left ventricular hypertrophy
What is left heart hypertrophy?The heart mass increases with increasing age in healthy people. This normal increase in mass occurs due to an increasing wall thickness of the left-sided cardiac ventricle.
A synonym is left ventricular hypertrophy. People who suffer from myocardial hypertrophy have a thickened heart muscle, either left or right depending on the condition. Left ventricular hypertrophy means an increasing myocardial mass. The muscle fibers thicken and the cells enlarge.
The process of gaining muscle is desirable in other areas of the body, such as when people do certain sports that build muscle mass. Most people associate something positive with the increase in muscle mass, but in the heart this increase is life-threatening. In this area, a distinction must be made between the desired physiological cardiac muscle hypertrophy of athletes (sports heart) and myocardial hypertrophy due to continuous pressure, which ultimately leads to morbidity.
It is an adaptation mechanism that allows the heart to adapt to the changed initial situation through the increased and chronic overloading of the heart muscle of the left ventricle. Triggers can be hemodynamic or non-hemodynamic processes. Possible causes include arterial hypertension (high blood pressure), hypertrophic cardiomyopathy or valvular heart failure.
Suffering memory disorders such as Fabry disease rarely occur in this context. The most common cause of myocardial hypertrophy is a constant pressure load of the heart muscle due to hypertension. Left ventricular hypertrophy results in obstruction of left ventricular output due to aortic valve stenosis (narrowed heart valve). The pressure on the ventricle wall increases. The heart reaches for a "cunning" and tries to compensate for this undesirable process in the form of an increased burden of muscle growth.
Sport-related cardiac hypertrophy, on the other hand, is a desirable phenomenon that differs physiologically in terms of its reversibility and structure from the pathological process. Left ventricular hypertrophy is more common than right heart hypertrophy. That is, the left ventricle is more often affected than the right ventricle.Heart specialists distinguish between concentric (myocardial hypertrophy) and eccentric myocardial hypertrophy.
- The concentric form of muscle growth results from a pressure load on the heart. The volume of the affected ventricle is small, the heart muscle walls thickened. Under normal circumstances, the heart walls are yielding. This compliance decreases during the filling phase, which enriches muscle tissue. Fiber tissue accumulates in the muscles.
- The eccentric form of heart muscle growth is caused by a volume load of the heart chamber. This is caused for example by an insufficiency of the aortic valve (leaky aortic valve). A more or less trained part of the systole (tension phase) blood, which is normally ejected into the large body artery, flips back into the ventricle during the relaxation and filling phase (diastole).
Blood volume is increased by this process leading to myocardial hypertrophy or ventricular expansion. The left ventricle is hypertrophied more frequently than the right ventricle. 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 & signs
With increasing muscle tissue, the left ventricle stiffens due to the incorporation of non-muscular fibrous tissue, which is embedded in the muscle fibers. This results in a reduced elasticity of the ventricle, which is also referred to as diastolic dysfunction. The main symptom occurs in the form of shortness of breath when the patient is exposed to physical stress.
It is a congestive heart failure in which the systolic pumping function and the size of the heart are preserved. If the heart size increases by more than 500 grams due to muscle growth, a mismatch between the oxygen demand of the heart muscle and the actual supply of oxygen arises.
The capillary blood system supplies the heart muscle with oxygen, but comes in the face of muscle growth to its limits, because the organ grows too strong or the blood vessels in places by calcification (atherosclerosis) change. The consequences are chest pain (angina pectoris), heart muscle disorders, heart attack and heart failure.
Diagnosis & disease course
The heart mass increases with increasing age in healthy people. This normal increase in mass occurs due to an increasing wall thickness of the left-sided cardiac ventricle. In parallel, the elasticity of the heart muscle decreases. As a result, blood pressure increases in both retirement and exercise. These symptoms lead to a diagnosis by means of an ultrasound examination of the heart, which is called echography. Further clinical findings are provided by magnetic resonance imaging (MRI).
Left ventricular hypertrophy can in the worst case lead to death of the patient. For this reason, this disease must definitely be diagnosed and treated by a doctor. This can be used to avoid various consequential damages and other complications. As a rule, sufferers suffer from a shortness of breath, which is associated with a reduced resilience of the patient.
Not infrequently, a strong fatigue occurs and those affected no longer actively participate in everyday life. Furthermore, even heavy physical stress for the person concerned is usually no longer possible or associated with a strong effort. Not infrequently it also comes to chest pain. In the worst case, the person suffering a heart attack and dies of it.
Cardiac insufficiency significantly reduces the patient's life expectancy due to left ventricular hypertrophy. As a rule, left heart hypertrophy can be treated with the help of medication. However, those affected are dependent on a lifelong therapy. In some cases, surgical interventions are necessary so that it does not lead to the death of the person concerned. Furthermore, no special complications occur during the treatment.
When should you go to the doctor?
Complaints about the heart should always be clarified by a doctor. If there is a feeling of tightness in the chest or disagreements in movements of the upper body, a visit to a doctor is advisable. A limitation of respiratory activity or the feeling of shortness of breath should be examined and treated. Tachycardia, changes in blood pressure or cardiac arrhythmias are warning signs of the organism. To prevent a life-threatening condition, a doctor's visit must be made. If physical activities can no longer be carried out as usual, or if the usual capacity decreases, the person concerned needs medical care. To clarify the cause, a visit to a doctor is required.
Chest pain or a stabbing sensation in the left breast should be presented to a doctor. If a feeling of pressure in the chest is perceived, it comes to disturbances of the blood circulation, dizziness or nausea, a physician visit is necessary. A diffuse feeling of illness, a general malaise or a weakness are also to be examined and treated by a doctor. Sleep disorders, anxiety or problems of concentration are indications that should be investigated. A visit to a doctor is advisable as soon as the symptoms persist for several weeks or increase in intensity. If professional activities or usual sports activities can only be carried out to a limited extent, a doctor is needed to clarify the cause. Excessive efforts should be avoided until the cause is determined.
Therapy & Treatment
Conservative therapies such as the surgical removal of the heart valve defect and, to a lesser extent, drug therapy for lowering blood pressure are appropriate for eliminating or making tolerable. An ideal treatment of this heart disease does not yet exist. In most cases, the doctor prescribes calcium antagonists or beta-blockers.
A common drug is verapamil. These medications improve coronary blood flow and systolic filling. Hypertrophy is not further stimulated with this therapy. ACE inhibitors increase cardiac output due to decreased blood pressure.
Outlook & Forecast
If left untreated, left ventricular hypertrophy leads to premature death of the person affected. It comes to a steady increase in the symptoms, until ultimately a heart failure occurs. If the heart failure is diagnosed very late or in an acute condition, the prognosis is also unfavorable in a large number of cases. The patient requires surgery to relieve the existing symptoms. If this happens without further complications, his survival can be ensured. Nevertheless, a change in the current lifestyle for a lasting improvement in health is necessary.
If the previous physical or emotional stress persists, in most cases long-term impairments can be observed. In particular, the sporting and professional activities should be changed and adapted to the conditions of the organism. Regular follow-up examinations are also necessary after an intervention in order to observe the activity of the heart and to react as quickly as possible to irregularities. In acute situations intensive care is required. Otherwise, long-term health problems can occur.
Overall, patients with left heart hypertrophy have a reduced life expectancy. They depend on the administration of medicines to minimize cardiac arrhythmias. Nevertheless, they are exposed to increased risks due to their illness. If further illnesses occur in the course of life, this always represents an additional burden on the heart.
It is a cardiovascular heart disease for which, in addition to the age of the patient, 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 congestive 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 a lot of exercise and the avoidance of too many stimulants like alcohol and nicotine.
A medical accompaniment after a left heart hypertrophy is indispensable. As the use of beta-blockers by the patient is necessary, regular follow-up examinations should be undertaken. In the case of an operative therapy, it is important that the affected persons themselves test or observe and seek warning signs of their body immediately their doctor. By creating a blood count, possible inflammation levels are detected.
In the first few weeks after the operation, it is important to avoid torsion and strain on the chest and heavy work. Shorter air travel is possible, long-distance travel is advised against until six months after the operation. Sports activities should initially be limited to easy hikes, cycling and swimming and be taken back very gently. If chest pain occurs, or if the patient finds the sensation of a restriction to be disturbing, it is advisable to consult the attending physician.
You can do that yourself
A number of self-help measures can not only improve the symptoms of compensatory left ventricular hypertrophy, but in many cases also the objective finding of the disease. It is of great advantage if the causes are known that have led to left heart hypertrophy.
In the majority of cases, in which the compensatory thickening of the left ventricular muscular walls of the heart can be attributed to a permanent arterial hypertension, all measures that combat the causes of hypertension in addition to the medical treatment of hypertension help. For example, smokers may give up smoking, and exercising within the scope of individual options with moderate endurance performance may even lead to a gradual regression of the hypertrophied heart walls. Exercise and physical activity should by no means be associated with abruptly changing performance requirements as they occur in almost all dynamic ball games such as football, tennis, volleyball and similar sports. The golf sport has a particularly favorable effect on the heart and on the entire cardiovascular system. Swift walking alternates with short periods of concentration that serve to hit the ball.
The above self-help measures, however, reach their limits if the disease is caused by mitral valve insufficiency or aortic valve stenosis. The avoidance of sports with suddenly changing performance requirements also applies to hereditary hypertrophic cardiomyopathy.