What tests do you need to do for hypertensive heart disease?
 |
| What tests do you need to do for hypertensive heart disease? |
An examination
1.Electrocardiogram
The electrocardiogram can be normal, and left ventricular hypertrophy and strain can also occur. RV5+SV1>4.0mV (male), RV5+SV1> 3.5mV (female), the ST segment of the R-wave dominant lead can be moved down, or the T wave is inverted, and the electric axis is left-biased.
2. Chest X-ray film
In addition to dilatation of the aorta, the aorta extends tortuosity. The upper edge of the aortic arch can reach or exceed the level of the sterno-lock joint. The aortic node protrudes to the left and the heart is depressed. It becomes a typical "aortic heart".
3. Echocardiography
(1) M-mode echocardiography
- Compartment interval and left ventricular posterior wall thickness increase ventricular septum and left ventricular posterior wall showed uniform symmetry thickening, when the interventricular septum and left ventricular posterior wall absolute thickness greater than 12mm, can diagnose left ventricular hypertrophy.
- The increase of left ventricular myocardial weight is an important index for evaluating cardiac hypertrophy. In the past, the actual value of myocardial weight can only be understood through autopsy. In recent years, a large number of clinical studies have shown that the weight of myocardium obtained by echocardiography is used. Values are highly correlated with autopsy results. Therefore, the American Society of Echocardiography recommends the use of the Devereux correction formula to calculate myocardial weight and myocardial weight index.
Left ventricular mass = 0.8 × 1.04 [(LVDd + IVST + PWT) - LVDd) + 0.6
Left ventricular mass index (g/m) = left ventricular weight / body surface area
Left ventricular mass index normal value male 135g / m, female 125g / m
(2) Two-dimensional echocardiography left ventricular long axis, short axis section showed left ventricular wall hypertrophy, left ventricular hypertrophy with centripetal hypertrophy, a few irregular irregular hypertrophy, centripetal hypertrophy ventricular septum and left ventricular posterior wall Symmetrical hypertrophy, irregular type is asymmetrical hypertrophy between the ventricular septum and the posterior wall of the left ventricle, the left ventricular cavity is normal or slightly reduced, the amplitude of the wall motion is enhanced, and the left atrium can be slightly increased. Two-dimensional ultrasound is applied. Cardiac measurements of left ventricular myocardium were more accurate than M-mode echocardiography, and heart failure during systolic dysfunction, as well as enlargement of the left atrium and left ventricle.
(3) Doppler echocardiography showed high systolic systole in early stage, increased peak velocity of aortic blood flow, normal cardiac output, normal ejection fraction, and frequent abnormal changes in mitral blood flow spectrum. When left ventricular hypertrophy and diastolic compliance decline, left ventricular filling resistance increases. In order to maintain cardiac output, the main compensatory mechanism is to increase atrial filling pressure, which is characterized by prolonged left ventricular isovolumic diastolic phase and decreased E peak peak velocity. Acceleration time, deceleration time, prolonged early diastolic duration, increased peak peak velocity of A peak, and decreased E/A ratio, reflecting impairment of left ventricular diastolic function.
(4) Tissue Doppler mitral annulus velocity The main manifestation is decreased diastolic function. It is characterized by mitral annulus early diastolic velocity (E') and late diastolic velocity (A'), E'/A'<1. For patients with impaired myocardial relaxation, E' decreases in the basal state and does not increase as the pre-load increases as in normal subjects. Thus, E' reduction is one of the earliest manifestations of diastolic dysfunction. The European Society of Cardiology guidelines believe that E/E'≥15 can diagnose left ventricular diastolic dysfunction. When E/E' is 8-15, another diagnostic evidence of non-invasive left ventricular diastolic dysfunction, such as mitral or pulmonary venous flow spectrum, left ventricular mass index, etc., is required.
