ASK THE DOCTOR Exercise improves the heart’s 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.

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