Left Ventricular Hypertrophy

Left ventricular hypertrophy (LVH) is a thickening of muscles in the walls of your lower left heart chamber. This happens when your heart works too hard to pump against high pressure and a large volume of blood. Your left ventricle can also stretch out when it’s handling too much blood.

Your left ventricle has the vital job of pumping oxygen-rich blood into your aorta (your largest artery). From there, blood goes all throughout your body.

LVH, an enlarged left ventricle, can happen when your heart tries to keep up with the demands on it. The condition affects nearly 1 in 5 people.

Types of this condition

To describe your condition, healthcare providers look at the size of your left ventricle and the thickness of its walls. Types of left ventricular hypertrophy are:

• Concentric. The walls get thicker inward and make the space inside of the ventricle smaller.
• Eccentric. The space inside gets larger as the ventricle expands outward.
• Concentric remodeling (CR). The walls get thicker but the total amount of wall tissue is normal.

Symptoms of left ventricular hypertrophy

With mild left ventricular hypertrophy, you may not notice any symptoms. As the condition gets worse, you may have LVH symptoms that include:

• Chest pain
• Dizziness or fainting (syncope)
• Fast or irregular heartbeat
• Heart palpitations
• Fatigue
• Shortness of breath

LVH causes

There are many different diseases and conditions that may cause LVH. The most common cause of left ventricular hypertrophy is high blood pressure (hypertension). High blood pressure makes your heart work harder than normal. The extra work it takes to pump blood can make the muscle in your left ventricle walls get larger and thicker.

Intense athletic training can sometimes lead to an increase in the size and thickness of your left ventricle walls. But in most cases, athletes’ hearts still function normally and don’t need treatment.

Other conditions that can lead to LVH include:

• Heart valve disease. This may include a leak or narrowing in your aortic valve or a leak in your mitral valve. All of these make it harder for blood to get where it needs to go.
• Diabetes. High blood sugar levels that occur with diabetes can lead to heart damage.
• Cardiomyopathy. Certain types of this heart muscle disease make your heart stiff or thick.
• Aortic coarctation. This is a narrowing in part of your aorta, which makes it hard for blood to get through.
• Cardiac amyloidosis. With this condition, proteins build up in your heart and make pumping more difficult.
• Renal artery stenosis. This is a narrowing of the arteries that bring blood to your kidneys.
• Ventricular septal defect (VSD). This is a hole in the wall of tissue between your two lower heart chambers.
• Genetic diseases. More rarely, some inherited or acquired genetic variations can cause left ventricular hypertrophy, like Fabry disease and Danon disease, among others.

Risk factors

You may have a higher risk of LVH if you have:

• A body mass index (BMI) greater than 30 (obesity)
• Chronic kidney disease
• Obstructive sleep apnea

You may also be at a higher risk of an enlarged left ventricle if you use tobacco products, eat a lot of salt and don’t get much physical activity.

What are the complications of left ventricular hypertrophy?

Other heart issues usually lead to left ventricular hypertrophy. Together, they can raise your risk of serious complications. Left untreated, LVH affects your heart’s ability to pump blood efficiently. These changes increase your risk of other issues, including:

• Arrhythmia
• Heart attack
• Cardiac arrest
• Heart failure
• Stroke
• Dementia

How doctors diagnose an enlarged left ventricle

Even if you aren’t having symptoms of LVH, your healthcare provider may find it during a routine heart screening. Because there are many different causes for LVH, your cardiologist may order different tests to rule out these conditions.

Tests providers use to diagnose left ventricular hypertrophy include:

• Echocardiogram
• Electrocardiogram (ECG or EKG)
• MRI
• A technetium pyrophosphate scan, a nuclear imaging test to evaluate for cardiac amyloidosis
• Blood work

How do you treat left ventricular hypertrophy?

Treating the cause of LVH will help stop or slow disease progression. Depending on the cause, you may need to change your daily habits, take medicine or have surgery.

Left ventricular hypertrophy treatment may include:

• Lifestyle changes. Heart-healthy habits can lower your blood pressure and reduce LVH complications. Good habits include eating healthy foods and being physically active.
• Blood pressure medication. Lowering your blood pressure will help prevent left ventricular hypertrophy from worsening. It also can reduce your risk of heart failure, heart attack or stroke.
• Other medicines. An SGLT2 inhibitor (an oral diabetes medicine) or allopurinol can help manage LVH.
• Heart valve surgery. If aortic valve stenosis caused your condition, you may need aortic valve surgery to replace the narrowed valve. This allows blood to flow properly.
• Implantable cardioverter defibrillator (ICD). This device can shock your heart when you have certain abnormal heart rhythms. This treats a complication of LVH.
• Bariatric surgery. Surgery for weight loss can lower your weight and blood pressure. Lowering your blood pressure can keep LVH from getting worse.

When should I see my healthcare provider?

You should call your healthcare provider if you experience:

• Severe chest pain
• Shortness of breath
• Signs of stroke
• Sudden racing or irregular heartbeat

You may want to ask your healthcare provider:

• Should I have testing to look for signs of left ventricular hypertrophy?
• What medications will I need to take to manage my condition?
• Will I need heart surgery?
• What lifestyle changes can I make to improve my heart health?

What can I expect if I have this condition?

Left ventricular hypertrophy can get better or worse. Studies have shown that LVH can improve — and even reverse — when you lower your blood pressure. Other factors come into play, though. If you’ve had high blood pressure a long time and have obesity, you may not be able to reverse LVH.

You may be able to live a normal life with LVH if you can manage the condition that caused it. Life expectancy with left ventricular hypertrophy is different from person to person. You may have many other conditions that stress your heart compared to someone who doesn’t. Your provider is the best person to help you understand what you can expect.

Prognosis of left ventricular hypertrophy

Left untreated, LVH (and related underlying heart conditions) increases your risk of serious heart disease or even death. Treatment to slow or stop the progression of left ventricular hypertrophy lowers the risk of severe heart damage. An early and accurate diagnosis is the key to improving the outlook for people with left ventricular hypertrophy.

Can this be prevented?

If you have a heart condition that could lead to LVH, catching and treating it early can make a big difference. Treatment can help prevent left ventricular hypertrophy from developing. It can also reduce the risk of damage to your heart muscle.

Preventing or managing high blood pressure is the best way to prevent left ventricular hypertrophy. In addition to taking any medications your healthcare provider prescribes, you can:

• Manage conditions that can cause LVH
• Eat foods that are low in fat, salt and cholesterol
• Be physically active on a regular basis
• Reach and maintain a weight that’s healthy for you
• Manage stress
• Stop using tobacco products