Left ventricular hypertrophy

hi guys my name is Sanjay Gupta I'm a consultant cardiologist I work in New York and one of my friends contacted me today and said could you please please please do a video on left ventricular hypertrophy and I thought I'd do this so um let me let's get started let me tell you a little bit about what left ventricular hypertrophy is um so basically I've got a model of the heart here and I'm gonna try and do it in very simplistic terms so that you understand okay then the first thing is what is left particular hypertrophy this is your heart alright your heart consists of four chambers this chamber which is the left ventricle and basically what it does is the left ventricle pumps blood through the valve be able to bulb into the aorta and that blood goes all around the body McCade goes to the kidneys it goes to the brain it goes to all the vital organs so the left ventricle is pretty important because it is the main pumping chamber of the heart it is the one that supplies the whole of the body with blood which is enriched with oxygen and to do so the left ventricle has to pump and the left ventricle then pumps through this this valve here now right the aortic valve now this has a certain dimension and usually it's no more than one centimeter thick this muscle but in some people it can get thicker and it can be much thicker than this okay it can be 2 centimeters or 3 centimeters and when it gets more thick it is considered that condition is called left ventricular hypertrophy the left ventricle is thicker ie more muscular than you would expect alright so that's what we're talking about that's what left ventricular hypertrophy refers to now the easy way to try and understand left ventricular hypertrophy is say you are the manager of a boxer okay and as a manager of your boxer you know that your boxer needs to be very strong but also needs to be very mobile it needs to be nimble-footed to do well in the ring okay now there are you you you want him to you want him to do weightlifting to get stronger but equally well you wanted to be do sort of footwork and mobility exercises and cardiovascular work to become nimble-footed and at some point you start noticing that your boxer is beginning to get more muscular okay so someone and the analogy is obviously that a doctor will come to you say and say oh your heart muscle looks a bit thicker you have left ventricular hypertrophy that is the same as someone coming to you or you as the manager turning around saying oh my boxers begin to look a bit more muscular so there's two things that are important here the first is to try and work out why your boxer is becoming it is beginning to look more muscular and the second thing you want to try and work out is what effect will it have if you have a more muscular boxer is it always good to have a more muscular boxer for the job that that boxer has to do which is to box and so let's start thinking about these two things because ultimately when you are told you have a thickened heart muscle you want to try and work out a why is it thick and to will the thickness impact on my future health will this thickness in some way affect my prognosis so the first thing to say is why is your boxer getting more muscular the most obvious cause is that he's working harder his June weight all right if he's doing weights and he's looking more muscular that's the most obvious thing so that is the same as the heart working harder against a higher pressure the heart is lifting more weight now how can the heart lift more weight well if you have a higher pressure in this blood vessel here in VA water then the heart has to pump much harder to pump blood out all right and it can do this over 10 15 20 years and because it's having to work much harder it gets thickened so the most likely reason for the majority of people to develop um a thicker heart muscle or have a more muscular bata is that the heart is working our dough the boxer is working harder he's doing more than you expect him to and if you leave that for several years then that can get worse and worse and worse so blood pressure is by far the Communist cause of left ventricular hypertrophy the second thing then is also to say well okay maybe maybe there may be another reason that he's getting more muscular if your valve here the aortic valve is narrowed okay then that causes the heart to work harder and harder and that can cause the heart to become more muscular um what about if your butter is taking something something that he shouldn't be taking let's say steroids maybe that's why he's becoming more muscular the analogy there is that if you have certain conditions such as amyloid or fabrice disease these conditions result in this in deposition of stuff within this muscle and that can make the muscle look thicker so that's another reason why people develop left ventricular hypertrophy similarly if you have kidney dysfunction then you absorb more you absorb Li you you don't get rid of things as easily if you've got kidney dysfunction you end and you have more salt rosier in your body and therefore you absorb more watery therefore you have more water in your body and the heart is having to work harder so kidney dysfunction also causes high blood pressure high blood pressure results then left ventricular hypertrophy another thing what about genetics if your boxer is genetically gifted and is just becoming more muscular as is getting older then that's the same as something called hypertrophic cardiomyopathy so some people have a genetic defect which they inherit and that can cause abnormal thickness of the heart wall Muslim alright um so those are the things to think of when someone tells you that you may have left ventricular hypertrophy you should always ask yourself why is my heart getting thicker we you don't want it to get thickened alright because when you're when your heart is getting more muscular it comes at a price now let me tell you if you're boxing becomes more and more muscular then it is that comes at a price you know he's going to be less nimble-footed alright and that's who I'll be builders do and make very good boxers because although they're really hypertrophy they've got real lots of muscle mass they can't move as quickly they're not as flexible and that is the big problem with left ventricular hypertrophy the more muscular the heart gets then stiffer it gets the less compliant it gets so so you don't want left ventricular hypertrophy and if you have left ventricular hypertrophy you have to ask yourself why did I get it because tackling the cause will help get rid of the left ventricular hypertrophy so if you're found to have left ventricular hypertrophy it's always a good idea first to ask someone to do a 24-hour blood pressure monitor on you make sure that your blood pressure isn't elevated because if it is treating it will help up get the left ventricular hypertrophy down okay number two um you want someone to do a heart scan to make sure your heart you know that you don't have this this narrowed aortic valve because if it is narrowed then treating that will help get rid of the left trickle hypertrophy similarly you want someone to make sure that your kidney function is normal okay and of course it's also important to know your family history and if there is no other condition found that for the left ventricular hypertrophy then you have to ask yourself could it be this thing called hypertrophic cardiomyopathy which I've in which people can inherit from from family members so you need to know if there's anyone else in the family who may have this condition but it's always good if you're found to have left ventricular hypertrophy to make sure you have an answer as to why the heart is becoming more muscular why is this boxer why is your boxer becoming more muscular okay now why is that important it's important because some of the conditions that cause left hypertrophy can be dangerous if you have high blood pressure high blood pressure is associated with strokes high blood pressure can cause heart attacks if you have a optic stenosis then that can get worse and worse and actually can cause the heart yeah it can cause you to blackout can cause the heart to weaken with time if you have kidney dysfunction then that could get worse so if you have this thing called amyloid or Febreeze disease then that can reflect another problem somewhere else and cause the heart to weaken so the conditions that can cause left ventricular hypertrophy are dangerous in their own right and therefore it's important that they're identified so let them take lipoatrophy can sometimes be a very helpful sign of something else going on in the body which main itself be dangerous and therefore by identifying the left ventricular hypertrophy by looking for the causes of the left ventricular hypertrophy you may identify a condition that you can potentially treat and thereby and not be susceptible to the dangers of that condition such as you know long-standing uncontrolled high blood pressure okay so that's one of the things and it is also true to say that if you have left ventricular hypertrophy then generally people say that your prognosis is not as good as if you don't have left ventricular hypertrophy in the long run okay and that is largely because of the conditions that have caused the left ventricular hypertrophy although the left ventricular hypertrophy itself can also play a role and I'll explain why but you know so if your left ventricular hypertrophy is caused by high blood pressure then of course people who have high uncontrolled blood pressure don't do as well in the long run unless it's very well controlled as someone who has no high blood pressure so you know research papers come out and say let them take lipoatrophy associated with the poor prognosis but what they actually mean is high blood pressure uncontrolled high blood pressure which is also causing the left ventricular hypertrophy and is associated with the pro progress but there is the other aspect of it is that well if you have left ventricular hypertrophy then can the left ventricular hypertrophy itself by itself not the condition that's causing it but by its self caused you any harm and the answer is yes it can and there are a variety of things that can do okay so I'm going to explain to you so the first thing to say is that if you have a very muscular boxer okay he's not going to be as nimble footed and therefore a hypertrophied heart okay a hypertrophic heart is generally a stiff heart it usually it contracts very well but it doesn't relax as easily okay so when the heart is there for filling with blood you've only got a certain amount of time before the next heart beat and if the heart is stiff it doesn't fill with as much blood as it should okay so although it is very good at pumping blood out it doesn't actually fill with much blood and therefore because it doesn't filled with much blood it has less blood to pump out and because it has less blood to pump out therefore what you will start getting is signs of a lack of blood to the vital organs such as the kidneys the kidneys will not necessarily over a number of years get as much blood as they are used to because over a number of years the thicker heavier um muscle of the heart is not relaxing as well it's not filling with that much blood it's therefore not pumping as much blood out it's pumping fine it's just if it's got less blood in it it's gonna pump less blood out okay so the kidneys will then detect that and they gave they go into a different kind of mode when they detect that and they will start saying well oh maybe this person is dehydrated maybe that's why we're not getting as much blood as we should and they will therefore start absorbing more fluid in your body they will activate various hormones which work towards um tightening up your blood vessels so that more pressure is generated to perfuse the kidneys okay so it propagates itself after a little while and that's bad because you know you get into this vicious cycle your your kidneys are absorbing more they're secreting more hormones than home they're absorbing more water that's overloading the hearts are you giving the heart more and more work to do and you're making it stiffer and you're not allowing the heart to relax so less relaxation more volume eventually what happens eventually what will happen is after a certain point you start over leading the heart so much that the heart actually starts weakening ok so left ventricular hypertrophy if left unchecked over a long period of time will result in the heart actually paradoxically weakening and the same thing could be said for your boxer you know he trains he keeps training he keeps training he keeps training but if he's training too much at some point his muscles will paradoxically start weakening rather than strengthening up the second problem is that the heart muscle relies on blood all right so this heart muscle needs blood which is supplied by these heart arteries all right and you only have a certain number of heart arteries of course over a number of years you will try and develop small vessels to try and supply this extra muscle that you've built by working harder but at some point what will happen is that the muscle will grow so thick that it will start out stripping its blood supply and if muscle doesn't get blood then muscle starts dying so what will happen is the muscle will get bigger bigger bigger bigger and then it will start not it will get so big that it's not getting enough oxygen and that can therefore lead to the bits of the heart muscle then weakening because they're not getting enough blood so the bits of heart muscle start dying and you start developing a weak heart so that's the other problem with left ventricular hypertrophy the third thing to say with left ventricular hypertrophy is that the heart muscle um remember what's happening over here okay you have the atria here this is where the blood comes in into the ventricle the ventricle then pumps the blood through the valve now if the ventricle is stiff and it doesn't open very much then the pressure in this cavity is going to be high because they're still you know it's just not opened as well so what happens is the blood which would normally just come in flow in can't flow in as easily and therefore there's more reliance on the atria the top chamber of the heart to pump the blood in okay usually what happens is the heart relaxes blood just comes through the atrium and by a suction effect and fills the ventricle and then the atrium contracts slightly towards the end to try and push a little bit more blood in however if blood isn't coming in by suction passively because the pressure here is high there's a greater reliance on the a trim to calm blood in normally the atrium will only pump around about ten or fifteen percent of all the blood into the left ventricle the rest 85% of it will come in passively but in people who have severe left ventricular hypertrophy what happens is only say 50% of the blood will come in passively and the rest of it has to be comped in by the atreus that means that the atria has to work harder and harder and over a period of time the atria because it's a thin walled structure will dilate when it dilates it becomes weak when it becomes weak it becomes flabby and when it becomes flabby it stops working and that condition is called atrial fibrillation so left ventricular hypertrophy exposes the atria to left atrial dilatation and as the atria gets bigger it becomes weaker and eventually you develop atrial fibrillation and now the problem is the atrial fibrillation is bad for people who have severe left ventricular hypertrophy for a lot of reasons one is that suddenly you know you're used to having the atria from 50% of the blood into this left ventricle and the atria if that stops working then you're pumping so much less blood out because so much less blood is actually filling into the left ventricle so people who have left severe left ventricular hypertrophy who develop atrial fibrillation don't like the atrial fibrillation because it suddenly results in a lot less blood coming out to the cart and that's why it's a problem the second thing to say is of until you develop atrial fibrillation you can still get a lot of atrial ectopy ik topics and a lot of people with significant left ventricular hypertrophy will complain with ectopic beats for a few months years and then eventually go into atrial fibrillation and the good news is like with your boxer if you tell him to keep off the weights then the left ventricular hypertrophy can regress and therefore it becomes really crucial that you identify what the cause of the left ventricular hypertrophy is and you get treated aggressively and if you're treated aggressively you take that extra pressure off the heart the left ventricular hypertrophy will start progressing another group that develops left ventricular hypertrophy is athletes people who are working really hard placing great demands on their body they can develop something called an athletic heart which is rarely and very dramatic it just causes a mild thickness of the left ventricle but it can sometimes predispose people to developing it topics etc and in that case three or six months of detraining stopping the exercise D training or reducing going on your form OD training program gradual reduction in exercise will result in regression of the left ventricular hypertrophy alright so this was for Rosalind my friend and I hope this answers some of your questions now I just wanted you to see my website address my website is your cardiology coach UK I have a Facebook page and this is me so I'm really grateful to you all for taking a time out to listen to my videos if you found this useful please consider subscribing all the best take

Channel: York Cardiology

Views: 46,127

Rating: 4.9103141 out of 5

Keywords: #hangoutsonair, Hangouts On Air, #hoa, lvh, left ventricular hypertrophy, cardiomyopathy, enlarged heart, thickened heart muscle, hypertension

Id: JfOFKpZWFoU

Length: 19min 31sec (1171 seconds)

Published: Sun Apr 24 2016