Left ventriuclar hypertrophy

Left ventricular hypertrophy: Description, Causes and Risk Factors:Abbreviation: LVHLeft ventricular hypertrophy is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality.Left ventricular hypertrophy (LVH) is commonly encountered in clinical practice. The voltage developed by depolarizing cardiac muscle is proportional to the mass of muscle present, therefore, during the process of LVH, as the left ventricular muscle mass increases in bulk, greater depolarization voltages are produced in the thickened wall. The amplitude of the R wave in the left lateral leads becomes progressively higher while the S waves in the right sided chest leads become progressively deeper. Criteria ('voltage criteria') to diagnose LVH based on the magnitude of these ECG deflections have been developed.Left ventricular hypertrophyLeft 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 a healthy heart. Left ventricular hypertrophy (LVH) is more common in people who have high blood pressure or other heart problems such as aortic valve stenosis, hypertrophic cardiomyopathy, intense exercise, other medical conditions such as muscular dystrophy and Fabry's disease. Obesity is also one of the leading cause of LVH.Morphologically, LVH may be characterized by increased wall thickness (concentric LVH), increased chamber volume (eccentric LVH) or both.Left ventricular hypertrophy has a prevalence of approximately 40% in patients with chronic renal insufficiency, a figure that rises to approximately 75% by the onset of end-stage renal disease (ESRD). Cardiovascular mortality rates in ESRD patients are high and have been estimated to be between 100 and 1000 times more than expected in young adults. Cardiac failure and LVH are key prognostic variables. It became clear in the past decade that accelerated pump failure may be a greater problem than accelerated atherosclerosis, which remains a disputed entity in these populations.Anemia has been associated with left ventricular hypertrophy in most echocardiographic studies of renal patients. Most of the initial studies were performed in dialysis patients. One of the earliest studies to demonstrate this was that of London. Echocardiography was performed in 57 selected normotensive hemodialysis patients in comparison with 40 healthy control subjects who were matched for gender, age, and BP. Enlargement of the ventricle was related to the degree of anemia and the hemodynamic effect of the arteriovenous fistula. The study showed a robust association between modest declines in hemoglobin levels, from a baseline level of 12.8 g/dL, and progressive left ventricular growth in patients with early renal insufficiency.Symptoms:Symptoms may include:Shortness of breath.
  • Chest pain.
  • Sensation of rapid, fluttering or pounding heartbeats (palpitations).
  • Dizziness.
  • Fainting.
  • Rapid exhaustion with physical activity.
Diagnosis:In order to identify LVH, the EKG/ECG (electrocardiogram) is widely used as a primary screening tool. Various ECG criteria have been put forward, but there is little information as to the predictive values of the respective criteria for the correct diagnosis. Most importantly, the clinical utility of ECG has been limited by a low sensitivity at quite high specificity. Further, there is limited understanding of the contribution and importance of left ventricular volume, left ventricular mass and the ratio of left ventricular mass to volume on the value and performance of the individual criteria. Previously, the validation of the ECG criteria was mostly based on M-mode or 2D echocardiography for estimation of left ventricular mass (LVM). However, today there is no doubt that cardiovascular magnetic resonance (CMR) is a more accurate and reproducible tool to quantify LVM because of the excellent visibility and the lack of geometric assumptions. Therefore, CMR is currently deemed the gold standard for in-vivo measurements of LV mass.Treatment: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:Thiazide diuretics act on your kidneys to help your body eliminate sodium and water, thereby reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications.
  • Angiotensin-converting enzyme (ACE) inhibitors are a type of drug that widens, or dilates, 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.
  • 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), nifedipine (Procardia) and verapamil (Calan, Verelan, Covera-HS).
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 human-cadaver donor. If you have aortic valve regurgitation, the leaky valve may be surgically repaired or replaced.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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