Heart wall can thicken with BP

Dear Dr. Roach: What is the difference between eccentric LVH and concentric LVH? Which one is more dangerous and needs more attention? My mother was diagnosed with severe eccentric LVH for body surface area with adequate systolic and diastolic functions. — C.F.

The left ventricle is the chamber of the heart that pumps blood to the entire body, except for through the lungs; that is the job of the right ventricle. When the job is too hard, usually because of high blood pressure, the left ventricle hypertrophies, meaning its walls get thicker as a response to the increased workload. That hypertrophy can be symmetrical (concentric) or asymmetrical (eccentric). Early on, the left ventricle can still do its two jobs: It can push out all the blood the body needs (systolic function), and relax under low pressure (diastolic function). Your mother has adequate systolic and diastolic function; she is not in heart failure.

If not treated, it tends to get worse. Usually the diastolic function fails first, and the left ventricle, being thick and stiff, requires higher pressure to relax properly and allow the blood to flow in from the left atrium. The major symptom of diastolic heart failure is shortness of breath. Some people may progress to having both systolic and diastolic failure, where fatigue becomes a major symptom. Leg swelling and increasing nighttime urination are additional symptoms.

It’s not good to have either, but cardiac physiologists note that concentric LVH gives the heart less ability to adapt to increased stress and has a worse prognosis. Both situations need to be treated as rapidly as possible to allow the heart to return to a more normal state. Blood pressure reduction is the primary treatment. Some blood pressure medications are more effective than others in helping the heart return to a normal state.