LVH - Left Ventricular Hypertrophy Symptoms

hi guys my name is Sanjay Gupta I am a

consultant cardiologist I work in New

York in the UK and today I wanted to do

a little video on the subject of left

ventricular hypertrophy or LVH I think

it's Jaclyn one of my friends on the

internet asked me to do a video on this

because she until the G has LVH and this

is causing her a lot of concern so I

thought I'd do a quick video on LVH just

so that you understand what left

ventricular hypertrophy means and what

to do about it

okay so the good news is I have a model

of the heart okay and it's really

important to try and understand what the

heart's all about if you understand the

structure of the heart you'll understand

what we're talking about because

sometimes this jargon can be very

difficult to understand but basically

this is what the heart looks like okay

now if you dissect the heart if you cut

the heart this is what it looks like

alright so here you have the left

ventricle alright this is the main

chamber of the heart so the blood comes

in from here okay it comes in through

comes in from these little holes here it

goes in to the left atrium which is this

structure at the top then you see this

this is the mitral valve so the blood

goes through the left atrium into the

mitral valve into the left ventricle and

from the left ventricle it gets pumped

out through this valve here okay into

the aorta and this aorta is the tube the

big tube that supplies all the other

blood vessels so when you're feeling

your pulse in your wrist or in your neck

it's because that vessel that you're

feeling in your neck or in your wrist is

connected to the aorta it comes off the

aorta so the aorta is the most high

pressure chamber you know the within the

heart of the aorta and the left

ventricle that's where the pressure is

that's where the pulsatilla t is and

this this

left ventricle here this is composed of

muscle you see so that the actual

chamber itself has a muscular wall all

right and that muscular wall is supplied

by blood vessels so when you look at it

you see these small blood vessels here

the red and the blue the red are

arteries and they supply this muscle

with blood and then the veins are the

blue ones that take the blood away so

blood with fresh oxygen-rich blood comes

to the muscle the muscle takes up the

oxygen and once the oxygen is taken away

from the blood it becomes bluish because

it doesn't have much oxygen in it and

therefore it goes back to the lungs so

when we talk about people having heart

attacks what we're worried about is

these vessels getting blocked and if

this vessel gets blocked for whatever

reason that part of the heart muscle

here may not get the blood it needs and

that part of the haast muscle will

therefore die and if that dies then

that's called a heart attack okay now

what is left ventricular hypertrophy

left ventricular hypertrophy is when you

look at this muscle it looks thicker or

more muscular than normal

usually this should be no more than

about one centimeter wide okay this part

and the spot if you find that it's much

bigger than one centimeter then it is

abnormally thickened it is abnormally

muscular and therefore you have to ask

yourself why has it become more muscular

the increased muscularity or thickening

of the wall of the left ventricle is

what is called left ventricular

hypertrophy hyper meaning increased true

feeling meaning increased thickness so

left ventricular hypertrophy left

ventricle looks increasingly thick okay

so generally around about no more than

one centimeter the dimension of this bit

or the dimension of this that should be

no more than one centimeter if it's much

bigger than one centimeter that is

called left ventricular hypertrophy so

then you have to ask yourself well why

has it become more muscular why does it

look more

skilar how do you pick it up the first

way you pick it up is on the ECG because

when you do the ECG the ECG caught the

electricity has to go through a larger

pit larger amount of muscle so the

complexes of ECG will look much bigger

than normal then you have to say okay so

that's one way but that's not a very

accurate way of looking at it so the

next way you can look for it is do

something called an ultrasound an

echocardiogram where they put jelly on

the chest and have a look at this and if

on that it looks thick then you're

diagnosed with left ventricular

hypertrophy so the next question you

have to ask yourself is why is there

left ventricular hypertrophy what why

does it develop and what does it mean

what can it do to you and basically the

left ventricle gets thicker or you

develop left ventricular hypertrophy if

the left ventricle is having to work

harder if this chamber is having to pump

much harder than it needs to then being

a muscle this muscle will thicken it's a

bit like a bodybuilder if the

bodybuilder has to do more or he's doing

more he will his muscles will grow

bigger and so there are a variety of

reasons why this could get thicker the

first thing is if the pressure here in

this chamber because remember this wore

this this chamber is pumping directly

into this chamber okay now if the

pressure here is high then of course to

try and get the blood out this is going

to have to work harder and this will get

thicker so that when the pressure is

high here that is termed high blood

pressure so if you have high blood

pressure that is by far the communist

reason why people develop left

ventricular hypertrophy okay that's the

first thing the second reason people can

develop left ventricular hypertrophy is

for example this valve you see the

because the heart has to pump and then

it has to go through this valve God has

provided us with this valve because

otherwise the blood would go up in here

and as soon as the heart started

relaxing all the blood would come back

out would come back down into the heart

not go around the body so God has

provided us with this valve and what

this means is it opens allows the blood

to come out and then closest dropping

the blood from going back down into the

left ventricle but with wear and tear

and and particularly patients who are

getting older you can get a lot of wear

and tear of this valve and this can

become very narrowed and if it becomes

narrowed this is called aortic stenosis

because it's the aortic valve okay and

if it becomes de nosed here

if it becomes tight that condition is

called aortic stenosis and that would

mean that this chamber has to work much

harder to try and get the blood through

the narrowed valve into the aorta and

that condition will also cause left

ventricular hypertrophy other causes of

left ventricular hypertrophy well if

someone for example puts pinches this

area okay so you know this continues

down but if I pinch this area then of

course the pressure that has to be

generated to try and get and the blood

out is increased and that condition

where you get this pinching effect is

called coarctation of the aorta and that

is actually something that people are

often born with where this area is

narrowed and then they develop very high

blood pressures okay another way you can

develop high blood pressure is let's say

if this goes down this will go down this

this autry goes down all the way to

supply the kidneys and if you have a

narrowing in the artery that leads into

the kidneys then that is in essence the

same as being pinched but much more

downstream so what tends to happen there

is again the heart has to work much

harder to try and get the blood through

to the kidneys and therefore you develop

left ventricular hypertrophy okay so

that's what left ventricular hypertrophy

is now there are certain other

interesting things that can cause left

ventricular hypertrophy you know when we

say left ventricular hypertrophy all

we're saying is this looks thicker now

if you were born with abnormal

muscle okay so some people have a

genetic mutation where they this muscle

becomes up normally thick okay and that

condition is called hypertrophic

cardiomyopathy so where the muscle

itself is abnormal because of the

mutation and this can become very thick

significantly thick in fact and actually

if you do the blood pressure in the

patient you say oh what blood pressure

is not raised so why is the heart muscle

so thick and if it is abnormally thick

then that condition can be called

hypertrophic cardiomyopathy because it's

a disease where the heart muscle becomes

abnormally thickened hypertrophic

cardiomyopathy is very interesting

because in a small subset of patients it

can be associated with life-threatening

heart rhythm disturbances but that is

only on a small subset of patients and

often you hear about athletes who maze

you know who are playing football or

something and they often end they and

they say collapse or unfortunately drop

down dead and often on post-mortem

they're then diagnosed with this very

more thickening of the heart muscle and

if that is the case then they're

diagnosed with hypertrophic

cardiomyopathy the problem with

hypertrophic cardiomyopathy or is that

when the muscle is abnormal all sorts of

electrical abnormalities can occur

within the heart and therefore you know

some of these electrical abnormalities

can cause the heart to go very fast and

therefore the patient can collapse and

degrade into a dangerous heart rhythm so

hypertrophic cardiomyopathy is worth

bearing in mind what else there are

other conditions which can cause this to

be abnormally thick and some people can

get abnormal deposition of things in

particular people who have something

called amyloidosis people who have

myeloma or cancers sometimes they can

develop abnormal protein deposition

within the muscle walls and that can

cause the heart paradoxically to get

even weaker so though it looks more

muscular it becomes weaker and that is

called amyloid or take heart

so what is the problem with this with

with left ventricular hypertrophy let's

say someone tells you you've got a left

ventricular hypertrophy what is the

issue with it well there's clearly

something making the heart work harder

and you don't want the heart to work

harder so the left ventricular

hypertrophy is a good indicator that the

heart is working harder than normal so

you want to try and tackle whatever is

making the heart work harder than normal

so if you have high blood pressure you

want to control that blood pressure

because you don't want the heart to work

so hard why don't you want the heart to

work so hard because actually the more

muscular the heart gets the stiffer it

gets so the more muscular it gets the

stiffer it gets now what happens is the

heart is able to contract because it's

more muscular but it doesn't relax quick

enough and if it doesn't relax quick

enough then it doesn't fill without much

blood so when it compresses again or

when it contracts again less blood goes

around the body and because less blood

goes around to the body particularly the

kidneys the kidneys will sense this and

they will then get into a system where

they start absorbing more fluid trying

to restore the blood volume because the

kidneys automatically think if they're

getting less blood you're dehydrated so

they will then start absorbing fluid you

then get more fluid coming into the

heart and the heart has more work to do

with all this fluid and slowly and

gradually as time progresses the heart

can eventually start weakening so you

don't want that to happens now and

that's the first thing the other problem

with left ventricular hypertrophy is

that you know the heart is getting

thicker and thicker and thicker that the

blood supply to the heart is just coming

from these blood vessels here okay so

eventually you'll get more muscle and

the muscle will start out stripping its

blood supply and if it outstrips and

blood supply then bits of the heart will

start weakening because they're not

getting as much blood as they need to

and that is the other problem with left

ventricular hypertrophy so yes in the

early stages it tells you your heart is

working harder than normal if it is


our normal than you really don't want

your heart to be working harder than

normal so you should try and tackle

those things particularly blood pressure

or things like a optic stenosis if you

have a optic stenosis secondly if you do

let the heart work harder than normal

then eventually the heart rule gets

stiffer and stiffer and that will

translate into less a relaxation real

slow relaxation and if there's slow

relaxation that it fills with less blood

less blood goes out and the kidneys

start getting into this system where

they absorb more and cause all sorts of

adaptive mechanisms which can be bad for

the heart in the long run and finally if

it gets very thick it can start out

stripping its blood supply and that can

cause the heart to paradoxically weaken

because the heart muscle there's extra

heart muscle suffocates that's why yeah

you know bodybuilders as you can see you

know they they build a certain amount of

muscle and then despite everything you

can't go beyond a certain point because

you can develop a certain amount of

muscle and of course your blood vessels

develop to try and feed that muscle but

eventually if you get too big you start

out stripping the blood supply and

therefore the muscles actually

paradoxically get weak and the heart is

very similar to that the only other

thing I would say is if you have

unexplained left ventricular hypertrophy

I your blood pressure's plum normal and

there is no other explanation then it's

always worth seeing a heart specialist

to try and work out why this muscle is

more thick when you can't obviously

explain it by a mechanical thing in that

setting it may be worth having something

called an MRI scan because the MRI scan

actually looks at the muscle and

continue if there is any abnormal muscle

where and it's probably the best test we

have to understand what tissue looks

like the scan the ultrasound scan that

I'd recommended earlier that just looks

at the heart muscle it won't tell you it

won't give you too much information

about exactly what the muscle is

composed of is it abnormal protein like

this amyloid thing is it abnormal muscle

like the hypertrophic cardiomyopathy

thing or is it just normal muscle which

is thick so I hope you found this useful

my name is Sanjay Gupta and I'm gonna

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thanks alright all the best

take care