The heart is the little engine in our body that works non-stop and never takes a break. This heart works continuously even when we are sleeping, working, running, jumping. But what happens if the heart is put under too much pressure? Just like when we lift a heavy weight and the muscles in our arms get bigger, when the heart gets too tired, its walls, especially the walls of the main chamber (the left ventricle) that pumps blood to the body, start to thicken and grow. In medicine, we call this condition 'Left Ventricular Hypertrophy' or LVH. This is a very common condition among us in Sri Lanka. So, let's talk about this simply today, in a way that you can understand.
What exactly is Left Ventricular Hypertrophy (LVH)?
Simply put, LVH is a thickening of the muscular wall of the left ventricle, one of the four main chambers of our heart. This left ventricle is responsible for one of the most important functions of our heart. That is, pumping oxygen-rich blood from the lungs into the aorta, the largest blood vessel in our body. From there, blood is distributed throughout the body, from the scalp to the soles of the feet.
So, for some reason, when there is too much pressure or obstruction in this blood pumping process, this left ventricle has to work harder and harder than usual. It's like a water pump that makes a lot of noise when it's blocked. When you work too hard over time, the muscles in that chamber gradually thicken and get bigger. This is called LVH. Sometimes, this chamber can stretch and get bigger to handle the extra blood volume. Studies show that about one in five people on average may have this condition.
Are there types of LVH?
Yes, doctors classify your left ventricle into several types based on the size and thickness of its walls. It's important for you to know this.
| LVH type | Simply put, this is what happens. |
|---|---|
| Concentric | The walls of the heart chambers thicken inward, causing the space (inside the chamber) to fill with blood to become smaller. |
| Eccentric | The heart chamber expands outwards, increasing the space (inside the chamber) that is filled with blood. |
| Concentric remodeling (CR) | Although the walls are thick, the total muscle mass is normal. |
What symptoms does a person with LVH experience?
The biggest problem with this is that LVH can be asymptomatic in its early stages . Many people only find out they have it when they have a medical test for another reason. But as the condition gets worse, and the pressure on the heart increases, you may experience symptoms like these.
| Symptom | How does this feel? |
|---|---|
| Chest pain | Your chest may feel tight and constricted, especially when you are tired or exercising. |
| Dizziness or fainting (Syncope) | Suddenly, your head spins, your eyes turn blue, and sometimes you may even lose consciousness and fall. |
| Fast or irregular heartbeat | The heart rate suddenly increases, or it feels like it is beating without a rhythm. |
| Palpitations | When you go to sleep, when you are quiet, you can hear and feel the sound of your heart beating "dug dug". |
| Tiredness | Even doing the little things I normally do, I get tired quickly. I feel like I have no life left in my body. |
| Difficulty breathing | When I walk a little, climb a flight of stairs, or bend over, I find it hard to breathe, and I feel dizzy. |
Why does this LVH condition occur? What are the causes?
The main and most common cause of LVH is high blood pressure, also known as hypertension. When your blood pressure increases, the pressure inside your blood vessels increases. So your heart has to work harder than usual to pump blood against this increased pressure. When you work this hard over the years, the heart muscle thickens.
But it's not just pressure, there are many other reasons that can affect this.
- Heart valve disease: The valves in the heart are like doors. They keep blood flowing in one direction and prevent it from flowing back. If these valves become narrow (stenosis) or leak (regurgitation), the heart has to work harder to pump blood.
- Diabetes: Uncontrolled diabetes causes high blood sugar levels. This can damage the heart over time.
- Cardiomyopathy: Due to some genetic or other reasons, the heart muscle may simply thicken or weaken.
- Aortic coarctation: This is a condition that is present at birth. The main blood vessel that carries blood to the body is narrowed in one place. So the heart has to work harder to pump blood through that narrowed area.
- Other medical conditions: Cardiac amyloidosis (protein deposits in the heart), renal artery stenosis (narrowing of the blood vessels that supply blood to the kidneys), and ventricular septal defect (VSD) (a hole between the chambers of the heart) can also cause LVH.
- Intense athletic training: Athletes who exercise and train excessively may naturally have slightly enlarged hearts. However, this is not a medical condition. Their hearts function normally.
The important thing is that even if you have one or more of these conditions, it doesn't mean that you will develop LVH. But the risk is higher. Therefore, it is essential to properly control these conditions.
Who is at higher risk of developing LVH?
Some people are more at risk of developing this condition than others.
- Obesity: When you have excess body weight, your heart has to work harder to pump blood throughout your body. Your risk is higher if your BMI is over 30.
- Chronic kidney disease: When the kidneys fail, the amount of fluid and salt in the body increases, which can lead to high blood pressure.
- Obstructive sleep apnea: This condition, in which breathing frequently stops during sleep, puts a lot of pressure on the heart.
- Lifestyle mistakes: Things like tobacco use, adding too much salt to your diet, and lack of physical exercise also increase the risk.
What happens if LVH is left untreated?
This is where we all need to focus our attention. LVH is a signal that the heart is asking for help. If we ignore it, over time, the heart's pumping ability can weaken and serious complications can occur.
- Heartbeat irregularities `(Arrhythmia)`
- Heart attack
- Cardiac arrest
- Heart disease `(Heart failure)`
- Stroke
- Dementia
The risk of developing these serious conditions increases with LVH, so it is very important to diagnose this condition and start treatment as soon as possible.
How does a doctor find this?
Even if you don't have any symptoms, your doctor may suspect this when you undergo a routine checkup. Several tests will be performed to confirm the presence of LVH and to find the cause.
- Echocardiogram (Echo): This is the most important test. It's like a scan of a baby. It can clearly see the size of the heart's chambers, the thickness of the walls, the function of the valves, and how the heart pumps blood.
- Electrocardiogram (ECG or EKG): This records the electrical activity of the heart. If the heart is enlarged, changes may be seen on the ECG.
- MRI Scan: In some cases, an MRI scan may be necessary to study the structure of the heart more clearly.
- Blood tests: Blood tests are done to check for other medical conditions, such as diabetes and kidney disease.
What are the treatments for this?
The main goal of treating LVH is to treat the underlying cause of the condition. This will reduce the strain on the heart and stop or slow down the progression of LVH.
| Treatment method | What happens with this? |
|---|---|
| Lifestyle change | Blood pressure can be controlled by eating a low-salt, healthy diet, exercising daily, controlling weight, and avoiding smoking. This is the foundation of treatment. |
| Blood pressure medications | It is important to take the blood pressure medication your doctor prescribes exactly and on time. These medications reduce the pressure on the heart and prevent LVH from getting worse. |
| Other medications | Some diabetes medications (such as SGLT2 inhibitors) have been found to help manage LVH. |
| Heart valve surgery | If LVH is caused by a narrowing of a heart valve, surgically replacing or repairing that valve can relieve the pressure on the heart. |
| Weight loss surgery (Bariatric surgery) | If severe obesity cannot be controlled, sometimes this type of surgery can help reduce weight and control blood pressure. |
When should I see a doctor?
If you experience any of these symptoms, don't ignore them.
If you experience severe chest pain, severe difficulty breathing, signs of a stroke (drooping on one side of the face, numbness in an arm, difficulty speaking), or a sudden rapid or irregular heartbeat, go to a hospital's Emergency Department (ETU) immediately.**
Additionally, if your doctor has told you that you have LVH, inform your doctor about any changes or increases in your symptoms.
Can LVH be reversed?
This is the good news. Yes, in some cases, LVH can be improved, controlled, and even reversed completely! Studies have shown that when blood pressure is well controlled, the thickened heart muscle can recover to some extent.
But this depends on the severity of your condition, how long you have had high blood pressure, and whether you have other medical conditions like obesity. So the best thing you can do is to follow your doctor's instructions exactly. It's very important to take your medication, make lifestyle changes, and go to the clinic on time.
Take-Home Message
- Left Ventricular Hypertrophy (LVH) is a thickening of the walls of the heart's main pumping chamber. The main cause of this is high blood pressure.
- There may be no symptoms in the early stages, so get your blood pressure checked regularly and have medical checkups.
- The best way to control LVH is to properly treat the underlying disease (especially high blood pressure) that is causing the condition.
- A healthy lifestyle (good diet, exercise, weight control) can greatly help control this condition.
- If you have any questions or concerns about this, don't be afraid to talk openly with your doctor. With early detection and proper treatment, you can live a healthy life.
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