Left Ventricular Hypertrophy or LVH is a heart condition that causes mortal danger to one’s life if left untreated. LVH, as it is popularly known, is the thickening and enlargement of the heart wall in the heart’s left ventricle, a prominent blood-pumping chamber. The thickening causes the heart muscles to lose their elasticity and become rigid. The condition adds extra pressure to the heart to fill up the chamber and pump the blood. In the long run, LVH declines the heart capacity to produce enough pressure to pump blood to the body.
The condition develops gradually, and at times goes unnoticed until it reaches critical stages. Regular heart health checks, hence, make a huge difference in keeping up with the heart-wellness.
NYU Langone heart specialists often recommend certain lifestyle guidelines for people with hypertrophic cardiomyopathy (HCM). Your doctor may ask you to lose weight if you are overweight, quit smoking, and limit your alcohol intake.
Exercise is essential for health and wellbeing, and we encourage people with HCM to exercise. However, because this condition can cause serious heart problems during very strenuous exercise, your doctor may recommend limiting competition in athletics and extreme levels of exertion. Each person has recommendations for exercise tailored to their age and overall health.
These lifestyle changes can help improve symptoms and prevent the condition from worsening.
Regular exercise reduces heart rate and blood pressure and provides overall health benefits. However, it is important to follow your doctor’s recommendations regarding activity levels because extremes of exercise can be harmful to some people with HCM. Your NYU Langone doctor can help determine the type and amount of exercise that is right for you.
If exercise or activity causes symptoms, such as chest pain or shortness of breath, stop immediately and report them to your doctor. It’s also important to avoid exercising on hot days and to stay hydrated. Your doctor may recommend exercising on an empty stomach because eating a large meal can worsen obstruction in some people.
Be sure to consult with your heart specialist before starting any exercise program.
Hypertension can worsen the symptoms of HCM, so it’s important to achieve or maintain a healthy blood pressure. Take blood pressure medication as directed by the doctor managing your HCM. This is because some blood pressure medications can worsen obstruction in certain people.
Your doctor may advise you to use a home monitor to track your blood pressure levels and to report any unusual findings.
Eating a healthy diet can improve heart health. A heart-healthy diet includes a variety of fruits, vegetables, whole grains, and lean meats and fish. We recommend a diet low in animal fat to reduce cholesterol. Nutritionists at NYU Langone’s Rusk Rehabilitation can create a diet plan for you and teach you how to read food labels to get the best results.
NYU Langone doctors recommend that people with this condition limit or avoid alcohol. Alcoholic drinks can worsen obstruction in the heart, which reduce blood flow to the body. Alcohol consumption can also promote weight gain, which can worsen symptoms.
If you have diabetes, you’re at risk for coronary artery disease, which can worsen HCM symptoms. Your NYU Langone cardiac doctor may refer you to a specialist who can help you manage diabetes using home glucose monitoring, oral medication, or insulin injections.
Excessive stress can raise your blood pressure, which can increase the risk of cardiomyopathy. To better manage it, get plenty of sleep, exercise regularly as instructed by your doctor, and consider practicing relaxation techniques such as deep breathing and yoga, which can benefit the body and mind.
Smoking tobacco can worsen some HCM symptoms. It causes a narrowing of the coronary arteries. The combination of HCM and coronary artery disease is dangerous. If you smoke, experts at NYU Langone’s Tobacco Cessation Programs can teach you techniques designed to help you quit.
Left ventricular hypertrophy (LVH) means that the muscle of the heart's main pump (left ventricle) has become thick and enlarged. This can happen over time if the left ventricle has to work too hard. This part of the heart needs to be strong to pump oxygen-rich blood to your entire body. When the ventricle gets thick, other changes can happen in the heart. The heart's electrical system might not work normally, the heart muscle may not get enough oxygen, and the heart may not pump as well as it should.
LVH is usually caused by high blood pressure. It may also be caused by a heart problem, such as hypertrophic cardiomyopathy or a heart valve problem like aortic valve stenosis.
It can be stressful to learn that you have a problem with your heart. But there are things you can do to feel better and help keep this condition from getting worse.
LVH is usually caused by high blood pressure. It may also be caused by a heart problem, such as hypertrophic cardiomyopathy or a heart valve problem like aortic valve stenosis.
LVH may not cause symptoms. When it does, the most common ones are:
- Shortness of breath.
- Feeling tired or dizzy.
- Angina symptoms, such as chest pain or pressure, which may be worse when you're active.
- Feeling like your heart is fluttering, racing, or pounding (palpitations).
New or worse symptoms may be a sign of heart failure. Heart failure means that your heart doesn't pump as much blood as your body needs.
Your doctor will do a physical exam and ask you about any health problems you've had. You'll also be asked if any of your family members have or had heart disease or died suddenly from heart problems.
You may have tests such as an echocardiogram and an electrocardiogram (EKG).
The best treatment will depend on what caused LVH. For many people, the focus will be on treating high blood pressure. Getting high blood pressure under control may keep LVH from getting worse. This can help prevent heart failure. It can also help lower the risk of heart attack and stroke.
Medicines and lifestyle changes are used to treat high blood pressure. It may take some time to find the right medicine or medicines for you. Work with your doctor by taking your medicines as prescribed and going to all of your follow-up appointments.
If LVH was caused by a heart problem, you may have other treatment options. Treatment may help lower your risk of heart failure and other serious problems.
Healthy habits are important for your heart. Taking an active role in your treatment can help you feel better and protect your health.
- Be more active. Talk to your doctor before you start an exercise program. Together you can create a plan that can help keep your heart and body healthy. Your doctor might suggest that you get 30 minutes of exercise most days of the week.
- Eat heart-healthy foods. Heart-healthy foods include fruits, vegetables, high-fiber foods, fish, and foods low in sodium, saturated fat, and trans fat.
- Lose extra weight. Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.
- Take your medicines exactly as prescribed. Do not stop or change your medicines without talking to your doctor first. Talk to your doctor if you have problems with your medicines.
- Don't smoke. Quitting smoking lowers your risk of heart attack and stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
- Manage other health problems. These include diabetes and high cholesterol. If you think you may have a problem with alcohol or drug use, talk to your doctor.
Health Information Library
Left ventricular hypertrophy is thickening of the walls of the lower left heart chamber. The lower left heart chamber is called the left ventricle. The left ventricle is the heart's main pumping chamber.
During left ventricular hypertrophy, the thickened heart wall can become stiff. Blood pressure in the heart increases. The changes make it harder for the heart to effectively pump blood. Eventually, the heart may fail to pump with as much force as needed.
Uncontrolled high blood pressure is the most common cause of left ventricular hypertrophy. Complications include irregular heart rhythms, called arrhythmias, and heart failure.
Treatment of left ventricular hypertrophy depends on the cause. Treatment may include medications or surgery.
Left ventricular hypertrophy usually develops gradually. Some people do not have symptoms, especially during the early stages of the condition.
Left ventricular hypertrophy itself doesn't cause symptoms. But symptoms may occur as the strain on the heart worsens. They may include:
- Shortness of breath, especially while lying down
- Swelling of the legs
- Chest pain, often when exercising
- Sensation of rapid, fluttering or pounding heartbeats, called palpitations
- Fainting or a feeling of lightheadedness
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 have mild shortness of breath or other symptoms, such as palpitations, see your health care provider.
If you have high blood pressure or another condition that increases the risk of left ventricular hypertrophy, your provider is likely to recommend regular health checkups to check your heart.
Anything that puts stress on the heart's lower left chamber can lead to left ventricular hypertrophy. The lower left chamber is called the left ventricle. As the strain on the left ventricle increases, the muscle tissue in the chamber wall thickens. Sometimes, the size of the heart chamber itself also increases.
Left ventricular hypertrophy also may be caused by gene changes that affect the heart muscle's structure.
Things that can cause the heart to work harder and may possibly lead to left ventricular hypertrophy include:
- High blood pressure. Also called hypertension, this is the most common cause of left ventricular hypertrophy. Long-term high blood pressure strains the left side of the heart, causing it to grow bigger. Treating high blood pressure can help reduce left ventricular hypertrophy symptoms and may even reverse it.
- Narrowing of the aortic valve. The aortic valve is between the lower left heart chamber and the body's main artery, called the aorta. Narrowing of the valve is called aortic stenosis. When the valve is narrowed, the heart must work harder to pump blood into the aorta.
- Intensive athletic training. Intense, long-term strength and endurance training causes changes in the heart. The changes help the heart adapt to the extra physical workload. But the changes can make the heart muscle grow larger. Sometimes this is called athlete's heart or athletic heart syndrome. It's unclear whether the increased heart size in athletes can lead to stiffening of the heart muscle and disease.
Certain conditions passed down through families — called genetic conditions — can make the heart thicker. They include:
- Hypertrophic cardiomyopathy. This condition is caused by changes in genes that cause the heart muscle to thicken. The thickening makes it harder for the heart to pump blood. It can occur even without high blood pressure. People with one parent with hypertrophic cardiomyopathy have a 50% chance of having the genetic mutation for the disease.
- Amyloidosis. Proteins build up around the organs, including the heart. The protein buildup interferes with how the organs work. When the condition is passed down through families, it is called familial amyloidosis. The inherited disorder also may affect the nerves and kidneys.
Things that increase the risk of left ventricular hypertrophy include:
- Age. Left ventricular hypertrophy is more common in older people. So is high blood pressure, which can cause heart muscle thickening.
- Weight. Being overweight increases the risk of high blood pressure and left ventricular hypertrophy.
- Family history. Changes in genes passed down through families may lead to left ventricular hypertrophy.
- Diabetes. Having diabetes increases the risk of left ventricular hypertrophy.
- Female gender. Women with high blood pressure are more likely to get the condition than are men with similar blood pressure measurements.
Left ventricular hypertrophy changes the structure and function of the heart. The thickened left ventricle becomes weak and stiff. This prevents the lower left heart chamber from filling properly with blood. As a result, blood pressure in the heart increases.
As a result of these changes, complications of left ventricular hypertrophy include:
- Heart failure
- Irregular heart rhythms, called arrhythmias
- Too little oxygen to the heart, called ischemic heart disease
- Sudden, unexpected loss of heart function, breathing and consciousness, called sudden cardiac arrest
The same healthy lifestyle changes recommended to treat heart diseases and high blood pressure also help prevent it. To prevent left ventricular hypertrophy caused by high blood pressure:
- Don't smoke
- Eat healthy foods
- Use less salt
- Limit or avoid alcohol
- Exercise regularly
- Maintain a healthy weight
- Get 7 to 9 hours of sleep daily
- Manage stress
Uncontrolled high blood pressure increases the risk of left ventricular hypertrophy. Get your blood pressure checked at least every two years if you're 18 and older. If you have risk factors for heart disease or are over age 40, you may need more-frequent checks. Ask your health care provider what blood pressure reading is best for you. Your provider may recommend checking your blood pressure at home. Home blood pressure monitoring devices are available at local stores and pharmacies.
Your health care provider does a physical exam and asks questions about your symptoms and family's health history. The care provider checks your blood pressure and listens to your heart with a device called a stethoscope.
Tests
If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart.
Tests used to diagnose left ventricular hypertrophy may include:
- Lab tests. Blood and urine tests may be done to check for conditions that affect heart health. Tests may be done to check blood sugar, cholesterol levels, and liver and kidney function.
- Electrocardiogram. Also called an ECG or EKG, this quick and painless test measures the electrical activity of the heart. During an ECG, sensors called electrodes are attached to the chest and sometimes to the arms or legs. Wires connect the sensors to a machine, which displays or prints results. An ECG can show how well the heart is beating. Your care provider can look for signal patterns that suggest thickened heart muscle tissue.
- Echocardiogram. An echocardiogram uses sound waves to create pictures of the heart in motion. This test shows blood flow through the heart and heart valves. It can show thickened heart muscle tissue and heart valve problems related to left ventricular hypertrophy.
- Heart MRI. This test, also called a cardiac MRI, uses magnetic fields and radio waves to create detailed images of the heart.
Treatment for left ventricular hypertrophy depends on the underlying cause. It may include medications, catheter procedures or surgery. It's important to manage conditions such as high blood pressure and sleep apnea, which can cause blood pressure to be higher.
Medications
Medicines are used to treat symptoms and prevent complications of left ventricular hypertrophy. Blood pressure drugs may help reduce or prevent thickening of the heart muscle. The type of medication prescribed depends on the cause of left ventricular hypertrophy.
Medications that might be used to treat left ventricular hypertrophy or the conditions that cause it include:
- Angiotensin-converting enzyme inhibitors. Also called ACE inhibitors, these medications widen blood vessels to lower blood pressure. They can improve blood flow and decrease the strain on the heart. Side effects include a persistent cough.
- Angiotensin II receptor blockers. Also called ARBs, these medicines have benefits similar to ACE inhibitors but don't cause a persistent cough.
- Beta blockers. These drugs help control the heart rate. They also help the heart move blood with less force.
- Calcium channel blockers. These drugs relax the heart muscle and widen blood vessels. This reduces blood pressure.
- Water pills, also called diuretics. These drugs reduce the amount of fluid in the body, lowering blood pressure.
Surgery or other procedures
Left ventricular hypertrophy that is caused by aortic valve stenosis might require a catheter procedure or surgery to repair or replace the valve.
Surgery or other procedures may be needed to treat underlying conditions.
- Hypertrophic cardiomyopathy. Surgery may be done if the condition causes heart failure symptoms or a blockage that interferes with the heart's pumping action.
- Amyloidosis. If other treatments don't work, a stem cell transplant may be needed. Treatment for amyloidosis is available at specialized clinics.
Together you and your provider can develop a treatment plan that's best for you.
Lifestyle changes can help lower blood pressure and boost heart health. Try these healthy lifestyle changes:
- Eat a nutritious, healthy diet. Choose fruits, vegetables, whole grains, low-fat dairy products and good fats, such as olive oil. Limit foods and beverages higher in added sugars, salt and saturated fat. Choose low-sodium or no-salt-added foods. Don't add salt to your meals.
- Don't smoke or use tobacco. Quitting is the best way to reduce the risk of heart disease and its complications. If you need help quitting, talk to your provider.
- Limit or avoid alcohol. Alcohol can raise blood pressure, especially if consumed in large amounts. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
- Exercise regularly. Regular physical activity helps to lower blood pressure. With your provider's OK, aim for at least 30 minutes of physical activity most days of the week. Some sports or exercises can temporarily raise blood pressure. Talk to your health care provider about the amount and type of exercise that's best for you.
- Manage weight. If you are overweight or have obesity, losing just a few pounds can help lower blood pressure. Weight loss may help reverse left ventricular hypertrophy. Talk with your care provider to set realistic goals for weight.
- Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce stress.
You may be referred to a doctor trained in treating heart diseases. This type of provider is called a 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 important medical information, including other conditions you may have.
- Write down key personal information, including any recent life changes or stressors in your life.
- Write down questions to ask your health care provider.
- Find out if your family has a history of heart disease.
- Ask a relative or friend to come with you to help you remember what the care provider says.
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What tests do I need? How do I prepare for them?
- What types 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?
Don't hesitate to ask any other questions during your appointment.
What to expect from your doctor
Your health care provider is likely to ask you many questions. Being ready to answer them may leave time to go over items you want to spend more time on. You may be asked:
- What are your symptoms?
- When did the symptoms start?
- 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 trouble 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?