Ventricular hypertrophy

What ventricular hypertrophy is

The ventricles are the two lower chambers of the heart and they are its main pumping chambers. The right ventricle pumps blood to the lungs to exchange carbon dioxide for fresh oxygen, while the left ventricle delivers freshly oxygenated blood to the body. Where the heart muscle thickens, it is the walls of the left ventricle that are particularly affected.

Ventricular hypertrophy describes that thickening. It is not a growth or a lump on the heart, but the heart muscle itself becoming bulkier. Like any muscle, heart muscle can become weakened, thickened or stiff under certain circumstances.

The condition belongs to the group known as structural heart issues, meaning conditions that affect the physical structure of the heart, including the heart muscle, chambers and valves. Problems of this kind can alter how blood flows through the heart or how effectively the heart pumps, and they may be present from birth or develop later in life.

The important point is that extra muscle does not mean extra performance. Thickened muscle can restrict blood flow and may interfere with the heart's electrical system. In hypertrophic cardiomyopathy, thickening can also make it harder for the heart to pump blood efficiently and may sometimes obstruct blood flow leaving the heart.

Why the heart muscle thickens

The heart must work harder when high blood pressure is present. Think of a pump trying to push water through a pipe that is already under constant pressure, because the pump has to exert more force to keep the flow going. Over time that extra workload can cause the heart muscle to thicken. While this may initially help the heart cope with the increased demand, it eventually makes the heart less efficient.

Blood pressure of 140/90mmHg or higher when checked by a healthcare professional is classed as hypertensive, though people over 80 have a different target, below 150/90mmHg in clinic. The systolic reading is the force with which the heart pumps blood, the diastolic is taken when the heart is at rest between beats, and the British Heart Foundation puts the normal range at 90/60mmHg to 130/85mmHg. Blood pressure tends to rise with age as the arteries stiffen, and many people feel perfectly well while their readings are elevated, which is why routine measurement matters so much.

Thickening of the heart muscle is also the defining feature of hypertrophic cardiomyopathy, a disease of the heart muscle itself. In that condition the thickening particularly affects the walls of the left ventricle, and it is often inherited, meaning it can run in families. Where a heart muscle condition runs in a family, screening of close relatives may help detect it early.

Sometimes no single cause is identified. The factors below are the ones recognised as causes of disease of the heart muscle generally, rather than causes of thickening alone, and identifying the underlying reason where possible helps guide both treatment and long term monitoring.

• Long standing high blood pressure
• Genetic inheritance, as in hypertrophic cardiomyopathy
• Previous viral infections affecting the heart
• Excessive alcohol consumption
• Certain other medical conditions, including those affecting other organs

Symptoms you may notice

Symptoms vary a great deal. Some people notice nothing at all and remain free of symptoms for long periods, with the thickening picked up on a test arranged for another reason. Others notice a gradual change in their energy levels or their breathing.

Where symptoms do appear, they tend to reflect the heart working less efficiently than it should.

None of these symptoms are unique to a thickened heart muscle, and each of them can occur with other heart conditions. Persistent or worsening symptoms should always be assessed by a medical professional rather than explained away.

• Shortness of breath, particularly during physical activity
• Fatigue or reduced stamina
• A drop in your exercise tolerance
• Chest discomfort
• Palpitations or irregular heartbeats
• Episodes of dizziness or fainting
• Swelling in the legs, ankles or abdomen

How ventricular hypertrophy is diagnosed

Diagnosis is usually made through imaging, supported by a clinical assessment and a discussion of your symptoms, your blood pressure history and your family history. Dr Jogiya will usually begin with an examination and a resting trace of the heart's electrical activity.

A 12 lead ECG looks at the heart from twelve different electrical angles at once and takes only a few minutes. It can show signs of strain on the heart muscle and evidence of an enlarged or thickened heart muscle, along with the rhythm and the conduction system. Most ECGs are completed within minutes, and many provide immediate reassurance.

An echocardiogram, which is an ultrasound scan of the heart, is the test that shows the thickening directly. It gives a live view of the heart beating and shows the size of each chamber, the thickness of the heart muscle, how strongly the left ventricle is contracting, and whether any walls are weakened, thickened or scarred. It is completely non invasive, with no needles and no radiation.

Further tests may be added depending on what the first results show. A cardiac MRI provides detailed images of the heart muscle. Blood tests help evaluate your overall health. Because blood pressure fluctuates through the day, a single high reading does not always confirm hypertension, so repeat measurements or a 24 hour blood pressure monitor may be used to build a fuller picture. Where an inherited form is suspected, genetic testing may also be considered.

One reassurance is worth stating plainly. A common misconception is that any variation on a scan indicates a serious problem. In reality many findings are mild and simply require monitoring, and the results always have to be interpreted alongside your symptoms and your general health.

How ventricular hypertrophy is treated

Treatment depends on the underlying cause and on how much the heart's function has been affected. It can range from lifestyle measures and medication through to procedures where these are needed to improve heart function.

Where high blood pressure is driving the thickening, controlling it is the priority. Treatment usually starts with changes to diet and exercise, and medication is added if lifestyle changes alone do not make enough difference. Different medicines work for different people, and the choice depends on factors such as age, ethnicity and your average overall blood pressure, so the first medicine prescribed is not always the one you settle on.

Medications may also be used to help the heart pump more effectively and to reduce strain on the heart muscle. In certain situations, devices such as pacemakers or implantable defibrillators may be recommended to manage abnormal heart rhythms.

Lifestyle measures make a genuine difference to blood pressure and to the workload on the heart. Regular follow up matters just as much, because it allows heart function and rhythm to be reassessed and treatment adjusted over time. Many people with a thickened heart muscle live active lives, and regular monitoring is an important part of that.

• Reducing salt intake and eating a balanced diet
• Maintaining a healthy weight
• Regular physical activity within safe limits
• Cutting down on alcohol
• Managing stress and protecting your sleep
• Keeping to your review appointments so heart function can be tracked

When to seek help

Call 999 immediately if you or someone with you has chest pain that does not settle, sudden severe breathlessness, or a collapse or blackout. Call 999 too if there is chest pain along with sweating, nausea, or pain spreading to the jaw, back or left arm, as these can be the signs of a heart attack. Do not wait to see whether the symptoms pass.

Outside an emergency, arrange an assessment if you are becoming breathless on activity that used to feel easy, if you are unusually tired, if you notice palpitations or dizziness, or if your ankles are swelling. The same applies if your blood pressure readings are consistently raised, or if a close relative has been diagnosed with a heart muscle condition.

Early detection can make a significant difference. When a heart muscle condition is identified early, treatment can begin before the heart muscle becomes severely weakened, so it is worth having persistent symptoms looked at rather than waiting. To arrange a consultation with Dr Jogiya, please get in touch with the practice.