Left Ventricular Hypertrophy

1. See Also
   1. Cardiomyopathy
2. Pathophysiology
   1. Primary Hypertrophy
      1. See Hypertrophic Cardiomyopathy
   2. Secondary Hypertrophy (See Causes below)
      1. Target organ response
         1. Chronic pressure overload
         2. Chronic volume overload
      2. Angiotensin II directly increases myocardial mass
3. Causes
   1. Hypertension
   2. Valvular disease
      1. Aortic Stenosis
      2. Aortic Regurgitation
      3. Mitral Regurgitation
   3. Patent Ductus Arteriosus
   4. Aortic Coarctation
   5. Chronic Renal Failure
   6. Acromegaly
   7. Thalassemia
4. Associated Conditions (LVH associated increased risk)
   1. Coronary Artery Disease
   2. Congestive Heart Failure
      1. Decreased left ventricular systolic function
   3. Cerebrovascular Accident
   4. All cause mortality
5. Diagnosis
   1. Echocardiogram
   2. Electrocardiogram (misses 50% of cases)
      1. See Left Ventricular Hypertrophy Related EKG Changes
6. Signs
   1. Accentuated Apical Thrust on palpation at PMI
7. Management: LVH with Diastolic Dysfunction
   1. Goals
      1. Preserve sinus rhythm
      2. Suppress Tachycardia
      3. Decrease elevated left atrial and diastolic pressures
      4. Avoid excessive preload reduction
      5. Avoid depressing cardiac output
      6. Treat comorbid Myocardial Ischemia
   2. Antihypertensive management
      1. Beta adrenergic blockers
      2. ACE Inhibitors
      3. Angiotensin Receptor Blockers (ARBs)
      4. Low dose Diuretics
      5. Long acting Calcium Channel Blockers
      6. Long Acting Nitrates
8. Management: LVH with Systolic Dysfunction (EF < 50%)
   1. See Congestive Heart Failure (Systolic Dysfunction)
   2. Decrease Fluid Overload
      1. ACE Inhibitors
      2. Beta adrenergic blockers
      3. Diuretics
   3. Reduce symptoms
      1. Digoxin
9. Prevention
   1. Control Hypertension
10. References
    1. Devereux (2000) Am Heart J 139:S9-14
    2. Lorell (2000) Circulation 102:470-9