According to WHO statistics, more than 5 million people die every year from heart pathologies. Right atrial overload (RAA) or its hypertrophy is rare among cardiac pathologies, but its significance is great, because it entails changes in other body systems.
A bit of physiology
The human heart includes 4 chambers, each of which, for certain reasons, can increase and hypertrophy. Usually hypertrophy is an attempt of the body to overcome any deficiency of the organ by 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.
GPP situations
Venous blood from the vena cava of the great circle enters the right atrium. Overloading of the right atrium occurs when blood flows from the vena cava in excess orwith pulmonary hypertension, when blood from the right atrium to the right ventricle cannot pass immediately and completely. The atrial cavity from this begins to gradually expand, the wall thickens.
Another cause of right atrial overload is hypertension in the pulmonary circulation, which leads to hypertension in the right ventricle as well. For this reason, the blood from the PP cannot immediately pass into the ventricle, which also leads to the HPP. The load on the right side of the heart also increases in chronic lung diseases. The main reason is excess blood and pressure.
This condition occurs when there is stenosis of the tricuspid valve that 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 the specified valve, in which its leaflets do not close completely and some part of the blood returns. This condition occurs when the left ventricle is dilated. Pressure load will occur with pulmonary pathologies: bronchitis, emphysema, asthma, genetic disease of the pulmonary artery. These diseases increase the volume of blood in the ventricle, and after it the atrium is overstressed. That is why right atrial and right ventricular overload are so often combined.
To restore normal blood flow, the atrium has to expel blood with greater force, and it hypertrophies. Right atrial overload develops gradually when the causative disease remains undetected anduntreated.
Time is individual for each patient, but the result is always the depletion of the compensatory capabilities of the heart muscle and the onset of chronic decompensated heart failure.
Other diseases leading to GPP
Provoke the development of right atrial overload can:
- Myocardial remodeling - this phenomenon is considered part of post-infarction cardiosclerosis, when a scar develops at the site of necrosis. He althy cardiomyocytes become more voluminous - they thicken, which outwardly looks like a hypertrophied muscle. It is also a compensatory mechanism and most often involves the left ventricle. This creates another combination of right atrial overload and left ventricular diastolic overload.
- Postmyocardial cardiosclerosis - scar tissue is formed by the same mechanisms, but after inflammatory processes in the myocardium.
- Ischemic heart disease - here we are talking about blockage of the coronary artery by a thrombus or atherosclerosis plaque. This necessarily causes myocardial ischemia, and the contractile function of cardiomyocytes is impaired. Then the areas of the myocardium adjacent to the affected areas begin to thicken compensatory.
- 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 typical for children and captures the myocardium of the right atrium, then an overload of the right atrium in the child is recorded.
Fromcongenital pathological conditions of the heart muscle overload of the heart causes:
- Defective septum between the atria. With this deviation, the heart supplies blood to the right and left sides of the heart at the same pressure, resulting in an increased load on the atrium.
- Ebstein's anomaly is a rare defect in which the leaflets of the atrioventricular valve are adjacent to the right ventricle, and not to the atriogastric 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 CCC 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, HPP occurs in a child under 1 year old. 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 UPP.
Symptomatic manifestations of pathology
GPP itself has no symptoms. Only symptoms associated with the underlying disease, which are complemented by venous congestion, may disturb.
Then we can say that signs of overload of the right atrium - shortness of breath even with minor exertion, pain behind the sternum.
Circulatory failure, cor pulmonale may develop. Cor pulmonale:
- shortness of breath in a horizontal position and at the slightest exertion;
- coughat night, sometimes with an admixture of blood.
Lack of blood flow:
- heaviness in the right side of the chest;
- swelling on the legs;
- ascites;
- dilated veins.
There may also be causeless fatigue, arrhythmias, tingling in the heart, cyanosis. If these complaints arose only during infections and for the first time, they can be counted on to disappear after treatment. For control, an ECG is performed in dynamics.
Diagnosis
There are no specific signs of pathology. It is only possible to assume the presence of overloads if a person suffers from chronic lung pathologies or has problems with valves.
In addition to palpation, percussion and auscultation, an ECG is used, which determines some signs of right atrial overload on the 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 to determine the increase in pressure and volume of blood in different parts of the heart. This method is able to detect violations in all parts of the heart and blood vessels.
Pulmonary heart (P-pulmonale)
With it, pathological changes occur in the pulmonary circulation, and this is the main reason for overloading the right atrium.
This is reflected on the ECG by an altered P wave(atrial prong). It becomes tall and pointed in the form of a peak instead of the flattened 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 GPP, it can also be normal in high asthenics. Therefore, other studies are used to differentiate.
If there are signs of right atrial overload on the ECG, the patient is recommended an echocardiogram. It is considered safe for any category of patients and can be repeated many times over time. Modern devices can give answers about the thickness of the walls of the heart, the volume of chambers, etc.
Together with EchoCG, the doctor can also prescribe Doppler ultrasound, then you can get information about hemodynamics and blood flow.
When opinions differ, CT or X-rays are 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 in pulmonary pathology as the root cause of GPP.
Effects of GPP
In chronic diseases of the pulmonary system, the active 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 causestheir hypertrophy.
Thus, the complications and consequences of MPD are:
- expansion of the chambers of the heart;
- impaired circulation, first in a small, and then in a large circle;
- cor pulmonale formation;
- venous congestion and heart valve insufficiency.
If left untreated, irregular heartbeats and heart failure attacks can develop, which can be fatal.
Treatment
It is possible to normalize the size of the atrium and improve the functioning of the heart muscle only if the underlying disease, the cause of the pathology, is treated. Such treatment is always complex, monotherapy does not make sense.
In the presence of pulmonary pathology, these are bronchodilators (tablets and inhalers), antibiotic therapy for bacterial etiology of disorders, anti-inflammatory drugs.
Surgical treatment is used for bronchiectasis.
For heart defects, corrective surgery is the best option. After heart attacks and myocarditis, it is necessary to prevent remodeling with the help of antihypoxant and cardioprotective drugs.
Shown antihypoxants: "Actovegin", "Mildronate", "Mexidol" and "Preductal". Cardioprotectors: ACE or angiotensin II receptor antagonists (ARA II). They can actually slow down the onset of chronic heart failure. More often than others, Enalapril, Quadropril,"Perindopril", etc.
Nitrongs, beta-blockers (Metoprolol, Bisoprolol, Nebivalol, etc.), ACE inhibitors, antiplatelet agents that prevent blood clots, statins that normalize cholesterol levels are required.
Glycosides (according to indications) and antiarrhythmics, drugs that improve metabolic processes in the heart muscle are also used in the treatment. Judging by the reviews, good results were obtained when prescribing Riboxin.
Relapse Prevention
If drug therapy is the prerogative of the doctor, a great responsibility lies with the patient himself. Without his participation, the efforts of doctors will not produce results. A person must definitely reconsider his lifestyle: give up smoking and alcohol, establish proper nutrition, eliminate physical inactivity, adhere to the daily routine, exercise moderate physical activity, and normalize body weight. If the pathologies of the cardiovascular and pulmonary systems become chronic, they cannot be completely cured.
You can only improve the condition by preventing exacerbations of these pathologies. Then the load on the cardiac system decreases.
MPD and pregnancy
During pregnancy, tremendous 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 right atrial overload during pregnancy, which in this situation is considered an extragenital disease. It is necessary not only to establish the diagnosis, but also to determine the abilitywomen to gestation and childbirth.
The best option is, of course, the diagnosis of heart pathologies before conception, but this is not always the case. Most often, pregnant women with heart pathologies are hospitalized three times during the gestation period, this is done to monitor the condition in dynamics.
At the first admission to the hospital, the defect is examined, the activity of the process is determined and the work of the blood circulation is evaluated, taking into account the question of a possible termination of pregnancy.
Rehospitalization is needed because the physiological stress of the body to maintain the work of the heart muscle in a woman reaches a peak. The third hospitalization helps doctors choose the method of delivery.
Prevention measures
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 stubborn fanaticism in sports. It exhausts the body and exhausts the heart. The pressure in the circulatory system rises, and hypertrophy will not be long in coming. Walking for an hour a day, swimming, cycling is enough.
Another problem is to avoid stress. They also have a very negative effect on the work of the heart and the whole organism as a whole. Yoga, meditation, relaxation can help in solving the problem.
