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Right Atrial Enlargement – Causes, Symptoms, ECG, Treatment

Right Atrial Enlargement - Causes, Symptoms, ECG, Treatment

The right atrium is one of the 4 chambers of the heart. The heart is comprised of 2 ventricles and 2 atria.

The right atrium is the 1st chamber of the heart to receive carbon dioxide-rich systemic blood from the body.

Moreover, the right atrium receives deoxygenated venous flow from:

  • the anterior and the smallest cardiac veins;
  • the coronary sinus;
  • the inferior vena cava;
  • the superior vena cava.

Additionally, the right atrium contains the sinoatrial node, the pacemaker of the heart.

This important piece of tissue functions as the pacemaker of the heart by controlling its rhythm and exciting the other cardiac muscle cells to contract.

Right atrial enlargement (RAE) is a marker of the severity of disease, plus, it predicts outcome in some situations.

These include pulmonary hypertension, tricuspid regurgitation (insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole), and right heart failure.

Symptoms

Common symptoms include:

  • shortness of breath;
  • a reduced capacity to practice exercise;
  • tightness in the chest;
  • confusion;
  • fatigue;
  • dizziness;
  • feeling light-headed;
  • weakness.

Causes

High Blood Pressure

Right atrial enlargement is commonly present in individuals with hypertension.

According to studies, RAE is present in about 50% of individuals with either treated or untreated hypertension.

Thyroid Disorders

Both an underactive thyroid gland and an overactive thyroid gland can substantially increase the risk of heart problems, including an enlarged heart.

Genetic

In some patients, a genetic anomaly causes a defect in the heart or surrounding tissue, causing the right atrium to enlarge.

Atrial Fibrillation

It is an irregular and commonly rapid heart rate which can increase the heart failure, risk of stroke, and other heart-related complications.

Atrial fibrillation is a frequent condition affecting over 3 million people in the United States.

Patients with atrial fibrillation may experience the following symptoms:

  • abdominal pain;
  • a racing sensation in the heart;
  • exercise intolerance;
  • fatigue;
  • lightheadedness;
  • shortness of breath;
  • chest pain or pressure.

According to recent research, right atrial dilatation may cause atrial fibrillation and vice versa.

Atrial Septal Defect

An atrial septal defect is a hole in the wall between the 2 upper chambers of the heart.

As a result, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it combines with oxygen-poor blood.

If your atrial septal defect is larger than 2 cm, you have an increased risk of health problems like:

  • leaking tricuspid and mitral valves;
  • right heart enlargement;
  • pulmonary hypertension, a condition of increased blood pressure within the arteries of the lungs;
  • stroke;
  • abnormal heart rhythms, including atrial flutter or atrial fibrillation.

Chronic Obstructive Lung Disease

It is an umbrella term used to describe progressive lung diseases, like – chronic bronchitis, emphysema (primarily causes shortness of breath), and refractory asthma.

Also, it is a major cause of morbidity and mortality in the world.

In about 85 percent of cases, COPD is caused by smoking.

Other causes of chronic obstructive pulmonary disease can include:

  • wood smoke and other biomass fuel used for cooking;
  • frequent lung infections as a child;
  • second-hand smoke;
  • occupational chemicals;
  • genetic reasons (alpha-1 antitrypsin deficiency).

The main symptoms of chronic obstructive pulmonary disease are:

  • persistent wheezing;
  • frequent chest infections;
  • a persistent chesty cough with phlegm;
  • increasing breathlessness, especially when you’re active.

The chronic obstructive pulmonary disease is an independent risk factor for atrial fibrillation, which may lead to RAE.

Pulmonic Valve Stenosis

It is a condition in which the pulmonary valve narrows the pulmonary valve opening and slows the blood flow.

Health problems can happen when pulmonary stenosis is severe and the right ventricle has to work harder to try to move blood through the tight pulmonary valve.

Symptoms of pulmonary valve stenosis may include:

  • loss of consciousness (fainting);
  • chest pain;
  • shortness of breath, particularly during exertion;
  • heart murmur — an abnormal whooshing sound heard using a stethoscope;
  • fatigue.

Right Ventricle Hypertrophy

It is commonly caused by a lung-related condition or a problem with the structure or function of the heart.

In cases with mild right ventricle hypertrophy, there may be no signs or symptoms whereas the clinical picture in individuals with severe hypertrophy is that of heart failure.

RVH can also put a lot of strain on the right ventricle, leading to RAE.

Tricuspid Regurgitation

It is a condition in which the valve between the 2 right heart chambers (right atrium and right ventricle) doesn’t close correctly.

Moderate tricuspid regurgitation is associated with right/left atrial enlargement.

Noticeable symptoms of tricuspid valve regurgitation may include:

  • shortness of breath with activity;
  • fatigue;
  • pulsing in your neck;
  • abnormal heart rhythms;
  • swelling in your abdomen or legs;
  • declining exercise capacity.

Mitral Regurgitation

Mitral valve regurgitation, also referred to as mitral regurgitation, is a condition in which the heart’s mitral valve doesn’t close tightly, allowing blood to flow backward in the heart.

Causes of acute mitral regurgitation can include:

  • mechanical failure of a prosthetic mitral valve;
  • ischemic papillary muscle rupture or dysfunction;
  • acute dilation of the left ventricle due to ischemia or myocarditis;
  • myxomatous rupture of the chordae tendineae (tendinous chords);
  • acute rheumatic fever;
  • infective endocarditis with rupture of the tendinous chords.

Many individuals with a mitral valve regurgitation don’t have symptoms and it may only be spotted during a heart scan carried out for another reason.

But, when symptoms occur, they may include:

  • noticeable heartbeats (palpitations);
  • dizziness;
  • an irregular heartbeat;
  • tiredness;
  • breathlessness.

Chronic severe mitral regurgitation is linked to compensatory dilation of the right and left atrium.

Mitral Stenosis

It is a narrowing of the mitral valve opening.

This condition is commonly asymptomatic early in the disease. See your healthcare professional if you develop:

  • chest pain;
  • shortness of breath, especially when you lie down;
  • chest discomfort;
  • coughing up blood;
  • fainting;
  • fatigue, particularly during increased physical activity;
  • dizziness;
  • heart palpitations;
  • swollen feet or legs.

Tricuspid Stenosis

The tricuspid valve is in the opening between the right ventricle and the right atrium.

Tricuspid stenosis means that there is a narrowing of the tricuspid valve opening.

When this occurs, it restricts blood flow between the lower and upper part of the right side of the heart, or from the right atrium to the right ventricle.

ECG

An electrocardiogram, also called an ECG or EKG, is widely used as a screening test for right atrial enlargement.

RAE is suggested by an ECG which has a pronounced notch in the P wave.

But, if atrial fibrillation is present, a P wave would not be present.

An abnormal ECG can also tell your healthcare professional if you have any of these issues:

  • a ‘silent’ heart attack (an interruption to blood flow in the coronary arteries without usual heart attack signs and symptoms);
  • areas of the heart with reduced blood supply;
  • problems with the spread of electrical activity within the heart;
  • irregular heartbeat (an arrhythmia).

Treatment of Right Atrial Enlargement

In order to ease the symptoms of right atrial enlargement, it is important to bring blood pressure under control.

Medications that are commonly prescribed to treat high blood pressure are beta-blockers (such as – atenolol, carvedilol, metoprolol, and bisoprolol) and angiotensin-converting-enzyme inhibitors.

Prevention & Natural Treatment For High Blood Pressure

  • walk and exercise regularly;
  • reduce sodium in your diet;
  • quit smoking;
  • lose extra pounds and watch your waistline;
  • eat a healthy diet, especially eat more potassium-rich foods;
  • cut back on caffeine;
  • limit the amount of alcohol you drink;
  • reduce your stress level.
Sources

https://www.ncbi.nlm.nih.gov/pubmed/8113560
http://circ.ahajournals.org/content/82/3/792
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.836.3902&rep=rep1&type=pdf
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/603810

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