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Left Ventricular Hypertrophy
Aka: Left Ventricular Hypertrophy, Left Ventricular Enlargement
- See Also
- Cardiomyopathy
- Pathophysiology
- Primary Hypertrophy
- See Hypertrophic Cardiomyopathy
- Secondary Hypertrophy (See Causes below)
- Target organ response
- Chronic pressure overload
- Chronic volume overload
- Angiotensin II directly increases myocardial mass
- Causes
- Hypertension
- Valvular disease
- Aortic Stenosis
- Aortic Regurgitation
- Mitral Regurgitation
- Patent Ductus Arteriosus
- Aortic Coarctation
- Chronic Renal Failure
- Acromegaly
- Thalassemia
- Associated Conditions (LVH associated increased risk)
- Coronary Artery Disease
- Congestive Heart Failure
- Decreased left ventricular systolic function
- Cerebrovascular Accident
- All cause mortality
- Diagnosis
- Echocardiogram
- Electrocardiogram (misses 50% of cases)
- See Left Ventricular Hypertrophy Related EKG Changes
- Differentiate from isolated High Left Ventricular Voltage (younger patients <age 40 years)
- Normal variant in young healthy patients, often athletes
- Signs
- Accentuated Apical Thrust on palpation at PMI
- Management: LVH with Diastolic Dysfunction
- Goals
- Preserve sinus rhythm
- Suppress Tachycardia
- Decrease elevated left atrial and diastolic pressures
- Avoid excessive Preload reduction
- Avoid depressing Cardiac Output
- Treat comorbid Myocardial Ischemia
- Antihypertensive management
- Beta adrenergic blockers
- ACE Inhibitors
- Angiotensin Receptor Blockers (ARBs)
- Low dose Diuretics
- Long acting Calcium Channel Blockers
- Long Acting Nitrates
- Management: LVH with Systolic Dysfunction (EF < 50%)
- See Congestive Heart Failure (Systolic Dysfunction)
- Decrease Fluid Overload
- ACE Inhibitors
- Beta adrenergic blockers
- Diuretics
- Reduce symptoms
- Digoxin
- Prevention
- Control Hypertension
- References
- Devereux (2000) Am Heart J 139:S9-14 [PubMed]
- Lorell (2000) Circulation 102:470-9 [PubMed]