Left ventricular hypertrophy describes tissue enlargement of the left myocardium (heart muscle) of the left ventricle of the heart. The medical term hypertrophy stands for tissue enlargement. The cardiac ventricle is the term used to describe the two cardiac cavities of the human heart located between the semilunar valves and the leaflet valves. The opposite of left ventricular hypertrophy is right ventricular hypertrophy, which involves the right myocardium of the right ventricle.
What is left ventricular hypertrophy?
A synonym is left ventricular hypertrophy. People who have cardiac hypertrophy have thickened heart muscle, either on the left or right side, depending on the condition. Left heart hypertrophy means increasing heart muscle mass. The muscle fibers thicken and the cells enlarge. The process of muscle gain is quite desirable in other areas of the body, such as when people play certain sports that build muscle mass. Most people associate the increase in muscle mass with something positive, but in the area of the heart this increase has a life-threatening effect. In this area, a distinction must be made between the desirable, physiological cardiac muscle hypertrophy of athletes (sports heart) and cardiac muscle hypertrophy due to ongoing exposure to pressure, which eventually becomes pathological.
Causes
It is an adaptive mechanism by which the heart adapts to the altered baseline caused by increased and chronic overload of the myocardium of the left ventricle. Triggers may be hemodynamic or nonhemodynamic processes. Possible causes include arterial hypertension (high blood pressure), hypertrophic cardiomyopathy, or valvular heart disease. Rarely, storage diseases such as Fabry disease also occur in this context. The most common cause of cardiac hypertrophy is constant pressure on the heart muscle due to high blood pressure. Left ventricular hypertrophy results in obstruction of blood ejection from the left ventricle due to aortic valve stenosis (narrowed heart valve). The pressure on the ventricular wall increases. The heart resorts to a “ruse” and attempts to compensate for this undesirable process in the form of increased stress through muscle growth. Exercise-induced cardiac hypertrophy, on the other hand, is a desirable phenomenon that is physiologically distinct from the pathological process in terms of its reversibility (ability to regress) and structure. Left ventricular hypertrophy occurs more often than right ventricular hypertrophy. That is, the left ventricle is affected more often than the right ventricle. Cardiac physicians distinguish between concentric (myocardial hypertrophy) and eccentric cardiac hypertrophy.
- The concentric form of muscle growth results from a pressure load on the heart. The volume of the affected ventricle is small, and the myocardial walls thicken. Under normal circumstances, the heart walls are compliant. This compliance decreases during the filling phase, which accumulates muscle tissue. Fibrous tissue accumulates in the muscle.
- The eccentric form of cardiac muscle growth results from a volume load on the ventricle. This arises, for example, due to insufficiency of the aortic valve (leaky aortic valve). A more or less developed part of the blood located in systole (tension phase), which is normally ejected into the great aorta, rushes back into the ventricle during the relaxation and filling phase (diastole).
Blood volume is increased by this process, which leads to myocardial hypertrophy or ventricular dilation. The left ventricle is hypertrophied more often than the right. The latter is particularly affected by high pressure of the pulmonary vessels. Rarely, hereditary forms of this disease such as hypertrophic cardiomyopathy occur.
Symptoms, complaints, and signs
As muscle tissue increases, the left ventricle stiffens due to nonmuscular fibrous tissue becoming lodged in the muscle fibers. This results in decreased elasticity of the ventricle, also known as diastolic dysfunction. The main symptom occurs in the form of shortness of breath when the patient is subjected to physical exertion. It is a heart failure in which systolic pump function and heart size are preserved.If the size of the heart increases by more than 500 grams due to muscle growth, a mismatch occurs between the oxygen demand of the heart muscle and the actual oxygen supply. The capillary blood system supplies the heart muscle with oxygen, but reaches its limits in view of the muscle growth because the organ grows too much or the blood vessels change in places due to calcification (ateriosclerosis). The consequences are chest pain (angina pectoris), heart muscle disorders, heart attack and heart failure.
Diagnosis and disease progression
Heart mass increases with age, even in healthy people. This normal increase in mass occurs because of an increasing wall thickness of the left-sided cardiac ventricle. In parallel, the elasticity of the myocardium decreases. As a result, blood pressure increases both at rest and during exercise. These complaints lead to a diagnosis by means of an ultrasound examination of the heart known as echography. More extensive clinical findings are provided by magnetic resonance imaging (MRI).
Complications
Left ventricular hypertrophy can cause death of the patient in the worst case. For this reason, this condition must be diagnosed and treated by a physician in any case. In this way, various consequential damages and other complications can be avoided. As a rule, those affected suffer from shortness of breath, which is accompanied by a reduction in the patient’s ability to cope with stress. It is not uncommon for severe fatigue to occur and for those affected to no longer take an active part in everyday life. Furthermore, heavy physical exertion is usually no longer possible for the affected person or is associated with a strong effort. Not infrequently, there is also chest pain. In the worst case, the patient suffers a heart attack and dies. Due to the heart failure, the patient’s life expectancy is significantly reduced because of left ventricular hypertrophy. Usually, left ventricular hypertrophy can be treated with the help of medication. However, affected individuals are dependent on lifelong therapy. In some cases, surgical interventions are also necessary to prevent the death of the affected person. Furthermore, no particular complications occur during treatment.
When should one go to the doctor?
Complaints in the area of the heart should always be clarified by a doctor. If there is a feeling of tightness in the chest or inconsistencies in movements of the upper body, a visit to the doctor is advisable. Any restriction of breathing or feeling of shortness of breath should be investigated and treated. Palpitations, changes in blood pressure or cardiac arrhythmias are warning signs of the organism. To prevent a life-threatening condition, a visit to the doctor must be made. If physical activities can no longer be carried out as usual or if the usual performance capacity decreases, the affected person requires medical care. A doctor’s visit is required to determine the cause. Chest pain or a stabbing sensation in the left chest should be presented to a physician. If a feeling of pressure is perceived in the chest, if there are disturbances in blood circulation, dizziness or nausea, a visit to the doctor is required. A diffuse feeling of illness, general malaise or weakness should also be examined and treated by a doctor. Sleep disturbances, anxiety or problems with concentration are indications that should be followed up. A visit to the doctor is advisable as soon as the complaints persist over several weeks or they increase in intensity. If professional activities or usual sporting activities can only be carried out to a limited extent, a doctor is needed to clarify the cause. Until the cause is determined, overexertion should be avoided.
Treatment and therapy
To eliminate or make this condition tolerable, conservative therapies such as surgical removal of the valvular defect and, in less severe cases, drug therapy to lower blood pressure are appropriate. There is as yet no ideal treatment for this heart disease. In most cases, the physician prescribes calcium antagonists or beta blockers. A common drug is verapamil. These drugs lead to an improvement in coronary blood flow and systolic filling. Hypertrophy is not further stimulated with this therapy. ACE inhibitors increase the ejection fraction of the heart due to decreased blood pressure.
Outlook and prognosis
If left untreated, left ventricular hypertrophy leads to premature death of the affected individual. There is a steady increase in symptoms until ultimately heart failure occurs. If the heart failure is diagnosed very late or in an acute state, the prognosis is also unfavorable in a large number of cases. The patient requires surgery to alleviate the existing symptoms. If this proceeds without further complications, survival can be ensured. Nevertheless, a change in the previous lifestyle is necessary for a lasting improvement in health. If the previous physical or emotional stress continues, long-term impairments can be observed in most cases. In particular, sporting and occupational activities should be changed and adapted to the conditions of the organism. Regular control examinations are also necessary after an intervention in order to observe the cardiac activity and to be able to react as quickly as possible in case of irregularities. In acute situations, intensive medical care is required. Otherwise, long-term health disorders may occur. Patients with left ventricular hypertrophy have an overall reduced life expectancy. They are dependent on the administration of drugs to minimize cardiac arrhythmias. Nevertheless, they are at increased risk due to their condition. If other diseases occur in the course of life, this always places an additional burden on the heart.
Prevention
This is a cardiovascular heart disease for which, in addition to the patient’s age, left ventricular hypertrophy is the main finding (predictor). It acts as an independent risk factor for coronary diseases such as sudden cardiac death, stroke and heart failure. For this reason, there is no prevention in the clinical sense. A healthy lifestyle can help maintain normal heart muscle activity into old age. This includes plenty of exercise and avoiding too many stimulants such as alcohol and nicotine.
Follow-up
Medical follow-up after left ventricular hypertrophy is essential. Because the patient’s use of beta-blockers is necessary, regular follow-up examinations should be performed. In the case of surgical therapy, it is important that those affected test or observe themselves and consult their physician immediately after warning signals from their body. A blood count is taken to determine any inflammation levels. In the first weeks after the operation, rotational movements and transverse loads on the chest and heavy work should be avoided. Shorter flights are possible, but long-distance travel is not recommended for up to six months after the operation. Sporting activities should initially be limited to light walking, cycling and swimming and should be resumed with extreme caution. If chest pain occurs or the patient finds the feeling of constriction disturbing, it is advisable to consult the attending physician.
What you can do yourself
A number of self-help measures can improve not only the symptoms of compensatory left ventricular hypertrophy but also, in many cases, the objective findings of the disease. In this regard, it is of great advantage if the causes that led to the left ventricular hypertrophy are known. In the majority of cases where compensatory thickening of the left ventricular muscular walls of the heart can be attributed to permanent arterial hypertension, all measures that address the causes of hypertension in addition to drug treatment of hypertension will help. For example, smokers can stop smoking, and exercise within the individual’s capabilities with moderate endurance exercise can even lead to gradual regression of the hypertrophied heart walls. Exercise and sporting activity should in no case be associated with abruptly changing performance requirements as they occur in almost all dynamic ball games such as soccer, tennis, volleyball and similar sports. Golf has a particularly beneficial effect on the heart and the entire cardiovascular system. Brisk walking alternates with short phases of concentration that serve to hit the ball.However, the above self-help measures reach their limits when the disease is caused by mitral valve regurgitation or aortic valve stenosis. Avoidance of sports with sudden changes in performance demands also applies to hereditary hypertrophic cardiomyopathy.
