According to WHO statistics, more than 5 million people die from heart pathologies every year. Overload of the right atrium (GLP) or its hypertrophy is rare among cardiac pathologies, but its significance is great, because it entails changes in other body systems.
A little physiology
The human heart includes 4 cameras, each of which, for certain reasons, can increase and hypertrophy. Typically, hypertrophy is an attempt by the body to overcome any 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.
GLP situations
Venous blood from the vena cava enters the right atrium. Overload of the right atrium occurs when blood is received from the vena cava in excess or with pulmonary hypertension, when blood from the right atrium to the right ventricle cannot pass immediately and completely. The atrial cavity from this begins to expand gradually, the wall thickens.
Another cause of overload of the right atrium is hypertension in the pulmonary (pulmonary) circle of blood circulation, which leads to hypertension in the right ventricle. For this reason, blood from the PP cannot immediately pass into the ventricle, which also leads to GLP. The load on the right side of the heart increases with chronic lung diseases. The main reason is excess blood and pressure.
This condition occurs when stenosis of the tricuspid valve separates the atrium from the ventricle. In this case, part of the blood gets stuck in the atrium. Most often, such a defect occurs after a rheumatic attack, with bacterial endocarditis.
Another defect is the insufficiency of this valve, in which its valves do not close completely and some part of the blood returns. This condition occurs during dilatation of the left ventricle. Pressure loading will occur with pulmonary pathologies: bronchitis, pulmonary emphysema, asthma, and pulmonary artery genetic disease. These diseases increase the volume of blood in the ventricle, and the atrium is overstressed after it. Therefore, overload of the right atrium and right ventricle so often combined.
To restore normal blood flow, the atrium has to force the blood out with greater force, and it hypertrophies. Congestion of the right atrium develops gradually when the causative disease remains undetected and untreated.
Time for 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 the chronic course.
Other diseases leading to GLP
Provoke the development of congestion of the right atrium can:
- Myocardial remodeling - this phenomenon is considered part of post-infarction 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.
- Postmyocarditis cardiosclerosis - scar tissue is formed by the same mechanisms, but already after inflammatory processes in the myocardium.
- Coronary heart disease - here we are talking about blockage of the coronary artery with a thrombus or atherosclerosis plaque. This necessarily causes myocardial ischemia, and the contractile function of cardiomyocytes is impaired. Then adjacent to the affected areas of the myocardium begin to compensate thicken.
- Hypertrophic cardiomyopathy - occurs due to gene disorders in which there is a uniform thickening of the myocardium of the entire heart muscle. It is more often characteristic of children and captures the myocardium of the right atrium, then overload of the right atrium in the child is recorded.
From congenital pathological conditions of the heart muscle, heart overload causes:
- Defective septum between the atria. With this deviation, the heart delivers blood to the right and left half of the heart under the same pressure, as a result of which the atrium receives an increased load.
- Ebstein's anomaly is a rare defect in which the atrioventricular valve cusps are adjacent to the right ventricle, and not to the atrioventricular ring. Then the right atrium merges with part of the right ventricle and also hypertrophies.
- Transposition of the great vessels - the main arteries of the CVS 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, GLP occurs in a child up to 1 year old. This is a very serious deviation.
- It is also possible to overload the right atrium in adolescents prone to fanatical sports. Regular exercise is a common cause of GLP.
Symptomatic manifestations of pathology
The GSP itself has no signs. Only symptoms associated with the underlying disease, which are supplemented by venous congestion, may be disturbing.
Then we can say that the signs of overload of the right atrium are shortness of breath even with minor exertion, pain behind the sternum.
Circulatory failure, pulmonary heart may develop. With pulmonary heart:
- shortness of breath in a horizontal position and at the slightest exertion;
- coughing at night, sometimes with a touch of blood.
Blood flow insufficiency:
- heaviness in the right side of the chest;
- swelling on the legs;
- ascites;
- veins expansion.
There may also be causeless fatigue, arrhythmias, tingling in the heart, cyanosis. If these complaints arose only with infections and for the first time, you can count on their disappearance after treatment. For control, an ECG is performed in dynamics.
Diagnostics
There are no specific signs of pathology. It is only possible to assume the presence of overloads if a person suffers from pulmonary pathologies in a chronic form or has problems with valves.
In addition to palpation, percussion and auscultation, an ECG is used, with the help of which some signs of overload of the right atrium on the ECG are determined. However, even these indicators can be present only temporarily and disappear after the normalization of processes. In other cases, a similar picture may indicate the onset of atrial hypertrophy.
Ultrasound helps to determine the increase in pressure and the volume of blood located in various parts of the heart. A similar method can detect abnormalities in all parts of the heart and blood vessels.
Pulmonary heart (P-pulmonale)
With him, changes in 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 an altered P wave (atrial tooth). It becomes high and pointed in the form of a peak instead of a smoothed top in the norm.
Functional overload of the right atrium on the ECG can also give an altered P - this is noted, for example, with hyperactivity of the thyroid gland, tachycardia, etc. Deviation of the heart axis to the right does not always occur only with GLP, it can also be normal in high asthenics. Therefore, other studies are used to differentiate.
If signs of overload of the right atrium on the ECG are detected, echocardiography is recommended to the patient. It is considered safe for any category of patients and can be repeated many times in dynamics. Modern devices can give answers about the thickness of the walls of the heart, the volume of chambers, etc.
Together with echocardiography, the doctor can prescribe and dopplerography, 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, an x-ray will show the condition of other structures of the chest, which is very valuable for pulmonary pathology as the root cause of GLP.
The consequences of GLP
In chronic diseases of the pulmonary system, the acting alveoli are replaced by fibrous tissue, while the gas exchange area becomes smaller. Microcirculation is also disturbed, which leads to an increase in pressure in the small circle of blood. The atria have to actively contract, which ultimately causes their hypertrophy.
Thus, the complications and consequences of GLP are:
- expansion of the chambers of the heart;
- circulatory disorders, first in the small, and then in the big circle;
- pulmonary heart formation;
- venous congestion and heart valve failure .
If untreated, heart failure and heart failure can develop, which can lead to death.
Treatment
It is possible to normalize the size of the atrium and improve the functioning of the heart muscle 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 bronchodilator (tablets and inhalers), antibiotic therapy for bacterial etiology of disorders, anti-inflammatory drugs.
With bronchiectasis, surgical treatment is used.
With heart defects, corrective operations are the best way out. After heart attacks and myocarditis, prevention of remodeling with antihypoxic and cardioprotective drugs is necessary.
Antihypoxants are shown: Actovegin, Mildronate, Mexidol and Preductal. Cardioprotectors: ACE or angiotensin II receptor antagonists (ARA II). They can really slow down the onset of chronic heart failure. More often prescribed "Enalapril", "Quadropril", "Perindopril" and others.
Mandatory nitrongs, beta-blockers (Metoprolol, Bisoprolol, Nebivolol, etc.), ACE inhibitors, antiplatelet agents that prevent blood clots, statins, normalizing the amount of cholesterol.
Glycosides (as indicated) and antiarrhythmics, drugs that improve metabolic processes in the heart muscle, are also used in treatment. Judging by the reviews, good results were obtained with the appointment of riboxin.
Relapse prevention
If drug therapy is the prerogative of the doctor, the patient is also very responsible. Without his participation, the efforts of doctors will not produce results. A person must necessarily reconsider his lifestyle: give up smoking and alcohol, establish proper nutrition, eliminate physical inactivity, adhere to the daily regimen, exhibit moderate physical activity, and normalize body weight. If pathologies of the cardiovascular and pulmonary system turn into a chronic discharge, it is completely impossible to recover from them.
The condition can only be improved by preventing exacerbations of these pathologies. Then the load on the heart system decreases.
GLP and pregnancy
During pregnancy, enormous changes occur in the body, not only in terms of hormonal balance, but also in the functioning of internal organs. A difficult situation arises when diagnosing overload of the right atrium during pregnancy, which is considered extragenital disease in this situation. The diagnosis needs not only to be established, but also to determine the woman’s ability to bear the fetus and give birth.
The best option is, of course, the diagnosis of heart pathologies before conception, but this does not always happen. Most often, pregnant women with heart pathologies are hospitalized three times during gestation, this is done to monitor the dynamics of the state.
At the first admission to the hospital, the defect is examined, the activity of the process is determined, and the work of blood circulation is evaluated taking into account the issue of possible termination of pregnancy.
Re-hospitalization is needed because the physiological stress of the body to peak the woman’s heart muscle. The third hospitalization helps doctors choose the method of delivery.
Preventive actions
Prevention of hypertrophy of the right atrium begins with a review of the lifestyle, which implies a proper balanced diet and a rational regime of work and rest. If you are not a professional athlete and you do not need Olympic medals, do not show stubborn fanaticism in sports. It exhausts the body and depletes the heart. The pressure in the circulatory system rises, and hypertrophy will not take long. Quite enough daily walks for an hour an day, swimming, cycling.
Another problem is the elimination of stress. They also have a very negative effect on the work of the heart and the whole organism as a whole. In solving the problem can help yoga, meditation, relaxation.