Left ventricular hypertrophy (LVH): what it means, causes and treatment

The left ventricle is the heart's main pumping chamber. The BHF says left ventricular hypertrophy is when its walls become thickened and stiff, and that this can make it harder for the heart to pump blood around the body. It is a finding on a scan or tracing rather than a disease in itself, which is why the next step is always to find out why the wall has thickened.

The BHF explains that LVH is often caused by conditions that make the heart work harder, such as high blood pressure, or by an inherited heart condition called hypertrophic cardiomyopathy.

LVH itself may cause no symptoms and is often discovered on a scan done for another reason. When symptoms do occur, they depend on the underlying cause. For hypertrophic cardiomyopathy, the BHF says most people have no symptoms or feel stable throughout their life, while others have:

• chest pain

• light headedness and fainting

• palpitations (feeling your heartbeat pounding or beating more quickly than usual)

• shortness of breath

• fatigue (getting tired easily)

• swelling of the legs, feet, ankles and abdomen

The BHF names two main groups of cause: conditions that make the heart work harder, with high blood pressure the example it gives, and the inherited condition hypertrophic cardiomyopathy (HCM).

The NHS says high blood pressure puts extra strain on the blood vessels, heart and other organs, and that untreated it can increase the risk of serious conditions including heart disease, heart attacks, strokes and heart failure.

The NHS describes hypertrophic cardiomyopathy as a condition in which the heart muscle cells enlarge and the walls of the heart chambers thicken, thought to affect 1 in 500 people in the UK, and most people inherit it from their parents. The BHF adds that it is a genetic condition caused by a change in one or more genes, that the left ventricle is almost always affected, and that how thick the muscle is, and how much of it is affected, differs for everyone.

The BHF says an echocardiogram can pick up LVH. An echocardiogram is an ultrasound scan that uses sound waves to create images of the heart.

For suspected hypertrophic cardiomyopathy, the BHF lists the most common tests as a physical assessment (listening to the heart and lungs and checking blood pressure and pulse), an ECG, an echocardiogram, an exercise test and an MRI scan. If HCM is suspected you may be offered a genetic test, and close relatives may be asked to be tested too.

Your own results depend on measurements that a cardiologist can explain in context, such as how thick the wall is and how well the heart is working, so ask for a copy of your report.

Treatment depends on the cause. When high blood pressure is responsible, the NHS says a GP will usually prescribe medicine if blood pressure is very high, you are at higher risk of problems such as a heart attack or stroke, or your blood pressure is still high after lifestyle changes. It also says that lowering your blood pressure even a small amount can help reduce your risk of problems.

For hypertrophic cardiomyopathy, the BHF says there is currently no cure but treatments can help control symptoms and prevent other health issues. It lists medicines such as diuretics, beta blockers and cardiac myosin inhibitors, an ICD or CRT if you are at risk of a life-threatening abnormal heart rhythm, a pacemaker, catheter ablation for some arrhythmias, an LVAD, and septal myectomy, a type of heart surgery to remove part of the thickened wall.

The BHF says many people with HCM feel fine and have little or no symptoms, and those with symptoms find that they are managed well with treatment.

The BHF says people with HCM may be more at risk of abnormal heart rhythms such as atrial fibrillation or heart block, and there is a rare risk of a life-threatening abnormal rhythm that can cause cardiac arrest and sudden death, which is why diagnosing HCM matters. Other risks include endocarditis (infection of the inner lining of the heart) and a leaky mitral valve.

The NHS says hypertrophic cardiomyopathy is the most common cause of sudden unexpected death in childhood and in young athletes, though in most cases it will not have an impact on daily life. It says that if you have severe HCM your doctor will advise on the level of exercise you can do and recommend lifestyle changes.

See a GP if you have breathlessness, chest pain that comes and goes, palpitations that keep coming back, swollen ankles or feeling faint. If you have a high blood pressure reading, follow your GP's advice about medicines and regular checks.

The NHS says to call 999 if you have sudden chest pain or discomfort that does not go away, pain that spreads to your arm, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light headedness or shortness of breath, because you could be having a heart attack.

On the NHS, LVH is usually found on an ECG or echocardiogram arranged by a GP or hospital. A cardiologist investigates the cause, and inherited heart conditions clinics handle genetic testing and family screening. Some people choose a private cardiology review and echocardiogram for faster access. Ask for a written summary of the cause and plan, and share results with your GP so blood pressure and other conditions are managed together.