How to Manage Enlarged Heart?
Left ventricular hypertrophy (LVH) is the heart’s response to hypertension, increased filling loads, or both. Therefore, management is designed to treat the underlying causes of these predisposing factors. Their successful treatment, consequently, will also treat LVH.
Hypertension is often associated with obesity and the metabolic syndrome, lipid (cholesterol and triglyceride) abnormalities, smoking, stress, family history, age, and a sedentary lifestyle. Although age and genetics are not treatable, the others are. When the other factors are addressed, the impact of the unalterable age and genetic factors become less.
- Obesity is addressed with weight management, diet, nutritional counseling, and exercise
- Lipid abnormalities can be treated with statin drugs, which decrease the amount of cholesterol made in the liver and interfere with its absorption from the gastrointestinal tract
- Sedentary lifestyle can be altered with only minimal–but routine–activity and exercise each day
- Smoking must stop, but the addiction is very strong, sometimes needing medication to help (e.g., verenicline–Chantix)
- Stress can be managed via identifying stressors and learning strategies for reducing them. Professional psychological therapy can be very useful
- Hypertension itself, when the above conservative measures fail, can be treated with antihypertensive medications
The heart valves are designed to assure a one-way flow through the heart chambers. They ensure that once blood is forced into the next chamber from the atria, or to the pulmonary artery or aorta from the ventricles, that it won’t flow back. When these valves fail, retrograde flow-back is what occurs, and this leaves extra volumes of blood for the muscle fibers to deal with. As a result, they hypertrophy, i.e., they increase in size in compensation for the extra demand of this load for effective pumping.
To stop this process, heart valve disease can be treated with valve repair or replacement. Repair can be done percutaneously (i.e., by threading catheters to render balloon dilation at target sites of stenosis) or via surgical “commissurotomy,” to open the calcified leaflets of the valve; replacement can be with a biological prosthesis of donor tissue or a mechanical valve implant. Valve replacement often requires anticoagulation (blood clotting) therapy as part of the treatment.