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Left ventricular hypertrophyBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/left-ventricular-hypertrophy/DS00680
Left ventricular hypertrophy is enlargement (hypertrophy) of the muscle tissue that makes up the wall of your heart's main pumping chamber (left ventricle).
Left ventricular hypertrophy develops in response to some factor, such as high blood pressure, that requires the left ventricle to work harder. As the workload increases, the walls of the chamber grow thicker, lose elasticity and eventually may fail to pump with as much force as that of a healthy heart.
Left ventricular hypertrophy is more common in people who have uncontrolled high blood pressure or other heart problems. Treating high blood pressure can help ease your symptoms and may reverse the left ventricular hypertrophy.
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 and complications develop, you may experience these left ventricular hypertrophy symptoms:
- Shortness of breath
- Chest pain, often after exercising
- Sensation of rapid, fluttering or pounding heartbeats (palpitations)
- Dizziness or fainting
When to see a doctor
Call 911 or your local emergency number if you feel chest pain that lasts more than a few minutes or have severe difficulty breathing. 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, talk to your doctor about regular appointments to monitor your heart. Even if you feel well, you need to have your blood pressure checked annually, or more often if you smoke, are overweight or have other conditions that increase the risk of high blood pressure.
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|Left ventricular hypertrophy|
Left ventricular hypertrophy can happen when one or more things make your heart work harder than normal to pump blood to your body. For example, if you have high blood pressure, the muscles of the left ventricle must contract more forcefully than normal in order to counter the effect of the elevated blood pressure.
The work of adapting to high blood pressure may result in larger muscle tissue in the walls of the left ventricle. The increase in muscle mass causes the heart to function poorly.
Some factors that can cause your heart to work harder include the following:
- High blood pressure (hypertension). A blood pressure reading is given in a unit of measure called millimeters of mercury (mm Hg). Hypertension is generally defined as systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg, or 140/90 mm Hg. Systolic pressure is blood pressure while the heart contracts, and diastolic pressure is blood pressure while the heart rests between beats.
- Aortic valve stenosis. This disease is a narrowing of the aortic valve, the flap separating your left ventricle from the aorta, the large blood vessel that delivers oxygen-rich blood to your body. This partial obstruction of blood flow requires the left ventricle to work harder to pump blood into the aorta.
- Hypertrophic cardiomyopathy. In this disease, the heart muscle (myocardium) becomes abnormally thick — or hypertrophied. This thickened heart muscle can make it harder for the heart to pump blood.
- Athletic training. Intense, prolonged endurance and strength training can cause the heart to adapt so that it can handle the extra workload. In some people, these changes may lead to left ventricular hypertrophy.
Risk factors for left ventricular hypertrophy include the following:
- High blood pressure, a blood pressure reading greater than 140/90 mm Hg increases your risk of left ventricular hypertrophy. In addition, a nighttime blood pressure reading greater than 120/80 mm Hg also increases your risk.
- Obesity can cause high blood pressure and increase your body's demand for oxygen, factors that may lead to left ventricular hypertrophy.
- Aortic stenosis, narrowing of the main valve through which blood leaves the heart, may increase the left ventricle's workload.
- Certain genes. Certain genes are associated with an increased risk of left ventricular hypertrophy.
Left ventricular hypertrophy changes both the structure and function of the chamber:
- The enlarged muscle loses elasticity and stiffens, preventing the chamber from filling properly and leading to increased pressure in the heart.
- The enlarged muscle tissue compresses its own blood vessels (coronary arteries) and may restrict its own supply of blood.
- The overworked muscle weakens.
Complications that can occur as a result of these problems include:
- Inability of your heart to pump enough blood to your body (heart failure)
- Abnormal heart rhythm (arrhythmia)
- Insufficient supply of oxygen to the heart (ischemic heart disease)
- Interruption of blood supply to the heart (heart attack)
- Sudden, unexpected loss of heart function, breathing and consciousness (sudden cardiac arrest)
Preparing for your appointment
You're likely to start by seeing your family doctor. After your initial appointment, your doctor may refer you to a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist).
Here's some information to help you prepare for your appointment and know what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, and for how long.
- Make a list of your key medical information, including other recent health problems you've had and the names of any prescription and over-the-counter medications you're taking.
- Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
- Write down the questions you want to be sure to ask your doctor.
Questions to ask your doctor at your initial appointment include:
- What are the possible causes for my signs or symptoms?
- What tests do I need? Do these tests require any special preparation?
- Should I see a specialist?
- Should I follow any restrictions while I wait for my next appointment?
- What emergency signs and symptoms should prompt a call to local emergency services or 911?
Questions to ask if you are referred to a cardiologist include:
- What is my diagnosis?
- What is the underlying cause of my condition?
- What is my risk of long-term complications from this condition?
- What treatment do you recommend?
- If you're recommending medications, what are the possible side effects?
- If you're recommending surgery, what procedure is most likely to be successful in my case? Why?
- What diet and lifestyle changes should I make? How will these changes help me?
- What activity restrictions do I need to follow, if any?
- How frequently will you see me for follow-up visits?
- I have these 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 additional questions during your appointment.
What to expect from your doctor
A doctor or cardiologist who sees you for heart-related signs and symptoms may ask:
- What are your symptoms?
- When did you first begin experiencing symptoms?
- Have your symptoms gotten worse over time?
- Do your symptoms include chest pain?
- Do your symptoms include rapid, fluttering or pounding heartbeats?
- Do your symptoms include dizziness? Have you ever fainted?
- Have you had difficulty breathing?
- Does exercise or physical exertion make your symptoms worse?
- Does lying down make your symptoms worse?
- Are you being treated or have you recently been treated for any other health conditions, such as high blood pressure?
- Have you ever coughed up blood?
- Are you aware of ever having rheumatic fever?
- Are you aware of any history of heart problems in your family?
- Do you or did you smoke? How much?
- Do you use alcohol or caffeine? How much?
What you can do in the meantime
While you wait for your appointment, check with your family members to find out if any close relatives have been diagnosed with heart disease. The symptoms of left ventricular hypertrophy are similar to a number of other heart conditions, including some that tend to run in families. Knowing as much as possible about your family's health history will help your doctor determine next steps for your diagnosis and treatment.
If exercise makes your symptoms worse, avoid strenuous activity until you've been seen by your doctor.
Tests and diagnosis
If you have signs and symptoms associated with heart disease — such as shortness of breath, chest pain, palpitations or others — your doctor will examine your heart function and choose the best treatment.
If you have high blood pressure, your doctor may order heart-related tests as part of the ongoing management of the condition.
Screening tests for left ventricular hypertrophy include:
- Electrocardiogram. An electrocardiogram — also called an ECG or EKG — records electrical signals as they travel through your heart. Your doctor can look for patterns among these signals that indicate abnormal heart function and increased left ventricle muscle tissue.
Echocardiogram. An echocardiogram uses sound waves to produce live-action images of the heart. This common test enables your doctor to watch your ventricles squeezing and relaxing and valves opening and closing in rhythm with your heartbeat.
The echocardiogram is a primary tool for diagnosing left ventricular hypertrophy. If you have left ventricular hypertrophy, your doctor will be able to see thickening of muscle tissue in the left ventricle. An echocardiogram can also reveal how much blood is pumped from the heart with each beat and how stiff the heart muscle is. It may also show related heart abnormalities, such as aortic valve stenosis.
- Magnetic resonance imaging (MRI). Magnetic resonance imaging is a technique that uses a magnetic field and radio waves to create images of soft tissues in the body. It can be used to produce a thin cross-sectional "slice" of your heart or a 3-D image. Cardiovascular MRI can be used to diagnose left ventricular hypertrophy. However, this test is more expensive than echocardiography and may not be available everywhere.
Treatments and drugs
Treatment for left ventricular hypertrophy focuses on the underlying cause of the condition. Depending on the cause, treatment may involve medication or surgery.
Treating high blood pressure
Treatment for high blood pressure usually includes both medications and lifestyle changes, such as regular exercise; a low-sodium, low-fat diet; and no smoking.
In addition to lowering blood pressure, some high blood pressure drugs may prevent further enlargement of left ventricle muscle tissue and may even shrink your hypertrophic muscles. Blood pressure drugs that may reverse muscle growth include the following:
Angiotensin-converting enzyme (ACE) inhibitors widen, or dilate, blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
ACE inhibitors cause an irritating cough in some people. It may be best to put up with the cough, if you can, to gain the medication's benefits. Discuss this side effect with your doctor. Switching to another ACE inhibitor or an angiotensin II receptor blocker may help.
- Angiotensin II receptor blockers (ARBs), which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
- Thiazide diuretics act on your kidneys to help your body eliminate sodium and water, thereby reducing blood volume.
- Beta blockers slow your heart rate, reduce blood pressure and prevent some of the harmful effects of stress hormones. These drugs include atenolol (Tenormin), carvedilol (Coreg), metoprolol (Toprol XL) and bisoprolol (Zebeta).
- Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls. This lowers blood pressure. These drugs include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR, Tiazac), nifedipine (Procardia) and verapamil (Calan, Verelan, Covera-HS).
Treating sleep apnea
If you've already been diagnosed with sleep apnea, treating this sleep disorder can help shrink left ventricular hypertrophy. 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. Treatment for sleep apnea involves using a machine that provides continuous positive airway pressure (CPAP) while you sleep. This keeps your airways open, allowing you to get the oxygen you need to keep your blood pressure at a normal level.
Aortic valve repair or replacement
If left ventricular hypertrophy is caused by aortic valve stenosis, you may have surgery to remove the narrow valve and replace it with either an artificial valve or a tissue valve from a pig, cow or deceased human donor. If you have aortic valve regurgitation, the leaky valve may be surgically repaired or replaced.
Although they are not a treatment specifically for left ventricular hypertrophy, the cholesterol-lowering medications known as statins may help treat left ventricular hypertrophy. Clinical trials are currently being done to see if statins are a useful treatment for this disorder.
Lifestyle and home remedies
Lifestyle changes can help lower your blood pressure and improve left ventricular hypertrophy symptoms. Helpful changes you can make include:
- Weight loss. Losing just 10 pounds (4.5 kilograms) can help your blood pressure medications work more effectively and increase the chance of shrinking your left ventricular hypertrophy.
- Limit the amount of 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.
- Drink alcohol in moderation, if at all. Alcohol can also raise your blood pressure. If you choose to drink, drink a moderate amount. This is defined as one drink a day for women and men older than age 65, or two a day for men age 65 and younger.
- Exercise regularly. Aim for at least 30 minutes of physical activity, such as walking, most days of the week. Talk to your doctor about whether you need to restrict certain physical activities, such as weightlifting, which may temporarily raise your blood pressure.
The best way to help prevent left ventricular hypertrophy is to maintain healthy blood pressure. Here are a few tips to better manage your blood pressure:
- Monitor high blood pressure. If you have high blood pressure, get a home blood pressure measuring device and check your blood pressure frequently. Schedule regular checkups with your doctor. The target for healthy blood pressure is less than 130/80 mm Hg.
- Make time for exercise. Regular exercise helps lower blood pressure and keep it at normal levels. Aim for 30 minutes of moderate activity most days of the week.
- Watch your diet. Avoid foods that are high in fat and salt, and eat more fruits and vegetables. Avoid alcoholic beverages or drink them in moderation.
- Quit smoking if you're a smoker. Giving up smoking improves your blood pressure and overall health.
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- What is high blood pressure? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/. Accessed May 30, 2012.
- Aortic valve stenosis (AS) and aortic insufficiency (AI). American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Aortic-Valve-Stenosis-AVS_UCM_307020_Article.jsp. Accessed May 30, 2012.
- Gersh BJ, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:e783.