LVH

Left ventricular hypertrophy is a condition wherein the muscle wall of heart’s left pumping chamber (ventricle), which is considered as the main pumping chamber, expands and thickens (hypertrophy). There can be various causes related to this disease; one of them is high blood pressure, which stresses left ventricle to work harder. 

The increasing workload results in the thickening of the muscle tissue of the chamber wall, thus lead to increased size of the chamber itself. This further results in the loss of elasticity and ultimately may fail to pump with as much force as needed. 

This disease is most common in people with high blood pressure, but at the same time, high blood pressure does not matter much, once left ventricular hypertrophy has developed, it puts the person at a high risk of heart attack and stroke. Controlling blood pressure can reduce the symptoms and may reverse the left ventricular hypertrophy condition.

There appear no signs and symptoms at the initial stage of the condition, but as the left ventricular hypertrophy progresses one may experience following symptoms:

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

Immediate doctor consultation is recommended when a person:

• Feels chest pain that lasts more than a few minutes,
• Have severe difficulty in breathing with severe, recurring lightheadedness or lose consciousness.
• Experiences mild shortness of breath or other symptoms, such as palpitations.

The doctor may recommend you regular monitoring in case of high blood pressure, but even when one is not having high blood pressure he/she needs to get his/her blood pressure checked regularly. Smoker and overweight persons are at the high risk of high blood pressure.

Left ventricular hypertrophy occurs usually when certain factors cause the heart to work harder than normal to pump blood to your body. High blood pressure is the most important factor that results in left ventricular hypertrophy. 

It has been noticed that one-third of the people suffering from left ventricular hypertrophy has high blood pressure. Other risk factors are:

1. Aortic valve stenosis: It is a condition wherein the aortic valve (the tissue flop), responsible for the separation between the left ventricle and large blood vessel leaving your heart (aorta), becomes narrow. This requires the left ventricle to work harder to pump blood into the aorta. 
2. Hypertrophic cardiomyopathy: Another contributing factor is hypertrophic cardiomyopathy, a genetic disease which arises when the heart muscle becomes abnormally thick thus, making it harder for the heart to pump blood. 
3. Sleep apnea: Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. 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.

Making a diagnosis of left ventricular hypertrophy is done by performing several tests.

Consult a doctor immediately if you experience shortness of breath or palpitations. The patient may be referred to a cardiologist (heart specialist) if needed. One can note down the unusual symptoms, and also note the medication, vitamins and any supplements if one is a regular consumer of these. One should also know the family history related to heart disease.

The Questions you can ask your doctor may be:

• What is the cause of the symptoms?
• What tests are to be followed and any kind of precautions or preparations to be done before tests?
• What type of treatment is required?
• If there need for any change to the lifestyle or restrictions to any activity?
• Are there other related health problems?

The doctor will be interested to know about the following details:

• Symptoms and when did they first started.
• Does any symptom get worse with time?
• If you are having chest, pain rapid, fluttering or pounding heartbeats.
• If you have dizziness or ever fainted. 
• Any kind of difficulty in breathing? 
• If doing the physical exercise of other work make the symptoms worse.
• If there is blood along with a cough.
• High blood pressure?
• Any family history?
• Are you a smoker or consuming alcohol or caffeine?

1. Electrocardiogram: The doctor will suggest you Electrocardiogram (ECG or EKG) in which the electrical signals are recorded as they travel through your heart. The doctor will look into any kind of abnormal pattern which indicate abnormal heart function and increased left ventricle muscle tissue.
2. Echocardiogram: Another technique called echocardiogram, which uses sound waves to produce live-action images of your heart, can be used to reveal the thickness of the heart muscle, blood flow through the heart with each beat, and other heart abnormalities such as aortic valve stenosis. 
3. MRI: It is an imaging technique which is used to take images of the heart. The doctor analyzes these images to look for any abnormalities like left ventricular hypertrophy.

The treatment of left ventricular hypertrophy may include medication or surgery. The doctor may recommend the patient to change their lifestyle which may include regular exercise, low-fat diet and smoking cessation. 

Reducing the blood pressure is the utmost priority and medication is useful in controlling blood pressure. These medications may also help in reducing the expansion of the left ventricle and even shrink your hypertrophic muscles.

• Angiotensin-converting enzyme (ACE) inhibitors are one of the most common medicines prescribed for treating high blood pressure. Examples include Captopril, Enalapril, and Lisinopril. These medications have certain disadvantages like irritating dry cough. 
• Angiotensin II receptor blockers (ARBs) is another kind of medications which include drugs like losartan (Cozaar). These medicines have benefits similar to ACE inhibitors and don't cause a persistent cough.

• Beta blockers: Medications such as atenolol (Tenormin) helps in lowering the heart rate, reduces blood pressure and prevent some of the harmful effects related to stress hormones. This medication is not prescribed at the early stages of disease, but may be recommended if the other medicines are not effective when given alone.
• Calcium channel blockers: These helps in preventing the entry of calcium into the heart cells and walls of blood vessels, therefore, lowering the blood pressure. Examples of these drugs include amlodipine (Norvasc) and diltiazem (Cardizem)
• Diuretics: Diuretic also known as a thiazide-type diuretic is a medicine which helps in facilitating blood flow and lowering hypertension. Examples of diuretics include chlorthalidone and hydrochlorothiazide. 
• Aortic valve repair or replacement: 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 sleep apnea: Treating sleep apnea may help in lowering your blood pressure and reversing left ventricular hypertrophy. 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. 

The best way to prevent left ventricular hypertrophy is to maintain healthy blood pressure. 

• One should have a regular checkup for maintenance of the blood pressure. This can be achieved even at home by using the blood pressure measuring device. 
• The patient should do exercise regularly for at least 30 minutes. 
• One can also maintain blood pressure levels by following a strict diet plan like avoiding consumption of food with high content of fats and salts and must eat vegetables and fruits. 
• Avoiding alcoholic beverages or drink can also be helpful. 
• Quitting smoking will not only help in reducing the high blood pressure, but is good for the overall health of a human being.

Following lifestyle modifications are necessary in order to prevent left ventricular hypertrophy:

• Intense, prolonged endurance and strength training can help the heart to adapt to handle the extra workload. 
• Usually, an obese person is at higher risk of getting this condition, therefore, the patient must lose weight in order to stay healthy.  Weight has been shown to reverse left ventricular hypertrophy.
• Limiting salt in your diet. Excessive intake of salt has been shown to increase the chance of high blood pressure and therefore one must follow a diet with low salt content. 
• Aim for at least 30 minutes of physical activity, such as walking, most days of the week. Ask your doctor if you need to restrict certain physical activities, such as weightlifting, which may temporarily raise your blood pressure.

In addition to hypertension and aortic valve stenosis, factors that increase your risk for 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 hypertrophy. Diabetes. 
• Race: African-Americans are at 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 men with similar blood pressure measurements.

The enlarged left ventricle can weaken, stiffen and lose elasticity, preventing the chamber from filling properly and increasing pressure in the heart thus compressing the chamber's blood vessels (coronary arteries) and restricting blood supply. 

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

• Interruption of 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 (atrial fibrillation) that decreases blood flow to the body Insufficient supply of oxygen to the heart (ischemic heart disease) 
• Enlargement of a section of the aorta (aortic root dilation) 
• Stroke 
• Sudden, unexpected loss of heart function, breathing and consciousness (sudden cardiac arrest)