The heart has four chambers; two atria, comprising the upper portion of the heart, and two ventricles, comprising the lower portion of the heart, and each chamber is separated by a muscular wall known as a septum. Blood flows down from the atria and into the ventricles.¹ With each heartbeat, the left ventricle contracts to move blood to arteries which distribute blood to organs throughout the body. Therefore, an intact left ventricle is important for maintaining the function of organs by delivering blood, which contains the necessary oxygen and nutrients for organs’ survival.2
Left ventricular hypertrophy refers to an abnormal increase in the mass of the left ventricle. This is usually from thickening of the septum separating the heart’s ventricles or from enlargement of the muscular wall of the left ventricle, both being an adaptive response to excessive pressure on the heart or excessive volume of the heart. Left ventricular hypertrophy causes changes in the heart’s muscle which alters electrical conduction within the heart, eventually causing abnormal heart rhythms, and changes in left ventricular contraction– eventually causing failure of the heart to pump blood around the body. Though it can take years for signs and symptoms of left ventricular hypertrophy to become apparent, commencing treatment early, which commonly involves medication and lifestyle changes, can create better outcomes.3,4,5
Causes of left ventricular hypertrophy
Left ventricular hypertrophy results from the heart’s attempts to adapt to experiencing excessive pressure or volume. Several conditions can cause this excessive pressure or volume and thus lead to left ventricular hypertrophy.
- Aortic valve stenosis
- Aortic regurgitation
- Mitral regurgitation
- Ventricular septal defect
- Fabry disease
- Chronic kidney disease
- Diabetes mellitus
- Obstructive sleep apnea
Signs and symptoms of left ventricular hypertrophy
For the first few years, there tends to be no signs and symptoms. However, as the disease progresses, signs and symptoms may become more apparent, with the American Heart Association providing a list of what these may include:
- Shortness of breath
- Chest pain that is typically worsened with exercise
Management and treatment for left ventricular hypertrophy
Depending on how early left ventricular hypertrophy is diagnosed, and what the underlying cause is, management and treatment for the disease can vary for individuals. If an underlying condition is identified as being a cause of the disease, this condition should be addressed. The management and treatment for left ventricular hypertrophy typically involves lifestyle changes and medication, but rarely may require surgery. Depending on when treatment and management is implemented, therapies can lead to regression of the disease or prevent progression to life-threatening complications.³
Several risk factors for left ventricular hypertrophy are associated with an individual’s lifestyle so lifestyle changes are a common component of the management and treatment of left ventricular hypertrophy.³
Many patients, presenting with different risk factors for left ventricular hypertrophy, may benefit from management and treatment plans involving dietary changes and exercise routines. For patients who are obese, these plans can help them lose weight, reducing their risk of worsening left ventricular hypertrophy. Furthermore, plans involving exercise would also be of benefit to patients who lead sedentary lifestyles.7
Additionally, as high sodium intake increases the risk of left ventricular hypertrophy, diets lower in sodium may be of benefit to patients with the disease, particularly those with hypertension.8
For individuals who smoke, tobacco cessation can reduce their risk of worsening left ventricular hypertrophy. Quitting smoking can be difficult but a doctor can help you prepare a plan to do so.3,9
Many patients with left ventricular hypertrophy have hypertension, or high blood pressure, which can contribute to the worsening of the condition. Therefore, antihypertensive medication can play a role in regressing left ventricular hypertrophy in many patients. These medications include several classes of drugs:³
- Renin-angiotensin-aldosterone system inhibitors
- Calcium channel blocks
- Sodium-glucose cotransporter type 2 inhibitors
Some medications can be helpful in reducing risk factors for worsening left ventricular hypertrophy, such as in reducing obesity and ceasing tobacco use, and these options can be discussed with a doctor.7,9
As a wide range of conditions can cause left ventricular hypertrophy, various medications may aid in treatment and management, depending on the underlying condition.³
Aortic valve stenosis, the narrowing of the structure that allows blood to flow in one direction out of the left ventricle, commonly causes left ventricular hypertrophy. This condition can surgically be managed with the replacement of the aortic valve. Aortic valve replacement is associated with regression of left ventricular hypertrophy in patients with aortic valve stenosis.3,10
Bariatric surgery may sometimes be considered in addressing obesity as a risk factor for left ventricular hypertrophy, though this option is typically considered following the trial of lifestyle changes or medication when they are insufficient.³
Diagnosis of left ventricular hypertrophy involves a doctor taking a medical history during your consultation, and performing specific tests– primarily electrocardiograms and echocardiograms.
By asking you questions about your medical history, your doctor can find out about conditions you have been diagnosed with previously and gather information on your lifestyle, helping to identify potential causes or risk factors for left ventricular hypertrophy. Furthermore, the doctor can gather your signs and symptoms, perform a basic medical examination, and develop an understanding of how these are impacting your life to aid in diagnosis.11
Electrocardiograms are often used in diagnosing left ventricular hypertrophy.3,12 They involve electrodes being placed on your arms, legs, and chest, which are then used to measure the electrical activity of the heart, which can be interpreted in detecting disorders.13
Echocardiograms are also utilised in the diagnosis of left ventricular hypertrophy.12 They involve the use of an ultrasound to take images of the heart so abnormalities in the heart’s structure can be viewed.
Several factors can increase an individual’s risk of having left ventricular hypertrophy. Many of these risk factors, however, are modifiable through lifestyle changes:3,5,6
- Athletic training
- Sedentary lifestyle
- Tobacco use
- High sodium intake
If left untreated, left ventricular hypertrophy can cause several conditions:³
How can I prevent left ventricular hypertrophy?
As many risk factors for left ventricular hypertrophy are modifiable, lifestyle changes can help prevent the condition. Dietary changes and exercise routines can be helpful for obese patients in reducing their weight, though medical and surgical interventions may sometimes be implemented. For tobacco users, quitting smoking can help, and a doctor can help you prepare a plan to achieve this.
Seeing a doctor can help you identify risk factors or underlying conditions that may cause left ventricular hypertrophy and then help you devise a plan to address these to prevent the progression of left ventricular hypertrophy.3,5,6
How common is left ventricular hypertrophy?
About 15 to 20 percent of the population has left ventricular hypertrophy.⁵
What can I expect if I have left ventricular hypertrophy?
Signs and symptoms of left ventricular hypertrophy usually emerge at later stages. However, during these later stages, you may experience shortness of breath, fatigue, chest pain that is typically worsened with exercise, palpitations, dizziness, and fainting.
To relieve these signs and symptoms, and to treat and manage left ventricular hypertrophy, expect to potentially have to make changes to your lifestyle, particularly as it relates to diet and exercise, and to start taking medication.3,5,6
When should I see a doctor?
The American Heart Association recommends that you should see a doctor as soon as you begin experiencing any of the signs and symptoms of left ventricular hypertrophy, that being shortness of breath, fatigue, chest pain that is typically worsened with exercise, palpitations, dizziness, and fainting, so the problem can be diagnosed and treated as early as possible.
Left ventricular hypertrophy is a condition characterised by increased left ventricular mass caused by the heart’s attempts to adapt to increased pressure and volume in the heart. Many conditions and risk factors can contribute to this increased pressure or volume. Whilst left ventricular hypertrophy tends to initially be asymptomatic, signs and symptoms tend to appear after several years of the condition’s onset. This asymptomatic period means that an early diagnosis can’t necessarily be achieved through a doctor taking your medical history, but instead requires specific tests being employed. Better outcomes are associated with treating the condition early, typically through lifestyle changes and medication, where failure to treat left ventricular hypertrophy may lead to abnormal heart rhythms and eventual failure of the heart to pump blood.
- Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Front Psychol [Internet]. 2014 Sep 30 [cited 2023 Sep 15];5:1040. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179748/
- Davidson BP, Giraud GD. Left ventricular function and the systemic arterial vasculature: remembering what we have learned. J Am Soc Echocardiogr [Internet]. 2012 Aug [cited 2023 Sep 15];25(8):10.1016/j.echo.2012.06.020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856917/
- Sayin BY, Oto A. Left ventricular hypertrophy: etiology-based therapeutic options. Cardiol Ther [Internet]. 2022 Jun [cited 2023 Sep 15];11(2):203–30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135932/
- Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart [Internet]. 2005 Feb [cited 2023 Sep 15];91(2):250–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768675/
- Rasic S, Kulenovic I, Haracic A, Catovic A. Left ventricular hypertrophy and risk factors for its development in uraemic patients. Bosn J Basic Med Sci [Internet]. 2004 Feb [cited 2023 Sep 15];4(1):34–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245531/
- Yildiz M, Oktay AA, Stewart MH, Milani RV, Ventura HO, Lavie CJ. Left ventricular hypertrophy and hypertension. Progress in Cardiovascular Diseases [Internet]. 2020 Jan [cited 2023 Sep 15];63(1):10–21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0033062019301434
- Plourde G, Prud’homme D. Managing obesity in adults in primary care. CMAJ [Internet]. 2012 Jun 12 [cited 2023 Sep 15];184(9):1039–44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381747/
- Nista F, Gatto F, Albertelli M, Musso N. Sodium intake and target organ damage in hypertension—an update about the role of a real villain. Int J Environ Res Public Health [Internet]. 2020 Apr [cited 2023 Sep 15];17(8):2811. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215960/
- Reid RD, Pritchard G, Walker K, Aitken D, Mullen KA, Pipe AL. Managing smoking cessation. CMAJ [Internet]. 2016 Dec 6 [cited 2023 Sep 15];188(17–18):E484–92. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135525/
- Chester AH, El-Hamamsy I, Butcher JT, Latif N, Bertazzo S, Yacoub MH. The living aortic valve: From molecules to function. Glob Cardiol Sci Pract [Internet]. 2014 Jan 29 [cited 2023 Sep 15];2014(1):52–77. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104380/
- Flugelman MY. History-taking revisited: Simple techniques to foster patient collaboration, improve data attainment, and establish trust with the patient. GMS J Med Educ [Internet]. 2021 Sep 15 [cited 2023 Sep 15];38(6):Doc109. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493840/
- Marcato JP, Senra Santos F, Gama Palone A, Lenci Marques G. Evaluation of different criteria in the diagnosis of left ventricular hypertrophy by electrocardiogram in comparison with echocardiogram. Cureus [Internet]. [cited 2023 Sep 15];14(6):e26376. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329598/
- Meek S, Morris F. Introduction. I—Leads, rate, rhythm, and cardiac axis. BMJ [Internet]. 2002 Feb 16 [cited 2023 Sep 15];324(7334):415–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122339/