Left Ventricular Hypertrophy: A Cardiomyopathy Overview

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Left Ventricular Hypertrophy (LVH) is one of the many conditions associated with cardiomyopathy and heart failure.

LVH is a condition that affects the heart’s left ventricle, and can possibly be fatal. 

Knowing its treatment, as well as diagnosis, will be crucial in school and after graduation. In clinical or on the job as a nurse, it’s important to recognize the signs and symptoms of LVH before it’s too late (death).

In the classroom, it’s ideal to study as much as possible about cardiomyopathy (including LVH) to pass exams and coursework.

What is Left Ventricular Hypertrophy (LVH)?

LVH is a cardiac condition in which the walls of the main pumping chamber of your heart (left ventricle) thicken (hypertrophy). This thickening is a response to pressure overload, and according to research, LVH is present in 15% to 20% of the general population

When the left ventricle becomes enlarged, the heart must work harder to pump blood. In response to this pressure overload, the inner walls of the heart respond by getting thicker. 

These thickened walls can cause the left ventricle to weaken, stiffen and lose elasticity, which may prevent healthy blood flow.

Overall, LVH is caused by cardiac insufficiency, from the heart not pumping as vigorously as it should – resulting in dizziness and shortness of breath.

When assessing symptoms of LVH, it’s critical to distinguish between benign LVH and another condition known as “athlete’s heart.”

Athletes Heart vs. LVH

Both athlete’s heart and LVH cause thickening of the wall in the left ventricle, and result in symptoms like chest pain, fainting, shortness of breath, fatigue, palpitations, and excessive sweating.

Also called exercise-induced cardiomegaly, athlete’s heart is amply named after its most common victims, athletes training hard and performing heavy physical activity. Athletes heart is caused by increased cardiac wåorkload, and blood flow, resulting in enlarged heart. 

LVH typically isn’t caused by heavy physical activity, but most definitely from stress and heart muscle injury.

Left Ventricular Hypertrophy Causes & Symptoms

High blood pressure is the most common cause of LVH, and is commonly found in patients with chronic heart failure.

Treating high blood pressure will help with symptoms if it’s the underlying cause of your patient’s LVH. And if the patient actually follows post-visit advice, the heart damage caused by LVH can possibly be reversed.  

LVH may be present for many years before any symptoms become apparent. As it progresses, this is what will appear in patients: 

  • Breathing difficulty
  • Fatigue
  • Chest pain (especially with exercise)
  • Heart flutters
  • Fainting
  • Dizziness

Patients with LVH might also experience the feeling of a heartbeat that is quick, fluttery, or thumping (palpitations).

Concentric vs. Eccentric Hypertrophy

Concentric Left Ventricular Hypertrophy (LVH)Eccentric Left Ventricular Hypertrophy (LVH)
Concentric LVH is the result of the heart adapting to systemic pressure overload caused by hypertension or aortic stenosis.Eccentric hypertrophy deals with volume overload due to a significant valvular regurgitation issue or high cardiac index.
Affects both men and women, regardless of age. It’s associated with changes in LV geometry, diastolic function, longitudinal & radial myocardial function, and atrial size.More common – seen in patients with CAD, chagas cardiomyopathy, or myocarditis.
Signs of concentric LVH include:
  • Global increased wall thickness
  • Normal LV cavity size
  • Increased LVM (Left ventricular mass)
  • Increased RWT (Relative Wall thickness)
Signs of eccentric LVH include:
  • Normal LV wall thickness
  • Increased LV cavity size
  • Increased LVM (Left ventricular mass)
  • Decreased RWT (Relative Wall thickness)

LVH Nursing Diagnosis with ECG 

It can be challenging to identify LVH since it can develop under the radar over the years without any symptoms. 

However, even before symptoms become apparent, LVH may typically be identified by a simple echocardiography (ECG, or EKG) reading. An electrocardiogram (ECG) measures muscle activity by recording electrical impulses from the heart. 

Read more about EKG interpretation here.

LVH ECG Criteria

ECG results will show abnormalities that point to LVH with wave measurements. According to the University of Utah, this is the criteria used to diagnose LVH in an ECG reading:

  • ≥ QRS amplitude
  • tall R-waves in LV leads
  • deep S-waves in RV leads
  • Delayed intrinsicoid deflection in V6 
  • Widened QRS/T angle
  • Leftward shift in frontal plane QRS axis

Left Ventricular Hypertrophy Treatment

Patients with LVH are most at risk for cardiovascular fatalities. This is why LVH treatment should be vigorous and started as soon as possible.  

In the long-term, LVH can be avoided with lifestyle changes that lower blood pressure, mainly with the right foods and exercise.

While in a hospital, you need to administer IV solutions to the LVH patient while keeping the overall dosage below the limits. It is important to keep a close eye on the fluid administration rate. An important thing to note is not to use saline solutions on patients with LVH.

In addition to antihypertensive medications, you’ll need to administer medications that remove excess fluid, like diuretics – or slow down heart rate, like beta blockers

The patient might not be able to tolerate an increase in fluid volume because of their already elevated left ventricular pressure (preload). 

Learn about cardiac preload and afterload here.

An important thing to note is not to use saline solutions on patients with LVH.

LVH FAQs

Here are some common questions relating to LVH.

What is the most common cause of left ventricular hypertrophy (LVH)?

The most common cause of LVH is high blood pressure. Other causes include: 

  • Stress
  • Lack of exercise
  • Diabetes mellitus
  • Coronary artery disease
  • Hyperthyroidism
  • Rheumatic fever
  • Inflammatory disease
  • Valvular heart disease
  • Obesity

Can the left ventricle repair itself?

Yes, by regenerating new tissue – the scarring over damaged areas. This repair happens when the heart sends out stems cells that help grow new muscle cells and rebuild walls of the heart.

This repair requires plenty of rest from the patient. Without stress reduction and rest, a patient of LVH will continue to suffer symptoms and will possibly require rehospitalization.

How long does it take to reverse left ventricular hypertrophy (LVH)?

It depends, but typically six months to a year. Factors to consider include: age, the severity of their condition, and existing health conditions.

There’s so much more to learning LVH (and other cardiac conditions) inside and outside the classroom.

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