Left ventricular hypertrophy

Overview Thick heart muscle reduces blood flow to the aorta What is hypertrophic cardiomyopathy (HCM)? Hypertrophic cardiomyopathy (HCM) is a complex type of heart disease that affects your heart muscle. It can cause: • Thickening of your heart muscle (especially the ventricles or lower heart chambers). • Left ventricular stiffness. • Mitral valve changes. • Cellular changes. How does hypertrophic cardiomyopathy (HCM) affect my body? Thickening of the heart muscle (myocardium) This occurs most commonly at your septum. The septum is the muscular wall that separates the left and right sides of your heart. Problems happen when the septum between your heart’s lower chambers (or ventricles) is thickened. The thickened septum may cause a narrowing that can block or reduce the blood flow from the left ventricle to the HCM also may cause thickening in other parts of your heart muscle, such as the bottom of your heart (called the apex), right ventricle or throughout your entire left ventricle. In these cases, it’s called hypertrophic nonobstructive cardiomyopathy. Although this type reduces the amount of blood your ventricle can handle, it doesn’t keep blood from moving. Stiffness in the left ventricle This occurs as a result of cellular changes that happen in your heart muscle when it thickens. Your left ventricle can’t relax normally and fill with blood. Since there’s less blood at the end of filling, there’s less oxygen-rich blood pumped to your organs and muscles. The stiffness...

Left atrial enlargement is a warning sign that one of your heart’s upper chambers is handling high pressure and too much blood. People with this issue often have high blood pressure, heart valve problems or other heart issues. Treatment varies depending on the cause. You may need medication, healthier habits or valve repair/replacement. Overview What is left atrial enlargement? Left atrial enlargement is when one of your Sometimes, you may have a problem with your left ventricle, which pumps blood to your aorta. Other people may have something wrong with their mitral valve, which lets blood move between your left atrium and left ventricle. These issues can create high pressure and/or a large volume of blood in your left atrium. Your left atrium can get larger and stretch when it tries to adapt to make up for this high pressure and/or high volume. This stretching causes scarring and injury to your atrium. It’s like a big brother who tries to help his siblings carry the load but ends up getting hurt himself. Who does left atrial enlargement affect? Left atrial enlargement affects people with: • • Mitral valve disease. • Aortic valve disease. • • Certain kinds of • • • Congenital heart disease. How common is left atrial enlargement? An Italian study of adults found that 12% of them developed left atrial enlargement during a period of 10 years. Based on this, researchers believe the condition isn’t rare in the general population. In the study, most of the people who developed ...

Hypertrophic cardiomyopathy In hypertrophic cardiomyopathy (HCM), the muscular heart walls (septum) are much thicker (hypertrophied) than those in a typical heart. The thickening can occur anywhere in the left lower heart chamber (left ventricle). Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes thickened (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood. Hypertrophic cardiomyopathy often goes undiagnosed because many people with the disease have few, if any, symptoms. However, in a small number of people with HCM, the thickened heart muscle can cause shortness of breath, chest pain or changes in the heart's electrical system, resulting in life-threatening irregular heart rhythms (arrhythmias) or sudden death. Symptoms Signs and symptoms of hypertrophic cardiomyopathy might include one or more of the following: • Chest pain, especially during exercise • Fainting, especially during or just after exercise or exertion • Heart murmur, which a health care provider might detect while listening to the heart • Sensation of fast, fluttering or pounding heartbeats (palpitations) • Shortness of breath, especially during exercise When to see a doctor A number of conditions can cause shortness of breath and fast, pounding heartbeats. It's important to get a prompt, accurate diagnosis and appropriate care. See your health care provider if you have a family history of HCM or any symptoms associated with hypertrophic...

• There are numerous voltage criteria for diagnosing LVH, summarised below • The most commonly used are the Sokolov-Lyon criteria: S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm • Voltage criteria must be accompanied by non-voltage criteria to be considered diagnostic of LVH Voltage Criteria Limb Leads • R wave in lead I + S wave in lead III > 25 mm • R wave in aVL > 11 mm • R wave in aVF > 20 mm • S wave in aVR > 14 mm Precordial Leads • R wave in V4, V5 or V6 > 26 mm • R wave in V5 or V6 plus S wave in V1 > 35 mm • Largest R wave plus largest S wave in precordial leads > 45 mm Non Voltage Criteria • • ST segment depression and T wave inversion in the left-sided leads: AKA the left ventricular ‘strain’ pattern Pathophysiology • The left ventricle hypertrophies in response to pressure overload secondary to conditions such as aortic stenosis and hypertension • This results in increased R wave amplitude in the left-sided ECG leads (I, aVL and V4-6) and increased S wave depth in the right-sided leads (III, aVR, V1-3) • The thickened LV wall leads to prolonged depolarisation (increased R wave peak time) and delayed repolarisation (ST and T-wave abnormalities) in the lateral leads Left ventricular hypertrophy (LVH): • Markedly increased LV voltages: huge precordial R and S waves that overlap with the adjacent leads (SV2 + RV6 >> 35 mm). • R-wave peak time > 50 ms in V5-6 with associated QRS broadening. • LV strain pattern with ST depression and T-wave inversions in...

Article: • • • • • • • • • • • Images: • Terminology Although hypertrophic cardiomyopathy can generally describe a hypertrophied and non-dilated left ventricle due to any cause, this article focuses on hypertrophic cardiomyopathy in the absence of another systemic or cardiac disease. Epidemiology There is a slight male prevalence and is present in 1 out of 500 in the general population, probably remaining undiagnosed and asymptomatic in the majority of affected individuals 15. Associations • 12, it is defined as a gradient >30 mmHg • a gradient >50 mm Hg is often considered the threshold of hemodynamic significance 13 • often 'obstructive hypertrophic cardiomyopathy' is used when LVOT obstruction is present • most commonly occurs at the basal interventricular septum • with systolic anterior motion (SAM) of the chordal apparatus, the dynamic obstruction may occur deeper within the left ventricle • hypertrophic papillary muscles may cause obstruction in the mid-cavity • can be associated with • systolic anterior motion of the posterior leaflet, less commonly, may also occur • other secondary signs include: • • leaflet accessory tissue and elongation may also be observed • left auricle dilation • papillary muscle abnormalities • hypertrophy • direct insertion to anterior leaflet of mitral valve • antero-internal displacement Diagnosis The clinical diagnosis can be made by imaging modalities such as 17. Clinical presentation Patients present with symptoms and signs of left-pre...

Left atrial enlargement is a warning sign that one of your heart’s upper chambers is handling high pressure and too much blood. People with this issue often have high blood pressure, heart valve problems or other heart issues. Treatment varies depending on the cause. You may need medication, healthier habits or valve repair/replacement. Overview What is left atrial enlargement? Left atrial enlargement is when one of your Sometimes, you may have a problem with your left ventricle, which pumps blood to your aorta. Other people may have something wrong with their mitral valve, which lets blood move between your left atrium and left ventricle. These issues can create high pressure and/or a large volume of blood in your left atrium. Your left atrium can get larger and stretch when it tries to adapt to make up for this high pressure and/or high volume. This stretching causes scarring and injury to your atrium. It’s like a big brother who tries to help his siblings carry the load but ends up getting hurt himself. Who does left atrial enlargement affect? Left atrial enlargement affects people with: • • Mitral valve disease. • Aortic valve disease. • • Certain kinds of • • • Congenital heart disease. How common is left atrial enlargement? An Italian study of adults found that 12% of them developed left atrial enlargement during a period of 10 years. Based on this, researchers believe the condition isn’t rare in the general population. In the study, most of the people who developed ...

• There are numerous voltage criteria for diagnosing LVH, summarised below • The most commonly used are the Sokolov-Lyon criteria: S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm • Voltage criteria must be accompanied by non-voltage criteria to be considered diagnostic of LVH Voltage Criteria Limb Leads • R wave in lead I + S wave in lead III > 25 mm • R wave in aVL > 11 mm • R wave in aVF > 20 mm • S wave in aVR > 14 mm Precordial Leads • R wave in V4, V5 or V6 > 26 mm • R wave in V5 or V6 plus S wave in V1 > 35 mm • Largest R wave plus largest S wave in precordial leads > 45 mm Non Voltage Criteria • • ST segment depression and T wave inversion in the left-sided leads: AKA the left ventricular ‘strain’ pattern Pathophysiology • The left ventricle hypertrophies in response to pressure overload secondary to conditions such as aortic stenosis and hypertension • This results in increased R wave amplitude in the left-sided ECG leads (I, aVL and V4-6) and increased S wave depth in the right-sided leads (III, aVR, V1-3) • The thickened LV wall leads to prolonged depolarisation (increased R wave peak time) and delayed repolarisation (ST and T-wave abnormalities) in the lateral leads Left ventricular hypertrophy (LVH): • Markedly increased LV voltages: huge precordial R and S waves that overlap with the adjacent leads (SV2 + RV6 >> 35 mm). • R-wave peak time > 50 ms in V5-6 with associated QRS broadening. • LV strain pattern with ST depression and T-wave inversions in...

Overview Thick heart muscle reduces blood flow to the aorta What is hypertrophic cardiomyopathy (HCM)? Hypertrophic cardiomyopathy (HCM) is a complex type of heart disease that affects your heart muscle. It can cause: • Thickening of your heart muscle (especially the ventricles or lower heart chambers). • Left ventricular stiffness. • Mitral valve changes. • Cellular changes. How does hypertrophic cardiomyopathy (HCM) affect my body? Thickening of the heart muscle (myocardium) This occurs most commonly at your septum. The septum is the muscular wall that separates the left and right sides of your heart. Problems happen when the septum between your heart’s lower chambers (or ventricles) is thickened. The thickened septum may cause a narrowing that can block or reduce the blood flow from the left ventricle to the HCM also may cause thickening in other parts of your heart muscle, such as the bottom of your heart (called the apex), right ventricle or throughout your entire left ventricle. In these cases, it’s called hypertrophic nonobstructive cardiomyopathy. Although this type reduces the amount of blood your ventricle can handle, it doesn’t keep blood from moving. Stiffness in the left ventricle This occurs as a result of cellular changes that happen in your heart muscle when it thickens. Your left ventricle can’t relax normally and fill with blood. Since there’s less blood at the end of filling, there’s less oxygen-rich blood pumped to your organs and muscles. The stiffness...