Acute LVH and hypertension are one of the most common health problems found in all kinds of population found worldwide. Hence, providing some basic yet important information for all medical workers and approachers through my work

1. Acute Left Ventricular
Hypertrophy

2. Introduction
LVH is defined as an increase in the mass of the left ventricle, which
can be secondary to an increase in wall thickness, an increase in
cavity size, or both.
LVH is a term for a heart’s left pumping chamber that has thickened
and may not be pumping efficiently. Sometimes problems like aortic
stenosis or high blood pressure overwork the heart muscle. In
response to this pressure overload inside the heart, heart muscle
cells may respond by getting thicker along the inner walls of the
heart. This thickened wall can cause the left chamber to weaken,
stiffen and lose elasticity, which may prevent healthy blood flow.

3. CAUSES
▪ LV hypertrophy can be related to a multitude of cardiac or systemic diseases such as
hypertrophic cardiomyopathy (HCM) that can lead to Heart failure, cardiac amyloidosis,
Anderson-Fabry disease, and hypertensive heart disease.
▪ While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and
strength training (Athletic heart) , it is most frequently referred to as a pathological
reaction to cardiovascular disease, or high blood pressure.
▪ Causes of increased afterload that can cause LVH include aortic stenosis, aortic
insufficiency and hypertension.
▪ Neurohormonal alterations-angiotensin 2 norepinephrine, epinephrine, sympathetic NS.
▪ Risk factors- Age, gender, genetic factors {genes that modify motor unit composition
and regulation, (2) genes that modify energy metabolism, and (3) genes that encode
components of hormonal pathways (eg, atrial natriuretic peptide, angiotensin
converting enzyme). }, obesity and high blood pressure (140/90 mm hg).

4. Classification-
According to Morphological changes

5. According to cause
Asymmetric left ventricular hypertrophy -
associated with morbid obesity mimicking familial
hypertrophic cardiomyopathy (HCM) with or
without obstruction. It can be associated
nonspecifically with other forms of increased left
ventricular (LV) afterload.
According to severity-

6. Pathogenesis

7. Clinical Presentation
▪ Patients with LVH due to continuous pressure overload (aortic stenosis) or volume
overload (mitral regurgitation) may remain in a compensatory phase with no
symptoms and normal or near-normal exercise reserve for years. Others have a
transition to heart failure that may be due to diastolic dysfunction, systolic dysfunction,
or both.
▪ Symptoms- Angina, dyspnea and syncope on effort; shortness of breath; dizziness;
fainting; rapid exhaustion.
▪ Signs-Jerky pulse, double impulse at the apex (palpable 3rd and 4th heart sounds), bifid
carotid pulse.
▪ Auscultation- Midsystolic murmur at base
-Pansystolic murmur (due to MR) at apex

8. Diagnosis
The principal method to diagnose LVH is echocardiography, with which the thickness of the muscle of the heart
can be measured. The electrocardiogram (ECG) often shows signs of increased voltage from the heart in
individuals with LVH, so this is often used as a screening test to determine who should undergo further testing.
-Grading by posterior wall thickness
Mild12 to 13 mm
Moderate>13 to 17 mm
Severe>17 mm
-Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as
visualized on echocardiography correlates with its actual mass. Average thickness of the left ventricle, with
numbers given as 95% prediction interval for the short axis images at the mid-cavity level are:
Women: 4 - 8 mm
Men: 5 - 9 mm

9. ECG criteria
▪ There are several sets of criteria used to diagnose
LVH via electrocardiography. By using multiple
criteria sets, the sensitivity and specificity are
increased.
▪ The Sokolow-Lyon index:
-S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm
(≥ 7 large squares)
-R in aVL ≥ 11 mm
▪ The Cornell voltage criteria for the ECG diagnosis of
LVH involve measurement of the sum of the R wave
in lead aVL and the S wave in lead V3. The Cornell
criteria for LVH are:
-S in V3 + R in aVL > 28 mm (men)
-S in V3 + R in aVL > 20 mm (women)

10. The Romhilt-Estes point score system ("diagnostic" >5 points; "probable" 4 points):
ECG Criteria Points
1.Voltage Criteria (any of):R or S in limb leads
≥20 mm
2.S in V1 or V2 ≥30 mm
3.R in V5 or V6 ≥30 mm
3
•ST-T Abnormalities:ST-T vector opposite to QRS
without digitalis
•ST-T vector opposite to QRS with digitalis
3
1
Negative terminal P mode in V1 1 mm in depth and
0.04 sec in duration (indicates left atrial
enlargement)
3
Left axis deviation (QRS of -30° or more) 2
QRS duration ≥0.09 sec 1
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec) 1

11. ECG 1

12. ECG 2

13. ECG 3

15. ▪ Cardiac MRI

16. Treatment
▪ The enlargement is not permanent in all cases, and in some cases the growth can
regress with the reduction of blood pressure. It’s treatment depends on underlying
cause and involve medication and surgery.
▪ Aortic valve stenosis treatment
Left ventricular hypertrophy that is caused by aortic valve stenosis might require surgery
to repair the narrow valve or to replace it with an artificial or tissue valve.
▪ Hypertrophic cardiomyopathy treatment
Left ventricular hypertrophy due to hypertrophic cardiomyopathy may be treated with
medication, a nonsurgical procedure, surgery, implanted devices and lifestyle changes.

17. Pharmacological treatment
-Hypertension medication might also help prevent further enlargement of the left ventricle and
even shrink your hypertrophic muscles. Your doctor might recommend medications including:
1) Angiotensin-converting enzyme (ACE) inhibitors. These medications widen blood vessels to
lower blood pressure, improve blood flow and decrease the heart's workload. Examples include
captopril, enalapril (Vasotec) and lisinopril (Zestril). Side effects might include an irritating dry
cough.
2) Angiotensin II receptor blockers (ARBs). Medications such as losartan (Cozaar) have benefits
similar to ACE inhibitors but don't cause a persistent cough.
3) Calcium channel blockers. These medications prevent calcium from entering cells of the heart
and blood vessel walls, resulting in lower blood pressure. Examples include amlodipine (Norvasc)
and diltiazem (Cardizem, Tiazac).
4) Diuretics. Medications known as thiazide-type diuretics can facilitate blood flow, lowering
hypertension. Examples include chlorthalidone and hydrochlorothiazide.
5) Beta blockers. Medications such as atenolol (Tenormin) can lower your heart rate, reduce blood
pressure and prevent some of the harmful effects of stress hormones. Beta blockers aren't usually
given as an initial treatment for hypertension. Your doctor might recommend adding a beta
blocker if another type of medication isn't effective alone.

18. Non Pharmacological treatment
-Sleep apnea treatment - involves using a machine that provides continuous positive
airway pressure (CPAP) while you sleep. CPAP keeps your airways open, allowing you to
get the oxygen you need to keep your blood pressure at a normal level.
- Strategies to control blood pressure in LVH due to high blood pressure (hypertension)-
recommend heart-healthy lifestyle changes, including:
-Regular exercise
-A diet high in fruits, vegetables, whole grains and good fats, and reduced amounts of
refined carbohydrates, sodium and saturated fats; supplementations with fish oil,
potassium, calcium, and fibers that helps decrease weight.
-Smoking cessation, avoid alcohol

19. THANK YOU!!