Right ventricular hypertrophy (RVH) is a condition in which the muscle of the heart’s right ventricle thickens due to chronic abnormally high pressure as it pumps blood through the lungs. If left untreated, it leads to heart failure and death.

Patients suffering from pulmonary hypertension (PH) or chronic thromboembolic pulmonary hypertension (CTEPH) will eventually be confronted with some degree of right ventricular hypertrophy. It’s in the nature of the beast.

[Learn about the basic structure of the heart in this post.]

Causes of RVH

There are several possible causes of RVH. A prominent cause is chronic thromboembolic pulmonary hypertension (CTEPH). This post focuses on CTEPH driving right ventricular hypertrophy.

In CTEPH, blood clots clog the arteries in the lungs. The right side of the heart has to work extra hard to push blood through the blockages, resulting in abnormally high pressure (pulmonary hypertension). This damages the heart over time, leading to right ventricular hypertrophy and more.

The image shows a healthy heart and one suffering from right ventricular hypertrophy.
The image shows a healthy heart and one suffering from right ventricular hypertrophy. Note the thick wall (muscle) surrounding the right ventricle. Almost no space is left for blood to enter and be pumped into the lungs. – Image credit: Mariana Ruiz/Wikimedia, public domain.

Symptoms

You may have symptoms such as shortness of breath (dyspnea), chest pain or fainting (syncope) with physical activity, swelling in the limbs (edema), and pain in the upper right of the abdomen caused by liver congestion (passive hepatic congestion).

If you have any of these symptoms, always consult your healthcare provider and have them check for pulmonary hypertension regardless of what they say may be the cause of your discomfort. Testing for pulmonary hypertension is simple. It can initially be done through an echocardiogram (echo) [1, 2, 3, 4].

Here is why: CTEPH is often misdiagnosed due to the presence of unclear symptoms. Several of the listed symptoms can be associated with other conditions [2, 3]. The sooner you start treatment for pulmonary hypertension/CTEPH, the better for your heart. It’s crucial for your survival [4].

Souce: PHA – Echocardiogram – Pulmonary Hypertension Association (PHA UK)

Management of RVH

The management of right ventricular hypertrophy depends on the underlying cause but typically includes:

  • Diuretics (to remove excess fluid).
  • Oxygen therapy.
  • Anticoagulants (to prevent blood clot formation).

Prognosis for RVH patients

The prognosis for individuals with RVH depends on the underlying cause and the damage already done to your heart. 

CTEPH is the only form of pulmonary hypertension that can be cured [3, 5]. With proper treatment, the right ventricle may return to a healthier state (reverse remodeling) [5].

Takeaway

Right ventricular hypertrophy leads to death if the underlying cause is left untreated. To protect your heart, it’s important to start treatment as early as possible. If you experience any of the above symptoms, see your doctor and insist on being evaluated for pulmonary hypertension, regardless of the suspected cause of your symptoms. Early diagnosis of CTEPH is critical for your survival.

References

Please note that unless otherwise stated, the information presented is from Bhattacharya et al. (Reference [1]). My recommendation for people with symptoms to always get tested for PH is based on my personal experience as a patient and is only partially supported by the literature.

[1] Bhattacharya, P. T., & Ellison, M. B. (2022, August 1). Right Ventricular Hypertrophy. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved May 22, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK499876/

[2] Teerapuncharoen, K., & Bag, R. (2022). Chronic Thromboembolic Pulmonary Hypertension. Lung, 200(3), 283–299. https://doi.org/10.1007/s00408-022-00539-w

[3] Saia, F., Galiè, N., Matsubara, H. (Eds.). (2022). Balloon pulmonary angioplasty in patients with CTEPH. Springer. https://doi.org/10.1007/978-3-030-95997-5

[4] Augustine, D. X., Coates-Bradshaw, L. D., Willis, J., Harkness, A., Ring, L., Grapsa, J., Coghlan, G., Kaye, N., Oxborough, D., Robinson, S., Sandoval, J., Rana, B. S., Siva, A., Nihoyannopoulos, P., Howard, L. S., Fox, K., Bhattacharyya, S., Sharma, V., Steeds, R. P., & Mathew, T. (2018). Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo research and practice, 5(3), G11–G24. https://doi.org/10.1530/ERP-17-0071

[5] Liu, J., Yang, P., Tian, H., Zhen, K., McCabe, C., Zhao, L., & Zhai, Z. (2022). Right Ventricle Remodeling in Chronic Thromboembolic Pulmonary Hypertension. Journal of translational internal medicine, 10(2), 125–133. https://doi.org/10.2478/jtim-2022-0027