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Heart wall thickening - causes, symptoms and therapy
contents
- Heart wall thickening: definition and development
- Symptoms of heart wall thickening
- Common cause of heart wall thickening: hypertension
- Heart wall thickening due to aortic valve stenosis
- Athlete's heart: Thickening of the heart wall at competitive athletes
- Therapy in cardiac wall thickening
Heart wall thickening: definition and development
The term "heart wall thickening" will usually describe an increase in myocardial mass. A healthy heart is about as big as a closed fist, weighs about 300 grams and looks like a sloping cone. It is surrounded by a connective tissue bag called the pericardium, which separates it from other organs. Seen from the outside in, the heart itself consists of three heart walls: the outer wall is called an "epicard" and consists of a smooth, finely structured fabric layer. On the inside there is a muscle layer (myocardium), which is thicker the more the cardiac muscle is stressed. Accordingly, the muscle thickness in the heart can vary widely from human to human. Finally, the inner heart wall (endocardium) clings to the muscle layer. This fine fibrous wall covered with elastic connective tissue separates the heart muscle from the cavity of the heart.
When a heart wall thickening is an enlargement of the heart muscle. In most cases, the left ventricle is affected. (Image: lom123 / fotolia.com) In the case of a thickening of the heart wall or heart muscle, however, the heart is enlarged due to the altered ventricular walls. In most cases, the left ventricle is affected (left ventricular hypertrophy), in rare cases (for example, pulmonary vascular hypertension), right (right heart hypertrophy). As the thickness of the muscle wall in the chamber increases, it usually becomes stiffer and loses elasticity ("diastolic dysfunction"). This manifests itself mainly by shortness of breath during physical exertion. From a weight of about 500 g ("critical heart weight"), the coronary arteries can no longer provide sufficient oxygen to the heart. It comes to an expansion of the heart ("dilatation"), so that it can no longer pump enough blood into the body and develops a heart failure (heart failure).
For the thickening of the ventricle walls, various causes come into question, in addition, the disease can vary depending on the severity. In general, a distinction will be made between a natural (physiological) thickening of the heart wall as a result of intensive sports activity ("athlete's heart") and a pathological (pathological) thickening of the heart wall due to permanent loading of the heart. In rare cases, hereditary forms of myocardial hypertrophy occur, which can not usually be attributed to an increased pressure load.
Symptoms of heart wall thickening
Due to the reduced pumping capacity as a result of the pathological thickening of the cardiac wall, at the beginning, especially during physical exertion, reduced performance typically occurs. Likewise, the disease can initially run but completely symptom-free, which is why it is often discovered relatively late. From a certain extent sufferers often suffer from shortness of breath or shortness of breath, chest pain (angina pectoris), cardiac arrhythmia, dizziness or even fainting. Likewise, the resulting heart failure often shows by chronic fatigue, thick legs (edema) and frequent urination. If the disease is already advanced, the symptoms mentioned not only on exertion, but also in peace, making physical activity is almost impossible. In addition, there is an increased risk of a heart attack.
Cardiac hypertrophy can have life-threatening consequences such as heart failure or heart attack. (Image: psdesign1 / fotolia.com) Common cause of heart wall thickening: hypertension
The most common cause of myocardial hypertrophy is a persistent pressure load on the heart muscle due to high blood pressure (hypertension). The heart muscle thickens in this case to withstand the pressure in the vessels. In hypertension is a widespread disease of the vascular system, of which, according to information of the German High Pressure League e.V. in this country almost every third inhabitant is affected. Hypertension occurs when the blood pressure is consistently higher than 140/90 millimeters of mercury (mm Hg). For blood pressure values between 140/90 and 159/99 mm Hg, it is classified as "mild" and "moderate" for values between 160/100 and 179/109 mm Hg. Even higher levels are considered to be severe hypertension.
High blood pressure is a serious risk, because over the years important organs such as the heart, the coronary vessels, the brain, the kidneys and the blood vessels can be damaged. As a result, life-threatening diseases can develop. High blood pressure is considered the number one risk factor for cardiovascular diseases such as heart attack or stroke, which in turn are responsible for most deaths. Accordingly, it is important to achieve a permanent reduction in blood pressure by appropriate treatment in order to prevent serious health damage.
If hypertension is without a direct, recognizable cause, physicians speak of "primary" or "essential" hypertension. This can have various causes that can not be influenced, such as have a genetic predisposition or a higher age. Likewise, influenceable risk factors may favor the development. These include above all obesity, lack of exercise, unhealthy diet and prolonged negative stress. But smoking, increased alcohol consumption and high salt consumption can play a major role as a cause.
If the high blood pressure is the result of another illness, it is called a "secondary hypertension". This much less common form is often due to kidney disease or hormonal disorders e.g. during pregnancy or caused by hyperthyroidism. Likewise, e.g. Congenital narrowing of the main artery (aorta), the so-called "sleep apnea syndrome" or the use of certain medications (such as birth control pills, anti-inflammatory drugs) as a trigger into consideration.
It often takes years or even decades for the first symptoms to appear. Therefore, the disease often remains undetected for a long time, which is a great risk - because even without obvious symptoms, hypertension can cause serious health problems. It is therefore very important to take certain alarm signals seriously and have them medically checked. These include, for example, sleep disorders, inner restlessness, mood swings, increased irritability and reduced performance. If the high blood pressure has been around for a long time and has already affected the organs, dizziness, rapid heartbeat, headache, tinnitus, shortness of breath, excessive sweating or blurred vision may be important warning signs, depending on the affected region.
High blood pressure is the most common cause of thickening of the heart wall. Early warning signs such as sleep disturbances or diminished performance should therefore always be taken seriously. (Image: eyetronic / fotolia.com) Heart wall thickening due to aortic valve stenosis
Also a so-called "aortic valve stenosis" can lead to a thickening of the heart wall. In this valvular disease, the flap's orifice is narrowed, preventing it from opening as far as it should. As a result, the blood discharge from the left ventricle is made more difficult and it creates a congestion, which can reach into the lungs. This results in an increased pressure load on the ventricle wall, which tries to balance the heart by strengthening the muscles. Depending on the severity of the valve constriction sufferers often suffer from shortness of breath and fatigue even with slight effort, dizziness, chest pain or anguish (angina pectoris) are also possible, a pronounced feeling of weakness and fainting fits.
Athlete's heart: Thickening of the heart wall at competitive athletes
Since the heart is a muscle, it can - like any other muscle - grow through training. Competitive athletes often have an enlarged heart, which is therefore also referred to as "athlete's heart" or "athlete's heart". The change is due to the thickening of the muscles due to regular exercise - but unlike the pathological enlargement of the heart is usually no cause for concern. Instead, it is a natural adaptation response to the training stimulus, which is in principle reversible. Whether someone develops an athlete's heart or not, depends on the training time and intensity, as well as a certain genetic predisposition must be present.
In the case of health or recreational sports activities, as a rule, there is no enlargement of the heart; in the case of competitive athletes and persons with appropriate predisposition, on the other hand, the heart can even increase to twice that of non-active persons. Typically, a sports heart occurs in classic endurance sports, such as Long-distance running, cycling or triathlon, which are characterized by a cyclic (regularly recurring) movement. Sports with acyclic motion files, such as Ball games usually do not cause thickening of the heart muscles because they are not pure endurance sports. Accordingly, active people in the field of power and sprint sports do not develop an athlete's heart.
The enlarged heart leads to more efficiency. Because the stroke volume and cardiac output improve, allowing the heart to pump more blood into the circulation with each stroke. Under stress, the organism is better supplied with oxygen and even at rest, it must beat less often. Accordingly, endurance athletes often have a resting heart rate in the range of 35 to 50 strokes, while untrained people come to 60 to 100 strokes per minute. If an athlete, who has formed an athlete's heart over the years, gives up the activity, the heart muscle mass is restored - just like other muscles that are no longer trained. Of course, this also means that in endurance athletes a longer, e.g. injury-related break can lead to the fact that the performance can then be significantly limited and the heart must be strengthened again.
The regression occurs differently. Thus, the sports heart can completely, but only partially regress, for which genetic influences, but also a more sensitive reaction of the heart muscles can be responsible for low training stimuli. The process of regression takes place step by step and is only completed after a few months. For the former assets, there is no danger, so no special measures to avoid health risks are necessary. Anyone who has been practicing high-performance sport for many years should nevertheless train slowly, so that the body, circulation, the organs and the heart can get used to the lower load.
Therapy in cardiac wall thickening
If there is a pathological form of cardiac wall thickening, the goal of the treatment is to relieve the heart and thereby prevent progression of the disease. The therapy depends accordingly on the identified cause. Since arterial hypertension is very often responsible for the permanently existing pressure load of the heart muscle, it must be properly adjusted by appropriate measures. Moderate forms of primary hypertension are usually treated without the use of medication, but only by the conversion of lifestyle (healthy and varied diet, exercise, reduction of stress, abstinence from tobacco and alcohol). However, if there are other cardiovascular risk factors, such as Overweight or diabetes, antihypertensive drugs are usually used to prevent life-threatening damage. If severe hypertension is present with a value greater than 180 or 110 mmHg, however, an immediate ingestion of blood pressure medication is required without further risk factors.
Assistance in regulating blood pressure is provided by various medicinal plants such as e.g. Hawthorn flowers, horsetail, lemon balm and valerian. Since the diet should be as low in salt as possible, herbs are suitable as a healthy and at the same aromatic alternative to seasoning the food. Here are e.g. Lovage and basil are known to have a positive effect on hypertension.
Various medicinal plants such as lemon balm or valerian can provide good support in the treatment. (Image: PhotoSG / fotolia.com) Other proven home remedies for high blood pressure include apple cider vinegar and red berries, as well as various essential oils in the context of aromatherapy can contribute to a regulation of blood pressure. Well suited here are e.g. the oils of lavender, marjoram or melissa. In the naturopathic context, hydrotherapy also plays an important role in the treatment of hypertension. The well-known water applications of the pastor Sebastian Kneipp, such as morning changing showers or increasing foot baths in the evening, can be used very effectively here. However, it should be noted that extreme cold applications can even increase blood pressure and thus have to be avoided.
Since stress is considered to be one of the main risk factors in arterial hypertension, psychotherapeutic procedures as well as various methods for reducing stress are a central component of the naturopathic treatment of hypertension. Here, e.g. Relaxation techniques such as autogenic training, yoga or meditation provide very good "help for self-help" by helping people to maintain their inner peace and balance and thus better manage stress.
If the cause of the cardiac wall thickening in an aortic stenosis, the treatment is dependent on the severity of the disease. In a mild form of valve narrowing without symptoms, it may be sufficient if the person concerned avoids physical exertion and pays sufficient attention. In more severe cases, surgery is usually performed because there are no medications that can reverse a stenosis. The so-called "aortic valve replacement" can be performed either by an open heart surgery or a catheter-based aortic valve implantation (TAVI), the method of choice depends on the health of the patient and the assessment by the physician.
In general, a pathological heart wall thickening in contrast to the "athlete's heart" is not reversible or completely curable. However, if the disease is detected early, it can be kept in check by appropriate therapy and lifestyle adjustments. However, if diagnosed very late, it is often not possible. In this case, there is a high risk of serious complications, e.g. a heart failure, an infarct or even a sudden cardiac death. But even in these cases, invasive procedures are currently being discussed in order to remove the wall thickening of the heart. (No)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)