VERIFIED CONTENTConsultation: lek. Maciej Grymuza, a graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań.

Enlargement (hypertrophy) of the left ventricle is a response of the heart muscle to its damage or forced excessive work and may result from many heart diseases, but also from thyroid gland or rheumatic diseases. Find out what the causes of left ventricular enlargement are, which of them is the most common, and whether the diagnosis is always a cause for concern.

Left ventricular enlargement(hypertrophy, hypertrophy) is associated with excessive workload by increasing the amount of blood pumped or increasing resistance to the flow of blood from the heart.

Left ventricular enlargement has many causes and not all of them are cardiac diseases, but the most common is poorly controlled hypertension. Left ventricular enlargement is irreversible, but proper treatment of the underlying cause may stop its progression.

It is worth being aware of possible complications of this condition, such as heart failure or the development of coronary artery disease. For this reason, treatment of the disease leading to hypertrophy is necessary and regular echocardiographic monitoring is required.

When does left ventricular enlargement occur?

Left ventricular enlargement is not a disease, it is the heart muscle's response to increased stress. It can result from a so-called increased preload or afterload, i.e. a volume or pressure overload. What does this mean?

Volumetric overload (increased preload) occurs when the amount of blood pumped by the heart is increased, for example as a result of valvular defects or so-called leakage defects.

Then, more than the physiological amount of blood flows into the left ventricle, which in turn causes more energy on the part of the heart muscle to pump out this blood.

If this condition lasts for a long time - months and years, the heart muscle (like every trained muscle) grows larger and thickens the walls of the left ventricle.

In the event of pressure overload (increased afterload), the situation is similar, except that the cause of the overload is due tothe need to overcome the increased resistance of a flowing blood wave from a narrowed valve or diseased blood vessels.

As in the case described above, the heart does more than normal work, which in the long run causes its walls to thicken.

Rarely, the enlargement of the left ventricle or the entire heart is due to congenital defects - damaged genes that cause the formation of abnormal, less effective muscle fibers, which the body compensates for with an increased amount of them. In such cases, most often a family member is ill or there have been so-called cardiac deaths at an early age among relatives.

Left ventricular enlargement - causes

From the biophysical point of view, all the causes of left ventricular enlargement boil down to two mechanisms, but there are many diseases that can cause this disorder:

Hypertension

This is the most common cause of left ventricular enlargement, so if this disease leads to left ventricular enlargement, it is necessary to evaluate the pressure equalization.

In most cases, modification of therapy, regular blood pressure monitoring and periodic echocardiography are sufficient, and no further diagnosis of the hypertrophy is necessary.

It is therefore crucial to pay attention to your lifestyle, to take your medications regularly and to follow your doctor's recommendations, as it is essential to prevent further left ventricular enlargement.

Therefore, if the cause of the hypertrophy of this cavity is arterial hypertension, the enlargement is slight and does not increase, then such a condition is not very dangerous. However, it is worth bearing in mind the possible consequences of this left ventricular enlargement described below.

If another cause of left ventricular enlargement is suspected, the doctor undertakes further diagnosis of this condition.

Other diseases, much less common, and that may lead to left ventricular enlargement are:

  • Aortic valve stenosis - reduction of the surface of the outlet, which hinders the flow of blood from the left ventricle to the aorta, the increased work performed by this ventricle causes its hypertrophy.
  • Mitral regurgitation - a heart defect involving abnormal blood flow from the left ventricle to the left atrium, which results in an increased amount of blood in the left ventricle before contraction, and therefore the previously mentioned increased preload.
  • Aortic regurgitation, causing blood to flow backward from the aorta to the left ventricle as a result ofabnormal closure of the aortic valve leaflets. In this case, the volume of blood in the left ventricle is also increased - preload, but it is related to the return blood flow from the aorta to the left ventricle.
  • Heart failure - caused by many heart diseases, occurs when the muscles are working too weakly to keep the blood flowing. Echocardiography shows: hypertrophy, dilatation of the heart cavities, valve defects or congenital anomalies - depending on the cause of the failure.
  • Hypertrophic cardiomyopathy - a genetically determined disease in which there is an increase in the thickness of the left ventricular wall and it is not associated with an initial or subsequent left ventricular overload. In this case, relatives usually had the disease.
  • Restrictive cardiomyopathy - a disease in which, due to damage to the heart muscle, the relaxation of the left ventricular muscle is impaired, sometimes the left ventricular muscle grows thick.
  • Coexistence of mitral stenosis and regurgitation - both ventricles are enlarged, especially the right ventricle, which is related to the increased volume of blood flowing into the left ventricle before systole.
  • Hypothyroidism

It is worth noting that valve disease on the right side of the heart rarely causes left ventricular enlargement, usually when there are other heart conditions. However, in the case of aortic and mitral (left atrioventricular) valve defects, left ventricular enlargement occurs quite often.

Please note that left ventricular enlargement is most often irreversible, but it is nevertheless necessary to check the condition regularly and treat the underlying disease.

Unfortunately, long-term, significantly enlarged or constantly enlarging left ventricle can cause serious consequences related to the disturbance of diastolic heart.

It can also lead to heart failure, and if the coronary vessels are underdeveloped in relation to the muscle mass, people with left ventricular hypertrophy are at risk of developing ischemic heart disease and a heart attack.

Dilated cardiomyopathy

In this case, the walls of the left ventricle do not thicken, on the contrary - they become thinner, while the left ventricle and often the right ventricle becomes larger. Due to the fact that the term "left ventricular enlargement" is quite broad and does not indicate exactly whether the wall or the heart cavity is thickening, it can also include this disease.

Dilated cardiomyopathy has a lotcauses: genetic mutations, toxins, viral infections.

It is also worth knowing that professional sports can also lead to the enlargement of the left ventricle, in which case the muscle grows thick, especially the interventricular septum.

If such wall thickening is detected, regular inspection is necessary, and if it reaches a certain thickness, you may need to stop playing sports as it increases your risk of cardiac death. It happens that after stopping the exercise, the changes in the structure of the heart disappear.

Left ventricular enlargement - symptoms

There is no symptom or group of ailments that could indicate left ventricular enlargement. Initially, this condition is asymptomatic, but with time and progressive deterioration, it leads to heart failure, and its frequent symptoms are shortness of breath and deterioration of exercise tolerance.

In advanced left ventricular enlargement, there are also chest pains, which are the result of insufficient blood supply to the heart muscle.

The symptoms of the disease causing the enlargement of the left ventricle are much more common, e.g. in defects of the valves:

  • fatigue
  • shortness of breath
  • palpitations
  • dizziness
  • fainting

in cardiomyopathies:

  • exercise dyspnea

in hypothyroidism:

  • feeling cold
  • weight gain
  • constipation
  • skin changes

Left ventricular enlargement - diagnosis

The basis for the diagnosis of left ventricular enlargement are imaging tests, especially echocardiography (ECHO), it allows you to accurately visualize the heart, measure its dimensions, including the dimensions of individual cavities and walls.

If the wall of the left ventricle is more than 1.1 cm thick, it is called enlargement, thickening. The enlargement of the heart can also be assumed on the basis of the ECG - changes in the ST segment, QS complexes and T wave.

Of course, the methods of heart imaging also include computed tomography and magnetic resonance imaging, this way enlargement of the left ventricle can be detected. In this case, it is most often accidental, as they are not the first-choice tests for assessing the size of the heart.

The presence of left ventricular enlargement in imaging tests is an introduction to further diagnostics, during which it is necessary to identify the cause.

First of all, it is necessary to determine the pressure values, because as mentioned, hypertension is the most common cause of left ventricular enlargement.

Ifthis cause will be ruled out, it is necessary to perform more detailed research depending on the suspected cause:

  • laboratory tests
  • less frequent invasive examinations: coronary angiography in suspected ischemic heart disease and myocardial biopsy in suspected cardiomyopathy and genetic defects. The biopsy specimens are assessed in a histopathological examination, and genetic tests are also often performed. The echo of the heart can tell a lot about the structure of the heart and possible valvular defects, it enables the detection and assessment of the severity of regurgitation and stenosis of the valve. In the left ventricular enlargement, especially aortic valve defects and mitral (left atrioventricular) valve regurgitation.

Left ventricular enlargement - treatment

There is no specific treatment for left ventricular enlargement. The most important thing is to remove the cause, i.e. adequate control of arterial hypertension, proper treatment of coronary artery disease - pharmacological treatment, and, if necessary, coronary angiography and coronary angioplasty (stenting).

In case of valvular disease, timely intervention: cardiac surgery or, in some cases, endovascular surgery.

Not all damaged valves require interventional treatment, most require periodic echocardiographic inspection, and surgery is decided if the defect progresses rapidly, is severe, or causes severe symptoms.

Other causes are also treated depending on the underlying causes, e.g. heart failure and pulmonary hypertension pharmacologically.

The ultimate measure in advanced heart diseases is a heart transplant, but it is reserved only for the most seriously ill patients, in whom the current treatment: pharmacological and surgical did not bring results, and the symptoms of heart disease continue to worsen, leading to a life-threatening situation.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

Category:

Cardiology