Patient's Query
Hello doctor,
What is the risk of sudden cardiac death (SCD) in a patient with left ventricular hypertrophy (LVH), a history of premature ventricular contractions (PVCs), and possible nonsustained ventricular tachycardia (NSVT)? Will treating blood pressure alone reduce this risk? Everything I have read suggests that the prognosis is unclear, but I am very concerned and hope you can offer some clarity on my situation. I have not had confirmed NSVT, but I have experienced longer episodes of fluttering sensations and have had PVCs on and off for the past 10 years.
I am 23 years old, and my stress test was normal. I am currently wearing a wireless patch (an ECG monitor). My echocardiogram showed apparent LVH and aortic root dilation of 1.49 inches. If I have LVH, does this predispose me to arrhythmias similar to hypertrophic cardiomyopathy? Also, can LVH be reversed if I manage my blood pressure, which is currently higher than normal?
Please advise.
Hello,
Welcome to icliniq.com.
Firstly, how severe are your hypertension and hypertrophy? Can your hypertrophy be explained by your hypertension? If so, it is likely hypertension-induced. Hypertrophic cardiomyopathy can cause hypertrophy in younger individuals, but it typically results in severe hypertrophy, with thickness usually greater than 15 mm, and can be detected on an echocardiogram. Please attach the echocardiogram report if possible. Also, let me know the highest blood pressure reading you have had. You mentioned a reading of 145/90, which is mildly elevated.
Next, compared to those without ventricular premature complexes (VPCs), patients with VPCs have significantly higher cardiovascular mortality, somewhere between one to two times higher. However, the majority of patients with VPCs do well and lead normal lives. Additionally, your stress test was negative, which rules out coronary artery disease, a factor that also contributes to mortality.
You should be receiving treatment for hypertension, and it should be kept under control. Strict blood pressure control may help reduce hypertrophy and ectopic beats to some extent, though usually not completely. I would also recommend asking for a beta-blocker, such as Metoprolol, to help control both your blood pressure and ectopics.
Overall, the majority of patients with these conditions do well, and there is no need to be overly worried.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
My echocardiogram report is attached for your review. You can see that my septum is mildly dilated. Is this concerning? My main concern is the research showing that nonsustained ventricular tachycardia (NSVT) and ventricular premature complexes (VPCs) with left ventricular hypertrophy (LVH) significantly increase the risk of sustained arrhythmias. As I mentioned, my NSVT was unconfirmed, but I do experience ectopic beats. My blood pressure has reached up to 155/95 mmHg, but that was only on a few occasions. My usual readings are between 135/85 mmHg and 148/90 mmHg.
Also, you may notice diastolic dysfunction in the report. Would blood pressure management help reverse this as well? Why might I have this at age 23? Any additional reassurance would be helpful, as I am very worried.
Hello,
Welcome back to icliniq.com.
I have reviewed the report (attachment removed to protect patient identity). Firstly, it is unlikely to be hypertrophic cardiomyopathy. The left ventricular hypertrophy (LVH) is mild. We consider concentric LVH to be more than 12 mm, and your septum is 13 mm, so it is simply LVH. This is likely due to the slightly elevated blood pressure that you have. Since it is mild, it may reverse over time if your blood pressure is strictly controlled, and if you achieve some weight loss. Your elevated blood pressure is likely a result of being overweight.
You should adopt a healthy lifestyle by avoiding fatty, oily, and high-calorie foods. Follow a low-salt diet and monitor your blood pressure regularly—three times a day for one week, then once or twice a week. If your blood pressure remains above 140/90 mmHg, you should start medications. Engage in regular exercise, such as brisk walking or jogging, for at least 30 minutes a day, five days a week, depending on your capacity. Avoid smoking and alcohol, if applicable. You should also get your lipid profile and blood sugar levels tested once.
The aortic root is also mildly dilated, but this requires only monitoring for progression, with echocardiograms every one or two years. Overall, I do not think you need to worry about this. As I mentioned, these ectopic beats are benign and not concerning; the majority of individuals with them do very well. You should start taking beta-blockers like Metoprolol, which will help control your blood pressure and suppress the ectopics.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I just wanted to update you on my condition. I have continued to see my regular cardiologist and have an echocardiogram every six months at his office. I have attached both of my recent echocardiograms for your review. I have also seen an electrophysiologist for my PVCs, where I received one EKG. I have attached this EKG, along with another one from my cardiologist's office. I am currently taking Irbesartan 150 mg, up from 75 mg since we last spoke. I have not added any additional medication, besides once-daily CoQ10 200 mg. My blood pressure is currently controlled, averaging between 110/65 mmHg and 130/85 mmHg, depending on whether I am standing, seated, or stressed. When standing, my blood pressure does increase to over 140/90 mmHg.
My electrophysiologist reviewed my EKGs and rhythm strips and determined that my PVCs originate from the right outflow tract, and they are benign. I occasionally have two to three or more beats in succession (NSVT), which she also said is benign. My cardiologist has reviewed my echocardiograms and would like to perform a cardiac MRI to determine what is causing the left ventricle to grow in size. I have chosen not to do the MRI at this time due to concerns about the contrast agent, but he mentioned that the MRI is not urgent and can wait. I wanted to get a second opinion on what he is specifically looking for with the cardiac MRI and whether you think this is necessary in my situation.
Additionally, I would like to know your thoughts on what might be causing my hypertrophy, and if you have any other insights or research to share. I am concerned about my heart, but I exercise almost every day at moderate intensity. I have noticed that my heart rate tends to increase quickly during exercise, but I do not experience shortness of breath, chest pain, or dizziness, and I do not notice frequent PVCs while exercising.
In your judgment, what should I do at this point? I am a 24-year-old male with a family history of hypertension and a congenital heart defect on my mother’s side. My father’s side has a history of atrial fibrillation, and my grandfather may have died from either a malignant arrhythmia or a myocardial infarction, though it is unclear which. He was a smoker. I do not smoke or drink, and I maintain a healthy diet rich in olive oil, low in carbohydrates, and high in protein, fish, and dark chocolate. I am attempting to lose 60 to 100 pounds. My current weight is 612 pounds, and I am 6 feet 2 inches tall with a large body frame and broad shoulders. I also have a considerable amount of muscle mass.
If you need me to resend any older documents, please let me know.
Hello,
Welcome back to icliniq.com.
I have reviewed your reports (attachment removed to protect the patient's identity). I believe you should have an MRI (magnetic resonance imaging) due to the NSVT (nonsustained ventricular tachycardia) runs and the J-notch. It is better to rule out the possibility of structural heart diseases like ARVC (arrhythmogenic right ventricular cardiomyopathy). While these are likely benign, as the echocardiogram shows normal left ventricular (LV) and right ventricular (RV) function, an MRI can detect subtle changes that may not be visible on the echo. This will provide additional peace of mind for both you and your doctor.
Left ventricular hypertrophy (LVH) can be explained by hypertension, so it is not a reason for the MRI. The left atrium (LA) appears slightly enlarged compared to the previous echocardiogram, but this could be due to measurement variation. We should confirm this enlargement on the next echocardiogram. Losing weight may help resolve these issues.
I hope this information is helpful.
Please feel free to reach out if you have any further questions or concerns.
Patient's Query
Hello doctor,
Thank you for the reply.
So, are you saying that to rule out ARVD specifically, I should get the cardiac MRI? Can you think of any other reasons why my cardiologist would order the MRI? I have spoken with him, and all he mentioned was that it is to understand why my left ventricle is becoming larger. Additionally, I have already seen an electrophysiologist, who deemed my (unconfirmed) NSVT runs and J-notch to be benign. Are you suggesting that she might have overlooked any changes related to ARVD, or would she have been able to identify them?
I have been exercising frequently, sometimes at peak intensity for me. Could this be causing my atrium to enlarge? The reason I wanted to forego the MRI is due to concerns about gadolinium deposition in the brain (based on recent studies). I understand that contrast is necessary to detect any infiltrates in the heart muscle. My cardiologist said the MRI is not urgent and can wait, but I would like to know your opinion on this.
Hello,
Welcome back to icliniq.com.
Yes, the MRI is mainly for ruling out ARVD or other right ventricular dysplasias. A mild increase in size may even be related to your intense physical activity. I do not think it is absolutely necessary to assess the left ventricle, as your left ventricular size is still within normal limits. If the electrophysiologist is confident that the NSVT runs are benign, then you may be able to wait for the MRI. The increase in left atrial (LA) size could also be related to your exercise routine. Additionally, you may have diastolic dysfunction, which might not have been checked or mentioned.
I hope this has helped you. Thank you.
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Answered byDr. Sagar Ramesh Makode
Medically reviewed byDr. K. Shobana
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