The greatest alteration of the heart in right ventricular hypertrophy is an excessive thickening of the right heart muscle. The thickening usually begins during the adolescence and ends when adult body growth has been reached (between 15 and 25 years approximately). It is uncommon for thickening to progress from this age.
Sometimes at later ages the muscle can thin out slightly. The distribution of muscle thickening or hypertrophy is variable. The left ventricle is almost always affected, while in some patients the right one is also thickened.
Can Right Ventricular Hypertrophy Be Reversed?
The problem of right ventricular hypertrophy cannot be reversed. At present, there is no cure for right ventricular hypertrophy and unfortunately no treatment has been shown to return the heart to its normal state in this disease, but research is constantly being carried out in this area. The advances will probably come in the early detection of people carrying genetic alterations of right hypertrophic cardiomyopathy and treatment to prevent the progression of hypertrophy in these cases.
Heart Function in Hypertrophic Cardiomyopathy
The thickened muscle usually contracts well and expels most of the blood from the heart. However, the muscle in right ventricular hypertrophy is often rigid and relaxed with difficulty, requiring greater than normal pressures to expand with the blood flow it receives. The amount of blood that the heart can store is reduced and this in turn will limit the amount of blood that can be expelled in the next heartbeat.
In rare cases, patients have minimal right ventricular hypertrophy or even this is not observed, but there is severe rigidity to the normal blood filling of the ventricles.
In most patients with right ventricular hypertrophy, the physical examination is normal and the alterations are usually discrete. Most patients have a broad pulse and a strong heartbeat, which can be felt on the left side of the chest. These signs reflect the vigorous contraction of the thickened heart. Although the most striking in the examination is the auscultation of a murmur, it is only present in 30 to 40% of patients.
The treatment for right ventricular hypertrophy aims to improve symptoms and prevent complications. Although this disease is not curable, there are many forms of treatment available, which usually help to relieve symptoms. Many people who do not have symptoms or when these are mild do not require treatment.
Complications of Right Ventricular Hypertrophy
A minority of right ventricular hypertrophy patients may suffer from any of the following complications:
Irregularities of the heartbeat are called arrhythmia, and they are a frequent complication. Those affected may feel palpitations. Cardiac stress or Holter test can detect them. Arrhythmia such as atrial fibrillation (originating in the auricles) or ventricular tachycardia (originating in the ventricles) are especially important and may require treatment.
In atrial fibrillation the normal regular rhythm of the heart is lost and a rapid and irregular rhythm appears. This rhythm can be episodic and self-limiting (paroxysmal atrial fibrillation) or persistent. Although atrial fibrillation does not endanger the life of the affected person, the loss of normal atrial contraction increases the risk of atrial clots, which can rarely lead to an embolic stroke (thrombosis). Drugs that make blood more fluid like anticoagulants (warfarin) help to reduce the chances of this complication to occur. Patients often feel more fatigue due to the high heart rate, and therefore may also need medication that slows this accelerated pace. Sometimes it is necessary to perform an electrical cardioversion (controlled electrical shock) to return the normal rhythm to the heart. If this procedure is necessary, it would be performed under general anesthesia.
The term endocarditis refers to a heart infection, which rarely occurs in hypertrophic cardiomyopathy. Some bacteria that can be transported through the bloodstream could locate inside the heart in areas punished by turbulent flows. Patients with obstruction in the outflow tract have a higher risk of endocarditis. Endocarditis can be prevented by taking antibiotics before any dental, instrumental or surgical procedure.
The normal electrical signal can travel and descend to the ventricles with difficulty or can even be completely blocked. This is very infrequent, but when it happens it is necessary to implant a pacemaker.
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