characterized by an increase in the thickness of the walls of the ventricles. Hypertrophic cardiomyopathy (HCM) has a classification code according to ICD 10 No. 142. The disease is often asymmetric, with the left ventricle of the heart more susceptible to damage. This happens:

chaotic arrangement of muscle fibers;
damage to small coronary vessels;
formation of areas of fibrosis;
obstruction of blood flow - an obstacle to the ejection of blood from the atrium due to displacement of the mitral valve.

With heavy loads on the myocardium caused by diseases, sports, or bad habits, the body’s protective reaction begins. The heart needs to cope with increased work volumes without increasing the load per unit of mass. Compensation begins to occur:

increased protein production;
hyperplasia – increase in the number of cells;
increase in myocardial muscle mass;
wall thickening.

Pathological myocardial hypertrophy

With prolonged work of the myocardium under loads that are constantly increased, a pathological form of HCM occurs. A hypertrophied heart is forced to adapt to new conditions. Myocardial thickening occurs at a rapid pace. In this situation:

growth of capillaries and nerves lags behind;
blood supply is disrupted;
the influence of nervous tissue on metabolic processes changes;
myocardial structures wear out;
the ratio of myocardial sizes changes;
systolic and diastolic dysfunction occurs;
repolarization is disrupted.

Myocardial hypertrophy in athletes

Abnormal development of the myocardium—hypertrophy—occurs unnoticed in athletes. During high physical activity, the heart pumps large volumes of blood, and the muscles, adapting to such conditions, increase in size. Hypertrophy becomes dangerous, causing stroke, heart attack, sudden cardiac arrest, in the absence of complaints and symptoms. You should not suddenly stop training to avoid complications.
Sports myocardial hypertrophy has 3 types:

eccentric - muscles change proportionally - typical for dynamic activities - swimming, skiing, long-distance running;
concentric hypertrophy - the ventricular cavity remains unchanged, the myocardium increases - observed in gaming and static types;
mixed - inherent in activities with the simultaneous use of immobility and dynamics - rowing, cycling, skating.

Myocardial hypertrophy in a child

It is possible that myocardial pathologies may appear from the moment of birth. Diagnosis at this age is difficult. Hypertrophic changes in the myocardium are often observed during adolescence, when cardiomyocyte cells actively grow. Thickening of the anterior and posterior walls occurs until the age of 18, then stops. Ventricular hypertrophy in a child is not considered a separate disease - it is a manifestation of numerous ailments. Children with HCM often have:

heart disease;
myocardial dystrophy;
hypertension;
angina pectoris.

Causes of cardiomyopathy

It is customary to distinguish between primary and secondary causes of hypertrophic development of the myocardium. The first ones are influenced by:

viral infections;
heredity;
stress;
alcohol consumption;
physical overload;
excess weight;
toxic poisoning;
changes in the body during pregnancy;
drug use;
lack of microelements in the body;
autoimmune pathologies;
malnutrition;
smoking.

Secondary causes of myocardial hypertrophy are provoked by the following factors:

Left ventricular hypertrophy

More often, the walls of the left ventricle are susceptible to hypertrophy. One of the causes of LVH is high pressure, which forces the myocardium to work at an accelerated rhythm. Due to the resulting overloads, the left ventricular wall and IVS increase in size. In this situation:

the elasticity of the myocardial muscles is lost;
blood circulation slows down;
normal heart function is disrupted;
there is a danger of a sudden load on it.

Left ventricular cardiomyopathy increases the heart's need for oxygen and nutrients. Changes in LVH can be noticed during instrumental examination. Low output syndrome appears - dizziness, fainting. Among the signs accompanying hypertrophy:

angina pectoris;
pressure changes;
heartache;
arrhythmia;
weakness;
high blood pressure;
bad feeling;
shortness of breath at rest;
headache;
fatigue;

Right atrial hypertrophy

Enlargement of the wall of the right ventricle is not a disease, but a pathology that appears when there is overload in this department. It occurs due to the receipt of a large amount of venous blood from large vessels. The cause of hypertrophy can be:

birth defects;
atrial septal defects, in which blood enters the left and right ventricles simultaneously;
stenosis;
obesity.

Right ventricular hypertrophy is accompanied by symptoms:

hemoptysis;
dizziness;
night cough;
fainting;
chest pain;
shortness of breath without exertion;
bloating;
arrhythmia;
signs of heart failure - swelling of the legs, enlarged liver;
malfunction of internal organs;
cyanosis of the skin;
heaviness in the hypochondrium;
dilation of veins in the abdomen.

Hypertrophy of the interventricular septum

One of the signs of the development of the disease is hypertrophy of the IVS (interventricular septum). The main cause of this disorder is gene mutations. Hypertrophy of the septum provokes:

ventricular fibrillation;
atrial fibrillation;
mitral valve problems;
ventricular tachycardia;
impaired blood flow;
heart failure;
cardiac arrest.

Dilation of the heart chambers

Hypertrophy of the interventricular septum can provoke an increase in the internal volume of the heart chambers. This expansion is called myocardial dilatation. In this position, the heart cannot perform the function of a pump, and symptoms of arrhythmia and heart failure occur:

fast fatiguability;
weakness;
dyspnea;
swelling of the legs and arms;
rhythm disturbances;

Cardiac hypertrophy - symptoms

The danger of myocardial disease in asymptomatic progression for a long time. It is often diagnosed accidentally during medical examinations. As the disease progresses, signs of myocardial hypertrophy may be observed:

chest pain;
heart rhythm disturbance;
shortness of breath at rest;
fainting;
fatigue;
labored breathing;
weakness;
dizziness;
drowsiness;
swelling.

Forms of cardiomyopathy

It should be noted that the disease is characterized by three forms of hypertrophy, taking into account the systolic pressure gradient. All together the obstructive form of HCM corresponds. Stand out:

basal obstruction – resting state or 30 mm Hg;
latent – calm state, less than 30 mm Hg – it characterizes the non-obstructive form of HCM;
labile obstruction – spontaneous intraventricular gradient fluctuations.

Myocardial hypertrophy - classification

For convenience of work in medicine, it is customary to distinguish between the following types of myocardial hypertrophy:

obstructive – at the top of the septum, over the entire area;
non-obstructive – symptoms are mild, diagnosed by chance;
symmetrical – all walls of the left ventricle are affected;
apical - the heart muscles are enlarged only from above;
asymmetrical - affects only one wall.

Eccentric hypertrophy

With this type of LVH, the ventricular cavity expands and at the same time a uniform, proportional compaction of the myocardial muscles occurs, caused by the growth of cardiomyocytes. With a general increase in heart mass, the relative thickness of the walls remains unchanged. Eccentric myocardial hypertrophy can affect:

interventricular septum;
top;
side wall.

Concentric hypertrophy

The concentric type of disease is characterized by maintaining the volume of the internal cavity while increasing the mass of the heart due to a uniform increase in wall thickness. There is another name for this phenomenon - symmetrical myocardial hypertrophy. The disease occurs as a result of hyperplasia of myocardiocyte organelles, provoked by high blood pressure. This development of events is typical for arterial hypertension.

Myocardial hypertrophy – degrees

To correctly assess the patient’s condition with HCM, a special classification has been introduced that takes into account myocardial thickening. According to how much the size of the walls increases during heart contraction, cardiology distinguishes 3 degrees. Depending on the thickness of the myocardium, the stages are determined in millimeters:

moderate – 11-21;
average – 21-25;
pronounced – over 25.

Diagnosis of hypertrophic cardiomyopathy

At the initial stage, with a slight development of wall hypertrophy, it is very difficult to identify the disease. The diagnostic process begins with interviewing the patient, finding out:

presence of pathologies in relatives;
the death of one of them at a young age;
past diseases;
fact of radiation exposure;
external signs during visual inspection;
blood pressure values;
indicators in blood and urine tests.

A new direction is being used – genetic diagnosis of myocardial hypertrophy. The potential of hardware and radiological methods helps to establish the parameters of HCM:

ECG - determines indirect signs - rhythm disturbances, hypertrophy of sections;
X-ray - shows an increase in the contour;
Ultrasound – assesses myocardial thickness, blood flow disturbances;
echocardiography – records the location of hypertrophy, diastolic dysfunction;
MRI – gives a three-dimensional image of the heart, determines the degree of myocardial thickness;
ventriculography – examines contractile functions.

How to treat cardiomyopathy

The main goal of treatment is to return the myocardium to its optimal size. Activities aimed at this are carried out in a comprehensive manner. Hypertrophy can be cured when diagnosed early. An important part in the system of myocardial health is played by lifestyle, which implies:

diet;
giving up alcohol;
smoking cessation;
weight loss;
drug exclusion;
limiting salt intake.

Drug treatment of hypertrophic cardiomyopathy includes the use of drugs that:

reduce blood pressure - ACE inhibitors, angiotensin receptor antagonists;
regulate heart rhythm disturbances - antiarrhythmics;
drugs with a negative ionotropic effect relax the heart - beta blockers, calcium antagonists from the verapamil group;
remove fluid - diuretics;
improve muscle strength - ionotropes;
if there is a threat of infective endocarditis, antibiotic prophylaxis.

An effective method of treatment that changes the course of excitation and contraction of the ventricles is dual-chamber pacing with a shortened atrioventricular delay. More complex cases - severe asymmetric hypertrophy of the IVS, latent obstruction, lack of effect of the drug - require the participation of surgeons for regression. Help save a patient's life:

installation of a defibrillator;
pacemaker implantation;
transaortic septal myectomy;
excision of part of the interventricular septum;
transcatheter septal alcohol ablation.

Cardiomyopathy - treatment with folk remedies

On the recommendation of the treating cardiologist, you can supplement the main course with herbal remedies. Traditional treatment for left ventricular hypertrophy involves the use of viburnum berries without heat treatment, 100 g per day. It is useful to consume flax seeds, which have a positive effect on heart cells. Recommend:

take a spoonful of seeds;
add boiling water - liter;
hold in a water bath for 50 minutes;
filter;
drink per day - dose 100 g.

Oat infusion for regulating the functioning of the heart muscles has good reviews in the treatment of HCM. According to the healers' prescription, it is required:

oats – 50 grams;
water – 2 glasses;
heat to 50 degrees;
add 100 g of kefir;
pour in radish juice - half a glass;
stir, stand for 2 hours, strain;
put 0.5 tbsp. honey;
dosage – 100 g, three times a day before meals;
course – 2 weeks.

Video: hypertrophy of the heart muscle

Symptoms and description of hypertrophy of the interventricular septum

One of the characteristic symptoms of hypertrophic cardiomyopathy is hypertrophy of the IVS (interventricular septum). When this pathology occurs, thickening of the walls of the right or left ventricle of the heart and the interventricular septum occurs. This condition itself is a derivative of other diseases and is characterized by an increase in the thickness of the walls of the ventricles.
Despite its prevalence (IVS hypertrophy is observed in more than 70% of people), it is most often asymptomatic and is detected only during very intense physical activity. After all, hypertrophy of the interventricular septum itself is its thickening and the resulting reduction in the useful volume of the chambers of the heart. As the thickness of the cardiac walls of the ventricles increases, the volume of the heart chambers also decreases.
In practice, this all leads to a reduction in the volume of blood that is released by the heart into the vascular bed of the body. To provide the organs with a normal amount of blood under such conditions, the heart must contract stronger and more often. And this, in turn, leads to its early wear and tear and the occurrence of diseases of the cardiovascular system.
A large number of people around the world live with undiagnosed IVS hypertrophy, and only with increased physical activity does their existence become known. As long as the heart can ensure normal blood flow to the organs and systems, everything proceeds hidden and the person will not experience any painful symptoms or other discomfort. But you should still pay attention to some symptoms and contact a cardiologist if they occur. These symptoms include:

chest pain;
shortness of breath with increased physical activity (for example, climbing stairs);
dizziness and fainting;
increased fatigue;
tachyarrhythmia that occurs for short periods of time;
heart murmur on auscultation;
labored breathing.

It is important to remember that undiagnosed IVS hypertrophy can cause sudden death even in young and physically strong people. Therefore, a medical examination by a therapist and/or cardiologist should not be neglected.
The causes of this pathology lie not only in an incorrect lifestyle. Smoking, alcohol abuse, excess weight - all this becomes a factor contributing to the increase in severe symptoms and the manifestation of negative processes in the body with an unpredictable course.
And doctors call gene mutations the reason for the development of IVS thickening. As a result of these changes at the level of the human genome, the heart muscle becomes abnormally thick in some areas.
The consequences of the development of such a deviation become dangerous.
After all, additional problems in such cases will be disturbances in the conduction system of the heart, as well as weakening of the myocardium and the associated decrease in the volume of blood ejected during cardiac contractions.

What to do if hypertrophic cardiomyopathy is detected

Hypertrophic cardiomyopathy causes heart damage
HCM is an inherited cardiovascular disease. Occurs in 1 case out of 500, more often among the working population. However, spontaneous mutations in old age (non-classical Fabry disease) and early manifestation in children are possible.

Causes of pathology

?-myosin, protein C, light and heavy chains?;

Hypertrophy of the interventricular septum is a fairly common pathology.

troponin T, C, I;
potassium channels;
?-actin;
protein kinase type A;
titin.

In the first two groups, deformations occur most often. It is the troponin T gene that is responsible for the moment of onset of manifestations of the disease (person’s age), clinical signs of the course and lifespan. The pathology has no age or gender preferences and may not make itself felt for a long time.
The genes of healthy parents can mutate during pregnancy or in the child’s later life under the influence of negative factors: radiation, ionization, infections, bad habits (smoking, alcohol, use of other surfactants).

Smoking and alcoholism in pregnant women can provoke gene mutations in the child

Classification of the disease

Hypertrophic cardiomyopathies are divided according to several criteria. All of them are reflected in the table.
Hypertrophic obstructive cardiomyopathy affects the aorta, organ cavity and walls, and mitral valve. Malfunctions of these elements are reflected by a number of signs.

Cardiomyopathy can affect different areas and areas of the heart

Characteristic symptoms

Common clinical signs include:

Manifestations of heart failure (90% of cases): shortness of breath, increased fatigue, night attacks of asphyxia. chest pain (pressing, squeezing) that does not go away after taking painkillers. Provoked by an increase in systolic pressure.
Obvious, noticeable disruptions in the functioning of the heart (frequent and excessive or, on the contrary, rare contractions, interruptions. 70% of cases).
Dizziness, fainting and presyncope (small output syndrome. Frequency 20-25%).
Ischemia caused by oxygen starvation due to deformation of blood vessels, impaired circulation, constant tension in the muscles, walls of capillaries and ventricles.
In 30% of cases, sudden death (loss of consciousness for more than an hour) is the only sign of an ongoing illness.

With this pathology, dizziness and fainting are often observed.
Symptoms can intensify with physical activity, tension (the moment of defecation), and a sudden change in position to vertical (bending). Hypertrophic cardiomyopathy has a number of risks and complications.

Possible complications

The worst possible prognosis is sudden cardiac death (1-6% per year, 60% of which at rest). In 5-10%, the development of ventricular systolic dysfunction is noted. Complications also include infective endocarditis and thromboembolism, heart attack and stroke.
IVS hypertrophy and obstruction of the ventricular outflow tract (35-50% of cases) are dangerous due to the occurrence of life-threatening arrhythmias and arterial hypotension. Due to the enlarged septum, the valve rises to the surface and, at the moment of contraction of the ventricles, is attracted by the blood flow, which interferes with the normal circulation of the latter.

This disease can cause symptoms of hypotension when blood pressure drops to a critically low level.
People who work hard and professional athletes are most susceptible to SCD (sudden cardiac death). The risk group includes people suffering from obesity and other diseases, such as ischemia.

Diagnosis of the disease

Studying the anamnesis: the nature of the disease, the first manifestation, what is associated with the increase in symptoms, whether anyone in the family suffers from this, whether any deaths have been recorded.
Visually inspect the skin for painful whiteness or bluish discoloration.

At the appointment, the doctor must listen to the patient for the presence of systolic heart murmurs

Heart tapping (determining changes in value), auscultation (determining systolic murmurs), measuring pressure.

Secondary examination (in a hospital setting):

General and chemical analysis of blood, urine, feces, coagulogram (study of coagulation and blood clots). They allow you to determine the presence of adjacent inflammations and the general condition of the body.
Echocardiography (EchoCG). Detects murmurs; in HCM, systolic murmurs are noted over the aorta. Determines heart defects, cavity sizes and wall thickness (a decrease in the ventricular cavity in combination with compaction of the IVS and wall is noted). If it is impossible to use the method (for example, the patient is obese), radionuclide ventriculography is performed (injection of contrast into the blood).
Electrocardiography (ECG). Shows heart rhythm, electrical conductivity and ventricular size.

To make an accurate diagnosis, it is necessary to undergo an ECG

Daily ECG monitoring. Helps track the dynamics of the disease and the effectiveness of treatment.
Load tests are specially organized laboratory experiments on simulators to identify the characteristics of hypertrophy and endurance of the body. Help make recommendations for rehabilitation.
MRI (magnetic resonance imaging). Shows in detail the condition of all internal organs.
X-ray. Determines the size of the heart (in case of HCM – normal or slightly enlarged) and the presence of blood congestion. Additionally, it excludes other inflammations and diseases.
Gene testing. Identifies a mutated gene and is carried out with the participation of the patient’s relatives.

If after this complex the diagnosis is still inaccurate, then a biopsy (sampling of muscle tissue) and catheterization (measuring pressure from the inside through tubes) are performed.

In some cases, a heart biopsy is necessary
Considering the fact that there may be no other manifestations before sudden death, it is recommended to undergo routine examinations with a cardiologist or cardiac surgeon or therapist. In 0.5% of cases, the pathology in question is identified during the process.

Treatment methods

Treatment of hypertrophic cardiomyopathy can be conservative (medicines) or surgical. In case of a safe and stable course of the disease without signs of heart failure: regular observation, exclusion of negative factors (malnutrition, bad habits, hypothermia, physical and emotional fatigue). These same recommendations are common to all types.
If there is an identified risk of SCD (arrhythmias of various kinds), surgical insertion of an implant (an electrical device that monitors the heartbeat, which, when weakened, sends an impulse) For reduced obstruction, a two-chamber pacemaker; for ventricular tachycardia, a cardioverter-defibrillator. Surgical treatment includes myectomy (removal of part of the septum from the inside), ethanol ablation (injection of an alcohol solution into the septum with a syringe without cutting the chest; the cells die, the IVS decreases, and blood flow is restored).

Treatment involves the use of a whole range of drugs
In case of a progressive and complex course, a complex of medications is required. Taking into account the specifics of the disease, it is carried out in three directions: eliminating symptoms and preventing the development of secondary pathologies, preventing SCD, regulating and maintaining the neurohumoral system:

Drugs that restore rhythm. To eliminate ventricular tachycardia and atrial fibrillation - Amiodarone or Disopyramide. Supplement with inhibitors and diuretics. If there is more than one risk indicator for SCD, it is not prescribed.
Adrenergic blockers (Metoprolol, Nadolol, Propranolol). They are used for obstructive or non-obstructive forms. Effective at 30-60%. They suppress the activity of the sympathoadrenal system, which reduces the need for oxygen in the heart muscle. Eliminate symptoms and cause regression of hypertrophy. The approximate dose is 20 mg three times a day, varies depending on the dynamics of pressure, frequency of contractions and manifestations of insufficiency. To prevent blood clots, anticoagulants are prescribed.

Metoprolol helps reduce the manifestations of hypertrophy

Calcium channel blockers (Verapamil, Disopyramide). Suppress hypertrophy and eliminate symptoms. The functions are similar to the previous group; effectiveness was confirmed in 60-80% of cases. Dangerous due to increased gradient. The method of application is the same. Under the supervision of a doctor, the dose is increased.

Any treatment is carried out strictly in a medical facility and under constant supervision.
This video will tell you about the features of hypertrophic cardiomyopathy and its dangers: