Left Ventricular Hypertrophy

Aka: Left Ventricular Hypertrophy, Left Ventricular Enlargement

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II. Pathophysiology

  1. Primary Hypertrophy
    1. See Hypertrophic Cardiomyopathy
  2. Secondary Hypertrophy (See Causes below)
    1. Target organ response
      1. Chronic pressure overload
      2. Chronic volume overload
    2. Angiotensin II directly increases myocardial mass

III. Causes

  1. Hypertension
  2. Valvular disease
    1. Aortic Stenosis
    2. Aortic Regurgitation
    3. Mitral Regurgitation
  3. Patent Ductus Arteriosus
  4. Aortic Coarctation
  5. Chronic Renal Failure
  6. Acromegaly
  7. Thalassemia

IV. Associated Conditions (LVH associated increased risk)

  1. Coronary Artery Disease
  2. Congestive Heart Failure
    1. Decreased left ventricular systolic function
  3. Cerebrovascular Accident
  4. All cause mortality

V. Diagnosis

  1. Echocardiogram
  2. Electrocardiogram (misses 50% of cases)
    1. See Left Ventricular Hypertrophy Related EKG Changes
    2. Differentiate from isolated High Left Ventricular Voltage (younger patients <age 40 years)
      1. Normal variant in young healthy patients, often athletes

VI. Signs

  1. Accentuated Apical Thrust on palpation at PMI

VII. Management: LVH with Diastolic Dysfunction

  1. Goals
    1. Preserve sinus rhythm
    2. Suppress Tachycardia
    3. Decrease elevated left atrial and diastolic pressures
    4. Avoid excessive Preload reduction
    5. Avoid depressing Cardiac Output
    6. Treat comorbid Myocardial Ischemia
  2. Antihypertensive management
    1. Beta adrenergic blockers
    2. ACE Inhibitors
    3. Angiotensin Receptor Blockers (ARBs)
    4. Low dose Diuretics
    5. Long acting Calcium Channel Blockers
    6. Long Acting Nitrates

VIII. Management: LVH with Systolic Dysfunction (EF < 50%)

  1. See Congestive Heart Failure (Systolic Dysfunction)
  2. Decrease Fluid Overload
    1. ACE Inhibitors
    2. Beta adrenergic blockers
    3. Diuretics
  3. Reduce symptoms
    1. Digoxin

IX. Prevention

  1. Control Hypertension

X. References

  1. Devereux (2000) Am Heart J 139:S9-14 [PubMed]
  2. Lorell (2000) Circulation 102:470-9 [PubMed]

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