Cardiovascular / Cardiology COPD

Right ventricular hypertrophy: Causes and complications

Right ventricular hypertrophy is a heart disorder characterized by thickening of the walls of the right ventricle. It can be caused by excessive stress on the right ventricle.

Only one section of the heart is affected by right ventricular hypertrophy (RVH).


The right and left ventricles are two of the four chambers of the heart and make up the lower section of the organ.


RVH specifically affects the right ventricle, which is responsible for pumping deoxygenated blood back to the lungs.





What is RVH?


Right ventricular hypertrophy <br>Image credit: Mariana Ruiz, 2006</br>
Image credit: Mariana Ruiz, 2006


Hypertrophy is a term used to describe an organ or tissue that increases in size. This increase is due to the cells in the affected area getting bigger than their normal size. In the heart, hypertrophy causes the walls of one or more of the chambers to thicken. This is due to the cells in the area enlarging.


When hypertrophy happens in the heart, the thicker heart muscle can lose elasticity over time. In the case of the right ventricle, this causes it to struggle to pump blood to the lungs for more oxygen to be retrieved.


RVH can wear down the heart, leading to further complications as time goes on.




Causes of RVH




RVH is usually caused by either congenital heart conditions or high blood pressure in the lungs, which is known as pulmonary hypertension.


There are many different causes within these categories including:

Man holds chest in some discomfort
Heart palpitations, shortness of breath, and chest pain may be symptoms of RVH.

  • COPD

  • pulmonary emboli

  • chronic lung diseases, such as sarcoidosis and pulmonary fibrosis

  • pulmonary valve stenosis

  • tetralogy of Fallot

  • cardiac fibrosis

  • sickle cell anemia

  • chronic anemia, such as iron deficiency, folate or B12 deficiency, or thalassemia

  • sleep apnea

Signs and symptoms


Signs and symptoms of RVH can be difficult for a doctor to diagnose. Symptoms of RVH can include:


  • chest pain

  • dizziness

  • excess fluid buildup (edema)

  • shortness of breath

  • heart palpitations

  • rapid heart rate

Doctors will often carry out a range of tests to accurately diagnose RVH.


Anyone experiencing these symptoms should seek medical attention immediately, as they can be signs of serious or potentially fatal heart complications.




Complications and risk factors


man smoking a cigarette
Smoking may raise the risk of RVH.


Certain conditions and habits may put a person at greater risk for RVH. These include:


  • Smoking, which raises the risk of many heart and pulmonary conditions.

  • Sleep apnea, which is another common risk factor for RVH and may affect the arteries in the lungs.

  • Strenuous activity, as overexertion can produce signs of hypertrophy.

The main complications associated with RVH are caused by the unnecessary stress it places on the heart.


If it is not treated, RVH can result in a weakened heart and can heighten the risk of heart failure and cardiovascular death in some people.





Diagnosis and ECG findings


Doctors will begin a diagnosis with a physical examination. They will probably recommend imaging tests to look at the heart, including electrocardiograph (ECG) and echocardiogram, which are commonly used to diagnose RVH.


The left ventricle is usually bigger than the right, so for the right ventricle to show up on an ECG test, it will usually be more pronounced.


ECG tests have their drawbacks, however. The tests are often not sensitive enough to diagnose mild to moderate RVH, and may lead to misdiagnosis in these cases.


If there is any suspicion based on symptoms and ECG findings, the doctor may order a right-sided ECG. Cardiac magnetic resonance imaging (cMRI) may be necessary as well to get a more accurate image of the heart.




Treatment and prevention


Treating RVH involves treating the cause of the condition rather than the hypertrophy itself. For instance, people who have problems with their blood pressure may require blood pressure medications and lifestyle changes.


When RVH is caused by pulmonary hypertension, doctors will prescribe specific drugs to treat that condition. These medications include vasodilators or blood vessel dilators.


Some drugs that are used for erectile dysfunction in men can also help open up the pulmonary arteries and may be used for RVH.


Treatment also aims to reduce or stop the thickening of the walls of the right ventricle. Currently, there is no treatment to reverse the thickening of these walls completely, although ACE inhibitors have been shown to help.


Preventing right ventricular hypertrophy from getting worse is possible in many cases. Prevention methods for RVH include reducing individual risk factors and promoting a heart and lung-healthy lifestyle.


Quitting smoking, eating a balanced diet, and engaging in a regular, mild to moderate exercise routine are all ways to maintain heart and lung health. 

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