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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Related Studies

Ontology: Left Ventricular Hypertrophy (C0149721)

Definition (MSHCZE) Zvětšení levé komory srdeční. Nárůst ventrikulární hmoty lze přičíst trvale abnormálnímu tlaku nebo velikosti objemu a toto často přispívá ke kardiovaskulární morbiditě a mortalitě. R
Definition (NCI_FDA) Enlargement or overgrowth of the myocardium of the left ventricle, due to chronic pressure overload.
Definition (NCI) Enlargement or overgrowth of the myocardium of the left ventricle, due to chronic pressure overload.
Definition (MSH) Enlargement of the LEFT VENTRICLE of the heart. This increase in ventricular mass is attributed to sustained abnormal pressure or volume loads and is a contributor to cardiovascular morbidity and mortality.
Concepts Disease or Syndrome (T047)
MSH D017379
SnomedCT 155383002, 195127003, 266310003, 290911000009108, 55827005
LNC LP156346-1, MTHU044660
English Ventricular Hypertrophy, Left, Hypertrophy, Left Ventricular, Hypertrophies, Left Ventricular, Left Ventricular Hypertrophies, Ventricular Hypertrophies, Left, LVH - Left ventric hypertrophy, Left Ventricular Hypertrophy, LVH, LV+ - Left ventric hypertrophy, left ventricular enlargement (diagnosis), hypertrophy of left ventricle, left ventricular enlargement, hypertrophy of left ventricle (diagnosis), left ventricular hypertrophy, LVH (left ventricular hypertrophy), Hypertrophy, Left Ventricular [Disease/Finding], lvh, Hypertrophy;ventricular;left, hypertrophy left ventricular, lv hypertrophy, Ventricular hypertrophy (& [left]), Ventricular hypertrophy (& [left]) (disorder), Enlarged left ventricle, Left ventricle hypertrophied, Left ventricular enlargement, Cardiomegaly of left ventricle, Cardiomegaly of left ventricle (disorder), VENTRICULAR HYPERTROPHY, LEFT, LEFT VENTRICULAR HYPERTROPHY, LV hypertrophy, LVH - Left ventricular hypertrophy, Left ventricular hypertrophy, LV+ - Left ventricular hypertrophy, Left ventricular hypertrophy (disorder)
Dutch linkerventrikelvergroting, LVH, linkerventrikelhypertrofie, Hypertrofie, linkerventrikel-, Linkerventrikelhypertrofie, Ventrikelhypertrofie, linker-
French Augmentation de taille du ventricule gauche, HVG, Hypertrophie ventriculaire gauche, HVG (Hypertrophie Ventriculaire Gauche)
German Vergroesserung des linken Ventrikels, LVH, Linksherzhypertrophie, Hypertrophie, linksventrikuläre, Linksventrikuläre Hypertrophie, Ventrikuläre Hypertrophie, Links-
Italian Dilatazione ventricolare sinistra, Ipertrofia ventricolare sinistra, Ipertrofia del ventricolo sinistro
Portuguese Aumento do ventrículo esquerdo, Hipertrofia do ventrículo esquerdo, Hipertrofia Ventricular Esquerda
Spanish Aumento del ventrículo izquierdo, HVI, Hipertrofia ventricular izquierda, hipertrofia del ventrículo izquierdo, hipertrofia ventricular izquierda (trastorno), hipertrofia ventricular izquierda, Hipertrofia Ventricular Izquierda
Japanese 左室拡大, ｻｼﾂﾋﾀﾞｲ, ｻｼﾂｶｸﾀﾞｲ, LVH, ＬＶＨ, 左室肥大, 左心室肥大, 肥大左室, 肥大左心室
Swedish Hjärtkammarförstoring, vänstersidig
Czech srdce - hypertrofie levé komory, Zvětšení levé komory, Hypertrofie levé komory, hypertrofie levé srdeční komory, hypertrofie levé komory srdeční
Finnish Vasemman kammion hypertrofia
Russian GIPERTROFIIA LEVOGO ZHELUDOCHKA SERDTSA, SERDTSA ZHELUDOCHKA LEVOGO GIPERTROFIIA, LEVOZHELUDOCHKOVAIA GIPERTROFIIA, LEVOGO ZHELUDOCHKA GIPERTROFIIA, SERDTSA LEVOGO ZHELUDOCHKA GIPERTROFIIA, ГИПЕРТРОФИЯ ЛЕВОГО ЖЕЛУДОЧКА СЕРДЦА, ЛЕВОГО ЖЕЛУДОЧКА ГИПЕРТРОФИЯ, ЛЕВОЖЕЛУДОЧКОВАЯ ГИПЕРТРОФИЯ, СЕРДЦА ЖЕЛУДОЧКА ЛЕВОГО ГИПЕРТРОФИЯ, СЕРДЦА ЛЕВОГО ЖЕЛУДОЧКА ГИПЕРТРОФИЯ
Croatian HIPERTROFIJA LIJEVE KLIJETKE
Polish Przerost lewej komory, Przerost komory serca lewej
Hungarian Bal kamra hypertrophia, Bal ventricularis megnagyobbodás, LVH
Norwegian Venstre ventrikkel-hypertrofi, Ventrikkelhypertrofi, venstre, Hypertrofi, venstre ventrikkel
Derived from the NIH UMLS (Unified Medical Language System)

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