To Your Good Health
DEAR DR. ROACH: I have high blood pressure. My most recent echocardiogram said I have a “hyperdynamic left ventricle,” “concentric left ventricular hypertrophy” and “abnormal left ventricle relaxation.” Is this heart failure? My doctor put me on beta blockers. Worrying about my heart gives me sleepless nights. Is it serious? — G.D.
ANSWER: When high blood pressure isn’t treated rapidly and properly, the heart undergoes changes to try to adapt to its increased workload. The heart muscle thickens (“hypertrophy”) and strengthens, so it can empty more blood (“hyperdynamic”). Unfortunately, there are several costs to these changes. One is that the left ventricle chamber wall can get so thick and stiff it cannot relax properly, which is the third point in the echo report. That translates to higher pressures inside the heart, which are transmitted to the lungs.
Abnormal heart relaxation is found in a type of heart failure called heart failure with preserved ejection fraction (the ejection fraction is the proportion of the blood in the heart that is squeezed out with each beat: It’s normally 50-75%, and yours is at the high end of that, at 72%).
The treatment is to get to and keep the blood pressure at a normal level. Some medicines appear to be more effective than others. ACE inhibitors and certain diuretics have shown in some trials to be more beneficial.
However, it’s not clear to me whether you have heart failure, which requires symptoms. The major symptom of heart failure with preserved ejection fraction is shortness of breath, especially with exertion, and fatigue. Ideally, treatment should be begun before symptoms start, to prevent symptomatic heart failure.
Tobacco cessation and weight loss, if appropriate; regular exercise; moderate salt restriction and managing cholesterol all have benefit in improving the heart (and overall health) in people with abnormal left ventricular relaxation or heart failure with preserved ejection fraction.
DEAR DR. ROACH: Many years ago, I drove a friend to visit her husband in the hospital. He was 80 and had taken a fall in their yard (no broken bones). When we got there, he was sitting upright in bed, his legs extended with his ankles resting in the cushioned cuffs of a small machine that was about the size of a foot massager. As I remember it, the cushioned part rocked from side-to-side, lifting first one leg and then the other a few inches. The object was to keep the blood circulating in the legs.
I am now 77 myself, with wonky knees, and I think I could use such a machine while resting my legs on an ottoman. I’ve searched online but cannot find one. What I did find was a similar machine that moves from side to side in a fishtailing motion. Am I misremembering what I saw? Would this machine have the same effect on circulation, or would the swishing movement exacerbate the osteoarthritis in my knees? — S.G.
ANSWER: The intermittent pressure device you saw years ago is a way to try to prevent blood clots from forming in the legs, especially in people at high risk who are unable to walk. It is not as effective as medication. It is used in people who cannot tolerate an anticoagulant, such as people who have had a major bleed.
These devices do not help arterial circulation, nor would they help or hurt your knees.