Left ventricular hypertrophy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: LVH.

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Left ventricular hypertrophy(LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. While ventricular hypertrophy can occur naturally as a reaction to aerobic exercise and strength training, it is most frequently referred to as a pathological reaction to cardiovascular disease.While LVH itself is not a disease, it is usually a marker for disease involving the heart.

Causes

Disease processes that can cause LVH include any disease that increases the afterload in which the heart has to contract against. Some primary diseases of the heart muscle can also give rise to left ventricular hypertrophy.

Diagnosis

Electrocardiogram

The electrocardiogram (EKG) often shows signs of increased voltage from the heart in individuals with left ventricular hypertrophy, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.

Echocardiogram

The principal method used to diagnose LVH is echocardiography, during which the thickness of the muscle of the heart can be measured.

References

Sokolow Sokolow M, Lyon TP: The ventricular complex in left verntricular hypterfophy as obtained by unipolar precordial and limb leads. Am Heart J 37: 161, 1949
Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men Circulation. 2001 May 15;103(19):2346-51. PMID 11352882
Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB.Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994 Oct;90(4):1786-93.Related Articles, Links PMID 7923663
Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987). “Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings”. Circulation. 75 (3): 565–72. PMID 2949887.
Marriott, Henry J. L.; Wagner, Galen S. (2001). Marriott’s practical electrocardiography. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0683307460.
Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5

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Historical Perspective

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References

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Classification

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Pathophysiology

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Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: LVH

Overview

Disease processes that can cause LVH include any disease that increases the afterload in which the heart has to contract against (for example hypertension). Some primary diseases of the heart muscle can also give rise to left ventricular hypertrophy known as hypertrophic cardiomyopathies.

Causes

Life Threatening Causes

Acute myocardial infarction^[1]^[2]

Common Causes

Causes by Organ System

Cardiovascular	Acute myocardial infarction, alcoholic cardiomyopathy, amyloidosis, aortic insufficiency, aortic stenosis, athlete’s heart, autosomal dominant polycystic kidney disease, coarctation of the aorta, congenital heart disease, Danon disease, dilated cardiomyopathy, Fabry’s disease, familial dilated and hypertrophic cardiomyopathy, hemochromatosis, hypertension, hypertrophic cardiomyopathy, hypertrophic obstructive cardiomyopathy, idiopathic dilated cardiomyopathy, mitral regurgitation, myocardial ischemia, Noonan syndrome, patent ductus arteriosus, restrictive cardiomyopathy, systemic hypertension, tricuspid atresia
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Fabry’s disease
Drug Side Effect	Anthracyclines, thyroxine
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, amyloidosis, hemochromatosis, Pompe’s disease, hyperparathyroidism (primary and secondary)
Environmental	No underlying causes
Gastroenterologic	Hemochromatosis, Pompe’s disease, primary carnitine deficiency
Genetic	Danon disease, Fabry’s disease, Friedreich’s ataxia, hemochromatosis, MELAS, Noonan syndrome, Pompe’s disease, primary carnitine deficiency
Hematologic	Hemochromatosis, thalassemia
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	Hemochromatosis,MELAS
Neurologic	Fabry’s disease, Friedreich’s ataxia, MELAS
Nutritional/Metabolic	Danon disease, Fabry’s disease, MELAS, obesity, Pompe’s disease, primary carnitine deficiency
Obstetric/Gynecologic	Pregnancy
Oncologic	No underlying causes
Ophthalmologic	Fabry’s disease, hypertension, systemic hypertension
Overdose/Toxicity	Androgenic anabolic steroid abuse
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Autosomal dominant polycystic kidney disease, chronic renal failure, end stage renal disease, Fabry’s disease, hypertension, systemic hypertension
Rheumatology/Immunology/Allergy	Amyloidosis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Obesity

Causes in Alphabetical Order

References

↑ Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ (1985). “Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction”. N Engl J Med. 312 (18): 1137–41. doi:10.1056/NEJM198505023121801. PMID 3920520.
↑ Fesmire FM, Percy RF, Wears RL (1991). “Diagnostic and prognostic importance of comparing the initial to the previous electrocardiogram in patients admitted for suspected acute myocardial infarction”. South Med J. 84 (7): 841–6. PMID 2068623.
↑ Lazutin VK, Nychkina TN, Litvintsev VP, Iakovlev SV, Boĭko SE (1991). “[Clinical significance of arrhythmia in patients with hypertension]”. Kardiologiia. 31 (4): 71–4. PMID 2067187.
↑ Tuttolomondo A, Pecoraro R, Simonetta I, Miceli S, Pinto A, Licata G (2013). “Anderson-Fabry disease: a multiorgan disease”. Curr Pharm Des. 19 (33): 5974–96. PMID 23448451.
↑ Cauti FM, O’Mahony C, Pantazis A (2010). “Cardiac involvement in Anderson-Fabry disease”. BMJ Case Rep. 2010. doi:10.1136/bcr.02.2010.2760. PMC 3029827. PMID 22767366.
↑ Vanberg P, Atar D (2010). “Androgenic anabolic steroid abuse and the cardiovascular system”. Handb Exp Pharmacol (195): 411–57. doi:10.1007/978-3-540-79088-4_18. PMID 20020375.
↑ Mladosievicová B (2004). “[ACE inhibitors in the treatment of ventricular dysfunction caused by cardiotoxic cytostatics]”. Ceska Slov Farm. 53 (2): 55–60. PMID 15095572.
↑ Pavlik G, Major Z, Varga-Pintér B, Jeserich M, Kneffel Z (2010). “The athlete’s heart Part I (Review)”. Acta Physiol Hung. 97 (4): 337–53. doi:10.1556/APhysiol.97.2010.4.1. PMID 21138810.
↑ Masoumi A, Elhassan E, Schrier RW (2011). “Interpretation of renal volume in autosomal dominant polycystic kidney disease and relevant clinical implications”. Iran J Kidney Dis. 5 (1): 1–8. PMID 21189426.
↑ Schrier RW (2006). “Optimal care of autosomal dominant polycystic kidney disease patients”. Nephrology (Carlton). 11 (2): 124–30. doi:10.1111/j.1440-1797.2006.00535.x. PMID 16669974.
↑ Gonsorcík J, Palko S, Mydlík M (1995). “[Cardiologic management in patients on a long-term dialysis program]”. Bratisl Lek Listy. 96 (1): 47–50. PMID 7633909.
↑ Hayakawa M, Yokota Y, Kumaki T, Kaku K, Toh S, Takarada A; et al. (1984). “Clinical significance of left ventricular hypertrophy in dilated cardiomyopathy: an echocardiographic follow-up of 50 patients”. J Cardiogr. 14 (1): 115–23. PMID 6240508.
↑ Hammer F, Krane V, Störk S, Röser C, Hofmann K, Pollak N; et al. (2014). “Rationale and design of the Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease Study (MiREnDa)”. Nephrol Dial Transplant. 29 (2): 400–5. doi:10.1093/ndt/gft409. PMID 24166468.
↑ Groothoff JW (2005). “Long-term outcomes of children with end-stage renal disease”. Pediatr Nephrol. 20 (7): 849–53. doi:10.1007/s00467-005-1878-9. PMID 15834618.
↑ Mahmud HM (2014). “Fabry’s disease–a comprehensive review on pathogenesis, diagnosis and treatment”. J Pak Med Assoc. 64 (2): 189–94. PMID 24640811.
↑ Uyama E (2008). “[Fabry disease in light of recent review]”. Brain Nerve. 60 (11): 1235–44. PMID 19069157.
↑ Passino C, Franzoni F, Gabutti A, Poletti R, Galetta F, Emdin M (2004). “Abnormal ventricular repolarization in hypertensive patients: role of sympatho-vagal imbalance and left ventricular hypertrophy”. Int J Cardiol. 97 (1): 57–62. doi:10.1016/j.ijcard.2003.07.029. PMID 15336807.
↑ Maron BJ, Spirito P, Ackerman MJ, Casey SA, Semsarian C, Estes NA; et al. (2013). “Prevention of sudden cardiac death with implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy”. J Am Coll Cardiol. 61 (14): 1527–35. doi:10.1016/j.jacc.2013.01.037. PMID 23500286.
↑ Zalenski RJ, Sloan EP, Chen EH, Hayden RF, Gold IW, Cooke D (1988). “The emergency department ECG and immediately life-threatening complications in initially uncomplicated suspected myocardial ischemia”. Ann Emerg Med. 17 (3): 221–6. PMID 3345014.
↑ Alpert MA, Hashimi MW (1993). “Obesity and the heart”. Am J Med Sci. 306 (2): 117–23. PMID 8362892.
↑ Bartalena L, Bogazzi F, Martino E (1996). “Adverse effects of thyroid hormone preparations and antithyroid drugs”. Drug Saf. 15 (1): 53–63. PMID 8862963.

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Differentiating Left ventricular hypertrophy from other Diseases

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References

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Epidemiology and Demographics

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Risk Factors

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Screening

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Natural History, Complications and Prognosis

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Diagnosis

Treatment

Case Studies

Case #1

Related Chapters

Template:WikiDoc Sources

[pmid3920520-1] Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ (1985). “Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction”. N Engl J Med. 312 (18): 1137–41. doi:10.1056/NEJM198505023121801. PMID 3920520.

[pmid2068623-2] Fesmire FM, Percy RF, Wears RL (1991). “Diagnostic and prognostic importance of comparing the initial to the previous electrocardiogram in patients admitted for suspected acute myocardial infarction”. South Med J. 84 (7): 841–6. PMID 2068623.

[pmid2067187-3] Lazutin VK, Nychkina TN, Litvintsev VP, Iakovlev SV, Boĭko SE (1991). “[Clinical significance of arrhythmia in patients with hypertension]”. Kardiologiia. 31 (4): 71–4. PMID 2067187.

[pmid23448451-4] Tuttolomondo A, Pecoraro R, Simonetta I, Miceli S, Pinto A, Licata G (2013). “Anderson-Fabry disease: a multiorgan disease”. Curr Pharm Des. 19 (33): 5974–96. PMID 23448451.

[pmid22767366-5] Cauti FM, O’Mahony C, Pantazis A (2010). “Cardiac involvement in Anderson-Fabry disease”. BMJ Case Rep. 2010. doi:10.1136/bcr.02.2010.2760. PMC 3029827. PMID 22767366.

[pmid20020375-6] Vanberg P, Atar D (2010). “Androgenic anabolic steroid abuse and the cardiovascular system”. Handb Exp Pharmacol (195): 411–57. doi:10.1007/978-3-540-79088-4_18. PMID 20020375.

[pmid15095572-7] Mladosievicová B (2004). “[ACE inhibitors in the treatment of ventricular dysfunction caused by cardiotoxic cytostatics]”. Ceska Slov Farm. 53 (2): 55–60. PMID 15095572.

[pmid21138810-8] Pavlik G, Major Z, Varga-Pintér B, Jeserich M, Kneffel Z (2010). “The athlete’s heart Part I (Review)”. Acta Physiol Hung. 97 (4): 337–53. doi:10.1556/APhysiol.97.2010.4.1. PMID 21138810.

[pmid21189426-9] Masoumi A, Elhassan E, Schrier RW (2011). “Interpretation of renal volume in autosomal dominant polycystic kidney disease and relevant clinical implications”. Iran J Kidney Dis. 5 (1): 1–8. PMID 21189426.

[pmid16669974-10] Schrier RW (2006). “Optimal care of autosomal dominant polycystic kidney disease patients”. Nephrology (Carlton). 11 (2): 124–30. doi:10.1111/j.1440-1797.2006.00535.x. PMID 16669974.

[pmid7633909-11] Gonsorcík J, Palko S, Mydlík M (1995). “[Cardiologic management in patients on a long-term dialysis program]”. Bratisl Lek Listy. 96 (1): 47–50. PMID 7633909.

[pmid6240508-12] Hayakawa M, Yokota Y, Kumaki T, Kaku K, Toh S, Takarada A; et al. (1984). “Clinical significance of left ventricular hypertrophy in dilated cardiomyopathy: an echocardiographic follow-up of 50 patients”. J Cardiogr. 14 (1): 115–23. PMID 6240508.

[pmid24166468-13] Hammer F, Krane V, Störk S, Röser C, Hofmann K, Pollak N; et al. (2014). “Rationale and design of the Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease Study (MiREnDa)”. Nephrol Dial Transplant. 29 (2): 400–5. doi:10.1093/ndt/gft409. PMID 24166468.

[pmid15834618-14] Groothoff JW (2005). “Long-term outcomes of children with end-stage renal disease”. Pediatr Nephrol. 20 (7): 849–53. doi:10.1007/s00467-005-1878-9. PMID 15834618.

[pmid24640811-15] Mahmud HM (2014). “Fabry’s disease–a comprehensive review on pathogenesis, diagnosis and treatment”. J Pak Med Assoc. 64 (2): 189–94. PMID 24640811.

[pmid19069157-16] Uyama E (2008). “[Fabry disease in light of recent review]”. Brain Nerve. 60 (11): 1235–44. PMID 19069157.

[pmid15336807-17] Passino C, Franzoni F, Gabutti A, Poletti R, Galetta F, Emdin M (2004). “Abnormal ventricular repolarization in hypertensive patients: role of sympatho-vagal imbalance and left ventricular hypertrophy”. Int J Cardiol. 97 (1): 57–62. doi:10.1016/j.ijcard.2003.07.029. PMID 15336807.

[pmid23500286-18] Maron BJ, Spirito P, Ackerman MJ, Casey SA, Semsarian C, Estes NA; et al. (2013). “Prevention of sudden cardiac death with implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy”. J Am Coll Cardiol. 61 (14): 1527–35. doi:10.1016/j.jacc.2013.01.037. PMID 23500286.

[pmid3345014-19] Zalenski RJ, Sloan EP, Chen EH, Hayden RF, Gold IW, Cooke D (1988). “The emergency department ECG and immediately life-threatening complications in initially uncomplicated suspected myocardial ischemia”. Ann Emerg Med. 17 (3): 221–6. PMID 3345014.

[pmid8362892-20] Alpert MA, Hashimi MW (1993). “Obesity and the heart”. Am J Med Sci. 306 (2): 117–23. PMID 8362892.

[pmid8862963-21] Bartalena L, Bogazzi F, Martino E (1996). “Adverse effects of thyroid hormone preparations and antithyroid drugs”. Drug Saf. 15 (1): 53–63. PMID 8862963.

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Left ventricular hypertrophy

Overview

Causes

Diagnosis

Electrocardiogram

Echocardiogram

References

References

References

References

Overview

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

References

References

References

References

References

References

Diagnosis

Treatment

Case Studies

Related Chapters

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