How to manage LVH and diastolic dysfunction?

Question

Hello doctor,

I was referred to a cardiologist after an abnormal EKG during a routine physical examination. I also received a nuclear stress test and an echo, and was diagnosed from the echo with moderate to severe LVH and grade 2 diastolic dysfunction. The stress test was normal, other than the LVG.

I have been obese for a long time, but in the past year, I have lost 90 pounds, and my blood pressure was normal by the time of the tests. I have had no symptoms at all as I do cardio and weight lifting with no problems. I was advised to continue losing weight and exercising normally, and there was no need for meds, just follow up.

I am concerned about the severity of the LVH and if I should request further testing.

I was taking Irbesartan 150 mg, and currently I am on Rosuvastatin 10 mg.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your health concerns with us. I have reviewed your echocardiogram (attachment removed to protect the patient's identity), and the wall thickness falls within the severe category.

Your cardiac chambers are of normal size, and the heart cavity is adequate in volume, which is very reassuring. Additionally, there is no evidence of left ventricular outflow tract obstruction. Pulmonary artery pressure and left ventricular function are also within the normal range.

Left ventricular hypertrophy (LVH) means that your heart muscle is thicker than it should be. Diastolic dysfunction is secondary to prolonged hypertension and LVH. LVH can result from several conditions that need to be diagnosed and treated if present. These include:

Severe uncontrolled hypertension.
Valvular heart disease.
Infiltrative heart diseases.
Storage disorders.

Hypertension is the most common cause of hypertrophy. Hypertrophic cardiomyopathy is another cause of hypertrophy, which is a diagnosis of exclusion. Severe forms of hypertrophy may lead to left ventricular outflow tract obstruction, angina (chest pain), and scarring within the heart muscle.

Over time, this scarring can reduce the heart’s ejection fraction and lead to heart failure. It may also increase the risk of arrhythmias (abnormal heart rhythms). Your echocardiogram has only ruled out valvular heart disease as a cause of LVH, and further investigations are warranted to exclude other causes and for risk stratification.

A normal nuclear stress test is very reassuring and only rules out ischemia or any critical decline in blood supply to your heart. I would recommend a cardiac MRI (magnetic resonance imaging) to accurately quantify wall thickness and assess for any scar burden, if present, for further risk stratification.

Cardiac MRI may also detect any aneurysm commonly seen in hypertrophic cardiomyopathy. A Holter monitor may also be considered to evaluate for any possible arrhythmias if there is a history of palpitations or a fast heartbeat.

Cardiologists sometimes also advise a bike stress echocardiogram to assess for any rise in cardiac pressure gradients or left ventricular outflow tract obstruction and manage it accordingly. Now, regarding the management plan: after proper risk stratification, periodic observation is needed.

Good hydration and, depending on symptoms, medications such as beta-blockers may be prescribed to adequately control heart rate. Other medications may also be given if needed, which are given in advanced forms of hypertrophy where there is any outflow obstruction.

In the end, I would suggest talking to your cardiologist and discussing your concerns with them.

I hope this helps you.

Thank you.