According to WHO statistics, more than 5 million people die from heart disease every year. Overload of the right atrium (GPP) or its hypertrophy is rare among cardiac pathologies, but its significance is great because it entails changes in other systems of the body.
A little physiology
The human heart includes 4 cameras, each of which, due to certain reasons, can grow and hypertrophy. Hypertrophy is usually an attempt by the body to overcome some organ failure with this compensation. Hypertrophy of the heart does not become an independent disease – it is a symptom of other pathologies.
The main function of the heart is to create blood flow to provide all tissues and organs with nutrients and oxygen.
Venous blood from the hollow veins of the great circle enters the right atrium. An overload of the right atrium occurs when blood enters the vena cava in an excess amount or in pulmonary hypertension, when blood from the right atrium into the right ventricle cannot pass immediately and completely. The cavity of the atrium from this begins to expand gradually, the wall thickens.
Another cause of overload of the right atrium is hypertension in the small (pulmonary) circulation, which leads to hypertension and in the right ventricle. For this reason, the blood from the PP can not immediately go into the ventricle, which also leads to the GPP. The load on the right side of the heart also increases with chronic lung diseases. The main cause is excess blood and pressure.
This condition occurs when the tricuspid valve stenosis separates the atrium from the ventricle. In this case, part of the blood is stuck in the atrium. Most often, this defect occurs after rheumatic attacks, with bacterial endocarditis.
Another defect is the failure of this valve, in which its flaps do not fully close together and some part of the blood returns. This condition occurs with dilatation of the left ventricle. Pressure load will occur in pulmonary pathologies: bronchitis, pulmonary emphysema, asthma, genetic pulmonary artery disease. These diseases increase the volume of blood in the ventricle, and after it the atrium overloads. Therefore, the overload of the right atrium and the right ventricle are so often combined.
In order to restore normal blood flow, the atria has to push out blood with greater force, and it is hypertrophied. The overload of the right atrium develops gradually when the causative disease remains undetected and untreated.
The time of each patient is individual, but the result is always the depletion of the compensatory capabilities of the heart muscle and the onset of decompensated heart failure in a chronic course.
Other diseases leading to GLP
To provoke the development of an overload of the right atrium can:
- Myocardial remodeling – this phenomenon is considered part of postinfarction cardiosclerosis, when a scar develops at the site of necrosis. Healthy cardiomyocytes become more voluminous – they thicken, which looks like a hypertrophied muscle. It is also a compensatory mechanism, and most often it covers the left ventricle. So there is another combination of overload of the right atrium and diastolic overload of the left ventricle.
- Post-myocarditis cardiosclerosis – scar tissue is formed by the same mechanisms, but after inflammatory processes in the myocardium.
- Coronary heart disease – here we are talking about blockage of the coronary artery with a blood clot or plaque atherosclerosis. This necessarily causes myocardial ischemia, and the contractile function of cardiomyocytes is impaired. Then adjacent to the affected areas of the myocardium begin to thicken compensatory.
- Hypertrophic cardiomyopathy – arises due to gene disorders, in which there is a uniform thickening of the myocardium of the entire cardiac muscle. It is more common in children and captures the myocardium of the right atrium, then an overload of the right atrium in the child is recorded.
From congenital pathological conditions of the heart muscle, an overload of the heart causes:
- Defective septum between the atria. With such a deviation, the heart delivers blood to the right and left half of the heart under the same pressure, with the result that the atrium receives an increased load.
- Ebstein’s anomaly is a rare malformation in which the valves of the atrioventricular valve are adjacent to the right ventricle, and not to the atrial-gastric ring. Then the right atrium merges with a part of the right ventricle and also hypertrophies.
- The transposition of the great vessels – the main arteries of the cardiovascular system change their anatomical position – the main artery of the lungs is separated from the left heart, and the aorta from the right. In these cases, GPP occurs in a child under 1 year. This is a very serious deviation.
- It is also possible to overload the right atrium in adolescents who are prone to fanatical sports. Regular exercise is a common cause of AML.
Symptomatic manifestations of pathology
GLP itself has no signs. Only the symptoms associated with the underlying disease, which are supplemented by venous congestion, can be of concern.
Then we can say that the signs of an overload of the right atrium are shortness of breath even with minor exertion, pain in the chest.
Circulatory failure, pulmonary heart may develop. With pulmonary heart:
- shortness of breath in a horizontal position and with the slightest exertion;
- cough at night, sometimes mixed with blood.
- heaviness in the right side of the chest;
- swelling in the legs;
- varicose veins.
There may also be causeless fatigue, arrhythmias, tingling in the heart, cyanosis. If these complaints have arisen only for infections and for the first time, you can count on their disappearance after treatment. To control perform an ECG in the dynamics.
There are no specific signs of pathology. It is only possible to assume the presence of overloads if a person suffers from lung pathologies in a chronic form or has problems with valves.
In addition to palpation, percussion and auscultation, an ECG is used, which is used to determine some signs of an overload of the right atrium on an ECG. However, even these indicators can be present only temporarily and disappear after the normalization of processes. In other cases, such a picture may indicate the beginning of the process of atrial hypertrophy.
Ultrasound helps determine the increase in pressure and blood volume in various parts of the heart. This method is able to detect violations in all parts of the heart and blood vessels.
Pulmonary heart (P-pulmonale)
When it changes the pathological nature occur in the pulmonary circulation, and this is the main cause of overload of the right atrium.
On the ECG, this is reflected by a modified P wave (atrial tooth). It becomes high and sharpened in the form of a peak instead of a flattened top normal.
Functional overload of the right atrium on the ECG can also give a modified P – this is noted, for example, in thyroid gland hyperactivity, tachycardia, etc. The deviation of the heart axis to the right does not always occur only with AOP, it can be normal in high asthenics. Therefore, other studies are also used for differentiation.
If there are signs of an overload of the right atrium on the ECG, an echocardiography is recommended for the patient. It is considered safe for any category of patients and it can be repeated many times over. Modern devices can give answers about the thickness of the walls of the heart, the volume of chambers, etc.
Together with EchoCG, the doctor may prescribe Doppler sonography, then you can get information about hemodynamics and blood flow.
In case of disagreement, CT or radiography is prescribed. X-ray examination shows violations of the right atrium and ventricle. Their contours merge with the contours of the vessels. In addition, X-rays will show the state and other structures of the chest, which is very valuable in pulmonary pathology as the root cause of the GPP.
Consequences of GPP
In chronic diseases of the pulmonary system, the acting alveoli are replaced with fibrous tissue, while the area of gas exchange becomes smaller. Microcirculation is also impaired, which leads to an increase in pressure in the small circle of blood. The atria has to be actively reduced, which ultimately causes their hypertrophy.
Thus, the complications and consequences of GLP are:
- expansion of the heart chambers;
- circulatory disorders, first in the minor and then in the great circle;
- pulmonary heart formation;
- venous congestion and heart valve failure.
If left untreated, pulse failures and heart failure attacks can develop, which can be fatal.
Normalization of the size of the atrium and improve the functioning of the heart muscle is possible only if the underlying disease is treated – the cause of the pathology. Such treatment is always complex, monotherapy does not make sense.
In the presence of pulmonary pathology, these are bronchodilatory (pills and inhalers), antibacterial therapy for bacterial etiology of disorders, anti-inflammatory drugs.
For bronchiectasis, surgical treatment is used.
For heart defects, corrective surgery is the best option. After heart attacks and myocarditis, it is necessary to prevent remodeling with antihypoxant and cardioprotective drugs.
Antihypoxants are shown: "Actovegin", "Mildronat", "Mexidol" and "Preductal". Cardioprotectors: ACE or angiotensin II receptor antagonists (ARA II). They can actually slow the onset of chronic heart failure. Most often prescribed "Enalapril", "Quadropril", "Perindopril" and etc.
Nitrongs, beta-blockers ("Metoprolol", "Bisoprolol", "Nebivalol" and others), ACE inhibitors, antiplatelet agents that prevent the appearance of blood clots, statins, leading to normal amounts of cholesterol.
Also used in the treatment of glycosides (if indicated) and antiarrhythmics, means that improve metabolic processes in the muscle of the heart. Judging by the reviews, good results were obtained when prescribing Riboxin.
If drug therapy is the prerogative of the physician, a large responsibility is placed on the patient himself. Without his participation, the efforts of physicians will not produce results. A person must reconsider his lifestyle: give up smoking and alcohol, establish proper nutrition, eliminate physical inactivity, adhere to the daily regimen, exercise moderate physical activity, and normalize body weight. If the pathologies of the cardiovascular and pulmonary systems turn into a chronic discharge, they cannot be completely cured.
It is possible to improve the condition only by preventing exacerbations of these pathologies. Then the load on the cardiac system is reduced.
GPP and pregnancy
During pregnancy, there are tremendous changes in the body, not only in terms of hormonal balance, but also in the functioning of the internal organs. A difficult situation arises when diagnosing an overload of the right atrium during pregnancy, which is considered an extragenital disease in this situation. The diagnosis needs not only to be established, but also to determine the ability of a woman to bear a child and give birth.
The best option is, of course, the diagnosis of heart disease before conception, but this is not always the case. Most often, pregnant women with heart pathologies are hospitalized three times during gestation, this is done to monitor the state over time.
When the hospital is first placed in the hospital, a defect is investigated, the activity of the process is determined and the work of the blood circulation is assessed taking into account the question of a possible abortion.
Re-admission is necessary because the physiological stress of the body to maintain the muscle of the heart in a woman reaches a peak. The third hospitalization helps doctors choose the mode of delivery.
Prevention of right atrial hypertrophy begins with a revision of the lifestyle, which implies a proper balanced diet and a rational mode of work and rest. If you are not a professional athlete and you do not need Olympic medals, do not show obstinate fanaticism in sports. It exhausts the body and depletes the heart. The pressure in the circulatory system rises, and hypertrophy will not take long to wait. Enough daily walks of an hour a day, swimming, cycling.
Another problem is to eliminate stress. They also have a very negative effect on the work of the heart and the whole organism. In solving the problem can help yoga, meditation, relaxation.