Right ventricular hypertrophy

Right ventricular hypertrophy

Description, Causes and Risk Factors:

Abbreviation: RVH.

Right ventricular hypertrophy is the increase or the enlargement in the size of the right ventricle of the heart. The right ventricle is responsible for pumping blood towards the lungs. In the lungs, blood is mixed with oxygen and then pumped back to the left ventricle to be eventually distributed to the brain and to other parts of the body.

There are several possible causes of right ventricular hypertrophy. These include pulmonary valve stenosis, ventricular septal defect, pulmonary hypertension, and tetralogy of Fallot, among many others. Pulmonary valve stenosis is the narrowing of the membrane or valve that connects the right ventricle with the pulmonary artery, the blood vessel going to the lungs. The ventricular septal defect is a heart condition appearing during birth that presents with a defect in the wall separating the heart's right and the left ventricles.

Pulmonary hypertension is marked by the increase of blood pressure in the blood vessels of the lungs. Tetralogy of Fallot is also a heart defect that appears from birth and is often the cause of the blue baby syndrome. The blue baby syndrome occurs when there is not enough blood with oxygen circulating in the body of an affected child. In all these conditions, the flow of blood between the lungs and the heart is often decreased, putting much stress on the right ventricle. As the muscles of the right ventricle keep working overtime, the ventricle will eventually increase in size.

Right ventricular hypertrophy is commonly associated with any form of right ventricular outflow obstruction or pulmonary hypertension, which may, in turn, owe its origin to left-sided disease.

The disease is less common compared to left ventricular hypertrophy.

Symptoms:

When the extent of right ventricular enlargement is mild, affected individuals may not experience any symptoms. In cases of severe enlargement, however, symptoms associated with respiratory problems often occur. These symptoms include shortness of breath, dizziness, chest pain, and sometimes, loss of consciousness. Patients may also complain of frequent episodes of forceful and rapid heartbeats. Another manifestation of right ventricular hypertrophy is edema or swelling of the ankles, feet, and legs.

The echocardiographic signs are thickening of the anterior right ventricular wall and the septum. Cavity size is usually normal or slightly enlarged. In many cases there is an associated volume overload present due to tricuspid regurgitation, in the absence of this, the septal motion is normal.

Diagnosis:

The diagnosis of RVH requires careful scrutiny of the QRS complex. The most common ECG finding is right axis deviation of greater than 100. Like LVH, the reason for this is that all cells in the heart muscle depolarize, generating electrical activity. More cells (e.g., hypertrophy) create more electricity. This can cause a shift in the axis toward the hypertrophied chamber—in this case, the right ventricle. This finding should always be present before RVH is considered.

RVH is better appreciated in the precordial leads because they overlie the ventricles directly. Besides axis shift, other changes may also be used to determine the presence of RVH including abnormalities of the QRS segment (increase in voltage in V1, V5, and V6); P wave abnormalities (P pulmonale, Peaked Twaves inferiorly); and ST segment depression and T wave inversion (V2 through V6). RVH is recognized by the following findings on an ECG. At least one of the following findings must be present with RVH (the more findings, the higher the sensitivity), including:

Right axis deviation greater than 100.

  • R wave taller than S wave in V1 (R/S ratio greater than 1), or R wave smaller than S wave in V5 or V6 (R/S less than 1).

Imaging: Chest X-ray.

Treatment:

Treatment for right ventricular hypertrophy varies from patient-to-patient and depends on the underlying causes of this condition. Prescription medications such as ACE inhibitors, beta-blockers, and diuretics may be used to treat some symptoms associated with this disorder. Implantable devices such as a pacemaker or defibrillator may be used to regulate the heartbeat. In more severe situations, surgical intervention, or even heart transplantation, may be needed in order to successfully treat the condition. As there is no standardized treatment for this condition, any questions or concerns about the treatment of right ventricular hypertrophy in an individual situation should be discussed with a cardiologist.

Prescription medications may be used to treat specific conditions associated with right ventricular hypertrophy. Some of these conditions include bronchitis, blood clots in the lungs, and high blood pressure. Diuretics may be used to help eliminate extra fluid from the body, and ACE inhibitors or beta blockers are commonly prescribed to help control blood pressure levels. Additional medications may be used as necessary to treat individual symptoms as they develop.

A pacemaker or implantable defibrillator may be needed by some patients who are diagnosed with right ventricular hypertrophy. Each of these devices requires surgery, although the procedures are usually considered to be minimally invasive and do not involve a long period of recovery. Both the pacemaker and defibrillator are used to regulate heart rhythms, and the surgeon will decide which of the devices is most appropriate for a specific situation.

NOTE: The above information is for educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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