Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association | Circulation

What Causes Left Ventricular Hypertrophy (LVH) And How To Treat It

Left ventricular hypertrophy (LVH) is an increase in the mass (weight) of the left ventricle, which is the heart's main pumping chamber. LVH develops either when the force or volume of blood within the ventricle becomes excessive. Common conditions that cause LVH are high blood pressure and aortic stenosis (a heart valve disease).

Since LVH often manifests silently over many years, it's frequently diagnosed through a routine electrocardiogram (ECG). LVH can usually be reduced or reversed by treating the underlying cause, which entails adopting healthy lifestyle behaviors and taking medication or undergoing surgery.

Illustration by Zoe Hansen for Verywell Health

What Causes Anatomical Changes in LVH? The left ventricle is one of the heart's four chambers. It pumps oxygen-rich blood into the aorta, the largest artery in the body that delivers blood to vital organs. Over time, the left ventricle undergoes natural remodeling, a process influenced by non-modifiable factors like normal aging and ethnicity and modifiable risk factors like high blood pressure (hypertension), diabetes, obesity, and metabolic syndrome (a group of conditions that occur together to increase risk of type 2 diabetes, stroke, and heart disease). Left ventricular hypertrophy is a type of heart-related remodeling that involves an increase in the mass of the left ventricle. LVH is a response to one or both of the following: Blood pressure overload within the LV causes an increase in wall thickness. Blood volume overload within the LV ventricle causes an increase in the chamber size. Associated Conditions Two of the most common causes of LVH are: Hypertension is when blood's force, or impact, on artery walls is too high. Hypertension creates increased pressure within the left ventricle, causing the heart muscle to thicken as it works extra hard to pump blood into the aorta. Aortic stenosis narrows the aortic valve, interfering with blood flowing from the left ventricle into the aorta. The increased pressure within the left ventricle causes the walls to thicken. Other causes of LVH include: Aortic regurgitation is when the aortic valve leaks, causing blood to reverse its flow (in the wrong direction) back into the left ventricle. Mitral regurgitation occurs when the mitral valve leaks, causing blood to reverse its flow (in the wrong direction) back into the left atrium (the upper chamber above the left ventricle). Dilated cardiomyopathy is characterized by stretching and enlargement of the ventricles (usually starting in the left and spreading to the right). Possible causes of this condition are coronary artery disease, alcohol, and infection. Hypertrophic cardiomyopathy is a condition that runs in families and is characterized by thickening of the walls of the left ventricle. This condition is the most common cause of sudden cardiac death in young individuals and competitive athletes in North America. A ventricular septal defect is a hole in the wall between the right and left ventricles. It's the most common congenital (present at birth) heart disease. With a large VSD, blood wrongly flows from the left to the right ventricle, overwhelming the lung arteries and the left side of the heart. The left ventricle increases in size to compensate for the extra blood. An "athlete's heart" refers to heart-related changes in athletes that manifest as an adaptation to intense physical training. Even though these heart-related changes can meet the criteria for left ventricular hypertrophy, they are considered harmless, as they differ pathologically from those caused by high blood pressure, for example. Symptoms and Onset Left ventricular hypertrophy usually causes no symptoms for many years. Over time, as the left ventricle thickens and/or enlarges, the heart muscle becomes weaker and stiffer and is unable to pump blood very well. Left-sided heart failure may then occur, causing the following symptoms: How Serious Is LVH? LVH is a concerning finding because it indicates that a person's heart is working harder than usual. Depending on the severity of the LVH and its cause, the heart may not be pumping blood efficiently. In addition to heart failure, LVH is associated with the following complications: ECG Findings An electrocardiogram (ECG or EKG), which assesses the heart's electrical activity, is a readily available tool to detect LVH. During an ECG, a person lies on a bed or table, and small, sticky pads are strategically positioned on the chest, arms, and legs. Wires attach the pads to a machine, translating the heart's electrical activity onto paper. The paper is divided into large and small boxes to calculate time and distance. The heart's electrical activity appears like wavy, spiky lines on the paper. These lines consist of the following three parts: The P wave represents blood being pumped from the atria (the heart's upper chambers) into the ventricles (the heart's lower chambers). The QRS complex consists of three waves and represents blood being pumped out of the heart (into the lungs or the aorta). The T wave represents the ventricles relaxing before the above "pumping blood" cycle repeats itself. Many different criteria for ECG findings in LVH have been developed, although five general findings of LVH are: An elevation of the QRS voltage (height of the waves) occurs because there are more muscle fibers within the left ventricle for the electrical signals to travel through. The QRS complex widens because electrical signals travel a longer path within the left ventricle. Left axis deviation occurs because the direction of the electrical activity moving through the heart is distorted towards the left. ST changes occur when electrical signals move differently through the left ventricle due to its remodeling. This finding can mimic that seen with an ST-elevation ("STEMI") heart attack (when an artery that feeds the heart muscle is completely blocked). Left atrial abnormality is seen with thickening, widening, or both of the left atrium, occurring as a response to chronic left ventricular hypertrophy. Keep in mind that while an ECG is a reasonable "first-step" tool for identifying LVH and eventually monitoring LVH, imaging tests can more accurately diagnose the condition and its underlying cause. These imaging tests include: An echocardiogram is an ultrasound of the heart muscle. It uses sound waves to visualize the heart's size, shape, thickness, movement, pumping ability, and how well the valves are working. Cardiac magnetic resonance imaging (MRI) uses magnetic fields and radio waves to produce three-dimensional images of the heart. It offers a more precise evaluation of left ventricle structure and function than an echocardiogram. Does Treatment Reverse LVH? Depending on the cause, LVH can be reduced or reversed—a term called LVH regression. For example, if LVH is caused by high blood pressure, lowering the blood pressure can lead to LVH regression. Even better, research suggests that LVH regression improves cardiovascular prognosis with intensive blood pressure lowering, specifically maintaining a blood pressure lower than 120/80 mm Hg (millimeters of mercury). Classes of medications used to lower blood pressure include: Similarly, if LVH is caused by a heart valve problem, like aortic stenosis, surgery to repair or replace the valve may be performed to achieve LVH regression and improve the heart's functioning. Bottom Line: LVH Regression Improves Prognosis Achieving LVH regression through medication or surgery decreases the risk of severe complications like heart attack and stroke. Importance of Lifestyle Changes and Habits If you or a loved one has LVH, treatment is directed at managing or fixing the underlying cause. While medication and/or surgery may be indicated, adopting heart-healthy lifestyle behaviors also plays a key role. Heart-healthy behaviors include: Maintaining a healthy weight Exercising (under the guidance of a healthcare provider if you have heart/lung/joint or other health problems) Eating heart-healthy foods like fruits and vegetables and limiting excess salt Avoiding smoking and limiting or avoiding alcohol Appropriately managing causes of underlying LVH causes (e.G., taking high blood pressure medication as instructed) Summary Left ventricular hypertrophy (LVH) is an increase in the weight of the left ventricle due to thickening of the left ventricle walls, an increase in space within the left ventricle, or both. The two most common causes of LVH are high blood pressure and aortic stenosis (a heart valve disease). LVH symptoms are usually silent for years until the heart weakens and stops pumping blood efficiently. Once the left heart begins to fail, symptoms like trouble breathing, chest pain, fatigue, and dizziness develop. LVH can be diagnosed with an electrocardiogram (ECG), echocardiogram (ultrasound of the heart), or a cardiac MRI (three-dimensional images of the heart), usually before symptoms even develop. LVH can often be fixed by treating the underlying cause—for example, intensively lowering high blood pressure or repairing/replacing a faulty aortic valve. Engaging in heart-healthy habits like weight loss if overweight or having obesity and staying physically active are also essential to maintaining a structurally and functionally healthy left ventricle. If underlying causes of LVH are not addressed, potentially life-threatening problems may develop, like heart attack, stroke, or abnormal heart rhythms.

Clogged Arteries Diet: 5 Red Superfoods To Cleanse Heart Arteries And Prevent Stroke Naturally

Clogged arteries diet tips: Here are the top 5 red superfoods that can help cleanse the arteries and prevent a stroke. Clogged Arteries Diet: 5 Red Superfoods To Cleanse Heart Arteries And Prevent Stroke Naturally

Diet for Clogged Arteries: Clogged arteries, also known as atherosclerosis, is a serious health condition that can lead to major cardiovascular health problems including heart attack, cardiac arrest and stroke. One of the main culprits behind arterial blockages or blocked arteries, is the accumulation of cholesterol and fat, which can hinder blood flow. Thus, it is important to understand how following the right diet can affect heart health to fend off these issues. In this article, we will look at the 5 red superfoods that can help clear clogged arteries and boost overall heart health.

5 Red Superfoods To Cleanse Heart Arteries And Prevent Stroke

If you are at risk of developing any such health conditions, make sure to the below-mentioned red-coloured superfoods to your daily diet routine. These foods are rich in antioxidants that help in removing/flushing out toxins (including cholesterol) from the body, thus keeping the heart healthy.

Beetroot

Beets are a powerhouse when it comes to cleaning out clogged arteries. Loaded with nitrates, they enhance blood flow and lower blood pressure. Beets are also rich in antioxidants that work to reduce inflammation. Regularly including beets in your meals can improve the flexibility of your blood vessels, making them less vulnerable to blockages.

Tomato

Tomatoes stand out as another excellent red superfood for heart health. They're high in lycopene, an antioxidant known to help lower cholesterol and reduce the risk of heart disease. Cooked tomatoes have an even higher lycopene concentration, making them a valuable addition to your diet. Using tomatoes in various dishes can also shield your arteries from harm.

Red Bell Peppers

Red bell peppers are vibrant and flavorful, and they're also incredibly nutritious. They contain hefty amounts of vitamin C and antioxidants that help lower inflammation and oxidative stress in the body. The fiber found in red bell peppers is another plus, as it supports cholesterol management. Tossing red bell peppers into salads or stir-fries can greatly enhance your meals.

Raspberries

Raspberries are a delicious red superfood packed with health benefits. Their high dietary fiber content helps lower cholesterol levels and supports heart health. Additionally, they are rich in antioxidants that combat free radicals, which can damage arteries. Snacking on a handful of raspberries or blending them into smoothies is a tasty way to elevate your heart health.

Watermelon

Watermelon isn't just a refreshing treat; it's also good for your heart. It contains citrulline, an amino acid that enhances blood flow and helps lower blood pressure. Plus, watermelon's high water content is great for hydration, which is essential for healthy blood circulation. Including watermelon in your diet can aid in cleaning out your arteries while keeping you well-hydrated.

Home Remedies For Preventing Stroke Due To Clogged Arteries

Although the above-mentioned superfoods are natural and safe for consumption, you must consult a doctor or a dietician before making any changes to your daily diet routine. Superfoods are exceptionally nutritious foods offering a host of health advantages. Thus, not only for the heart, adding these foods to your diet can also help in keeping your overall health under check.

You must also have proper knowledge about the signs of artery blockage to ensure timely medical intervention Stay attentive to your body and reach out to healthcare professionals whenever needed. Remember that your legs and feet serve as vital indicators of your cardiovascular health. Don't overlook any concerning signs; they might be your body's way of signalling a serious issue that demands your attention.

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Abbott Kicks Off New Trial Aiming To Improve Heart Failure Outcomes With CardioMEMS, HeartMate 3

The HeartMate 3 LVAD. [Image courtesy of LVAD]Abbott (NYSE:ABT) announced today that it launched a new, first-of-its-kind clinical trial designed to help heart failure patients with advanced therapy options.

The company plans to utilize its CardioMEMS HF system to identify advanced heart failure patients at high risk of mortality. This could then identify those who could benefit from a HeartMate 3 left ventricular assist device (LVAD) earlier in their disease progression.

Implanted in a catheter-based procedure, the CardioMEMS HF system remotely monitors pulmonary artery pressure (PAP) changes. It works to provide an early warning of worsening heart failure.

HeartMate 3 helps the heart pump blood when it fails to pump blood effectively on its own. The devices work by mimicking the pumping function of the heart's left ventricle. The devices divert blood from the weakened left ventricle and propel it into the body's main artery to help circulate blood throughout the body.

Abbott plans to enroll 850 patients across 75 sites worldwide in its TEAM-HF trial. Using CardioMEMS HF to measure PAP, investigators can objectively identify those who might benefit from a HeartMate 3.

"The goal of the TEAM-HF trial is simple in concept but critical to the future care of patients. We want to break down patient care silos, offering a unified effort to not only improve the diagnosis of advanced heart failure but also enable rapid access to life-saving heart pumps. This study aims to take the guesswork out of deciding when a patient has reached the ideal time for LVAD implementation," said Dr. Jennifer Cowger, medical director of mechanical circulatory support and section head of the advanced heart failure program at Detroit-based Henry Ford Health, and one of the national co-principal investigators for the TEAM-HF trial.

More about the first-of-its-kind Abbott trial

Abbott says TEAM-HF will deploy a novel approach to assess the impact of earlier interventions in patients with worsening heart failure.

First, investigators plan to examine PAP data securely collected from CardioMEMS HF. If pressures fail to go down with guideline-directed medical therapy, the trial seeks to prove that patients would benefit from advanced therapies. Investigators then expect to randomize those patients to receive either the HeartMate 3 or continued treatment with their existing medications.

Patients whose existing medications reduce their PAP levels will enter a single-arm registry, where they'll continue to be managed based on data from their CardioMEMS sensor.

Abbott expects to commence enrollment in TEAM-HF across U.S. Sites shortly. It plans to evaluate the powered primary and secondary endpoints at two years, with long-term follow-up through five years.

"As the only healthcare company in the world that has developed medical devices designed to treat people at each stage of heart failure, our hope is that the TEAM-HF study will revolutionize care management for these patients and their families. Getting people on a heart pump more quickly could mean more time spent out of the hospital and with loved ones," said Keith Boettiger, VP of Abbott's heart failure business. "By having more objective methods to accurately gauge heart failure progression and refer people to receive this life-saving therapy faster, healthcare experts will be able to provide patients with improved survival rates and quality of life based on the anticipated results of the TEAM-HF study."

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