Left ventricular hypertrophy

Left ventricular hypertrophy is enlargement and thickening (hypertrophy) of the walls of your heart's main pumping chamber (left ventricle). The thickened heart wall loses elasticity, leading to increased pressure to allow the heart to fill its pumping chamber to send blood to the rest of the body. Eventually, the heart may fail to pump with as much force as needed.

Left ventricular hypertrophy is more common in people who have uncontrolled high blood pressure. But no matter what your blood pressure is, developing left ventricular hypertrophy puts you at higher risk of congestive heart failure and irregular heart rhythms.

If left ventricular hypertrophy is caused by high blood pressure, treating high blood pressure can help ease your symptoms and may reverse left ventricular hypertrophy.

Symptoms

Left ventricular hypertrophy usually develops gradually. You may experience no signs or symptoms, especially during the early stages of the condition.

As left ventricular hypertrophy progresses, you may experience:

• Shortness of breath
• Fatigue
• Chest pain, often after exercising
• Sensation of rapid, fluttering or pounding heartbeats (palpitations)
• Dizziness or fainting

When to see a doctor

Seek emergency care if:

• You feel chest pain that lasts more than a few minutes
• You have severe difficulty breathing
• You have severe lightheadedness or lose consciousness
• You have a sudden, severe headache, difficulty speaking, or weakness on one side of your body

If you experience mild shortness of breath or other symptoms, such as palpitations, see your doctor.

If you have high blood pressure or another condition that increases your risk of left ventricular hypertrophy, your doctor is likely to recommend regular appointments to monitor your heart.

Causes

Left ventricular hypertrophy has several causes — one is an increase in the size of heart muscle cells and the other is abnormal tissue around the heart muscle cells.

Your heart muscle cells may get larger in response to some factor that causes the left ventricle to work harder, such as high blood pressure or a heart condition. As the left ventricle's workload increases, the muscle tissue in the chamber wall thickens. Sometimes, the size of the chamber itself also increases.

Left ventricular hypertrophy may also develop due to problems in the structure of the heart muscle cell. These changes can be related to a genetic defect. Abnormal tissue around the heart muscle cells is a result of several rare conditions.

Factors that can cause your heart to work harder include:

• High blood pressure (hypertension). This is the most common cause of left ventricular hypertrophy. More than one-third of people show evidence of left ventricular hypertrophy at the time of their diagnosis with hypertension.
• Aortic valve stenosis. This disease is a narrowing of the aortic valve that separates the left ventricle from the large blood vessel leaving your heart (aorta). The narrowing of the aortic valve requires the left ventricle to work harder to pump blood into the aorta.
• Athletic training. Intense, prolonged endurance and strength training can cause the heart to adapt to handle the extra workload. It's unclear whether this athletic type of left ventricle hypertrophy can lead to stiffening of the heart muscle and disease.

Abnormalities in heart muscle cell structure that result in increased heart wall thickness include:

• Hypertrophic cardiomyopathy. This genetic disease occurs when the heart muscle becomes abnormally thick, even with completely normal blood pressure, making it harder for the heart to pump blood.
• Amyloidosis. A condition that causes abnormal protein deposits around the organs, including the heart.

Risk factors

In addition to hypertension and aortic valve stenosis, factors that increase your risk of left ventricular hypertrophy include:

• Age. Left ventricular hypertrophy is more common in older people.
• Weight. Being overweight increases your risk of high blood pressure and left ventricular hypertrophy.
• Family history. Certain genetic conditions are associated with developing left ventricular hypertrophy.
• Diabetes. The risk of left ventricular hypertrophy is higher in people with diabetes.
• Race. African Americans may have a higher risk of left ventricular hypertrophy than white people with similar blood pressure measurements.
• Sex. Women with hypertension are at higher risk of left ventricular hypertrophy than are men with similar blood pressure measurements.

Complications

Left ventricular hypertrophy changes the structure and working of the heart. The enlarged left ventricle can:

• Weaken
• Stiffen and lose elasticity, preventing the chamber from filling properly and increasing pressure in the heart
• Compress the chamber's blood vessels (coronary arteries) and restrict its supply of blood

As a result of these changes, complications of left ventricular hypertrophy include:

• Reduced blood supply to the heart
• Inability of the heart to pump enough blood to your body (heart failure)
• Abnormal heart rhythm (arrhythmia)
• Irregular, often rapid heartbeat that increases the risk of stroke
• Insufficient supply of oxygen to the heart (ischemic heart disease)
• Stroke
• Sudden, unexpected loss of heart function, breathing and consciousness (sudden cardiac arrest)

Prevention

The best way to prevent left ventricular hypertrophy caused by high blood pressure is to maintain healthy blood pressure. To better manage your blood pressure:

• Monitor high blood pressure. Purchase a home blood pressure measuring device and check your blood pressure frequently. Schedule regular checkups with your doctor.
• Maintain a healthy weight. There's a direct relationship between excess weight and higher blood pressure.
• Make time for physical activity. Regular physical activity helps to lower blood pressure and keep it at normal levels. Aim for 30 minutes of moderate physical activity most days of the week.
• Eat a healthy diet. Avoid foods that are high in saturated fat and salt, and eat more fruits and vegetables. Avoid alcoholic beverages or drink them in moderation.
• Quit smoking. Giving up smoking improves your overall health and prevents heart attacks.

Diagnosis

Your doctor will start with a health history, family history and thorough physical examination, including checking your blood pressure and heart function.

Your doctor might then recommend screening tests:

• Electrocardiogram (ECG or EKG). Electrical signals are recorded as they travel through your heart. Your doctor can look for patterns that indicate abnormal heart function and increased left ventricle muscle tissue.
• Echocardiogram. Sound waves produce live-action images of your heart. Echocardiogram can reveal thickened muscle tissue in the left ventricle, blood flow through the heart with each beat, and heart abnormalities related to left ventricular hypertrophy, such as aortic valve stenosis.
• MRI. Images of your heart can be used to diagnose left ventricular hypertrophy.

Treatment

Blood pressure medication may help prevent further enlargement of the left ventricle and even shrink your hypertrophic muscles. Your doctor might recommend medications including:

Medications

Blood pressure medication may help prevent further enlargement of the left ventricle and even shrink your hypertrophic muscles. Your doctor might recommend medications including:

• Angiotensin-converting enzyme (ACE) inhibitors. These medications widen blood vessels to lower blood pressure, improve blood flow and decrease the heart's workload. Examples include captopril, enalapril (Vasotec) and lisinopril (Prinivil, Zestril, Zestoretic). Side effects might include an irritating dry cough in a small percentage of people.
• Angiotensin II receptor blockers (ARBs). Medications such as losartan (Cozaar) have benefits similar to ACE inhibitors but don't cause a persistent cough.
• Calcium channel blockers. These medications prevent calcium from entering cells of the heart and blood vessel walls. This relaxes the muscle in the vessel walls, which lets the blood vessels open wider and reduces blood pressure. Examples include amlodipine (Norvasc) and diltiazem (Cardizem, Tiazac).
• Diuretics. Medications known as thiazide-type diuretics reduce the amount of fluid in your blood vessels, lowering blood pressure. Examples include chlorthalidone and hydrochlorothiazide (Microzide).
• Beta blockers. Medications such as atenolol (Tenormin) can lower your heart rate, reduce blood pressure and prevent some of the harmful effects of stress hormones. Beta blockers aren't usually given as an initial treatment for hypertension. Your doctor might recommend adding a beta blocker if another type of medication isn't effective alone.

Surgery or other procedures

Aortic valve stenosis treatment

Left ventricular hypertrophy that is caused by aortic valve stenosis might require surgery to repair the narrow valve or to replace it with an artificial or tissue valve.

Treating other underlying conditions

• Hypertrophic cardiomyopathy treatment. Left ventricular hypertrophy due to hypertrophic cardiomyopathy may be treated with medication, a nonsurgical procedure, surgery, implanted devices and lifestyle changes.
• Amyloidosis. Treatment for amyloidosis includes medications, chemotherapy and possibly a stem cell transplant. Treatment for amyloidosis is available at specialized clinics.

• Treatment of sleep apnea. If you've already been diagnosed with sleep apnea, treating this sleep disorder may lower your blood pressure and help reverse left ventricular hypertrophy if it's caused by high blood pressure.

  If you haven't been diagnosed with sleep apnea, but your partner tells you that you snore or that you stop breathing momentarily while you sleep, talk with your doctor about getting tested for sleep apnea.

  Sleep apnea treatment involves using a machine that provides continuous positive airway pressure (CPAP) while you sleep. CPAP keeps your airways open, allowing you to get the oxygen you need to keep your blood pressure at a normal level.

Lifestyle and home remedies

Lifestyle changes can help lower your blood pressure, boost your heart health and improve left ventricular hypertrophy signs if caused by high blood pressure. Your doctor is likely to recommend heart-healthy lifestyle changes, including the following:

• Quitting smoking.
• Losing weight. Left ventricular hypertrophy is often found in people who are obese regardless of blood pressure. Losing weight has been shown to reverse left ventricular hypertrophy. Keeping a healthy weight, or losing weight if you're overweight or obese, can also help control your blood pressure.
• Eating a heart-healthy diet. Eat a diet high in fruits, vegetables, whole grains, low-fat dairy products and good fats, such as olive oil. Reduce the amounts of refined carbohydrates, sodium and saturated fats in your diet.
• Limiting salt in your diet. Too much salt can increase your blood pressure. Choose low-sodium or no-salt-added foods, and don't add salt to your meals.
• Drinking alcohol in moderation, if at all. Alcohol can also raise your blood pressure, especially if consumed in large amounts.
• Getting regular physical activity. Aim for at least 150 minutes of moderate physical activity a week. For example, try brisk walking for about 30 minutes most days of the week. Even smaller amounts of activity will provide significant benefit. Ask your doctor if you need to restrict certain physical activities, such as very heavy weightlifting, which may temporarily raise your blood pressure.
• Managing stress. Find ways to manage stress, such as relaxation techniques.

Preparing for an appointment

You may be referred to a doctor trained in treating heart disease (cardiologist).

What you can do

• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Write down questions to ask your doctor.
• Find out if your family has a history of heart disease.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

• What's the most likely cause of my symptoms?
• What tests do I need? Is there any special preparation for them?
• What kinds of treatments do I need?
• Should I make any lifestyle changes?
• Should I restrict any of my activities?
• I have other health problems. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

• What are your symptoms, and when did they begin?
• Have your symptoms gotten worse over time?
• Do you have chest pain or rapid, fluttering or pounding heartbeats?
• Do you have dizziness? Have you ever fainted?
• Have you had difficulty breathing?
• Does exercise or lying down make your symptoms worse?
• Have you ever coughed up blood?
• Do you have a history of high blood pressure or rheumatic fever?
• Do you have a family history of heart problems?
• Do you or did you smoke? Do you use alcohol or caffeine?

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