Patient's Query
Hi doctor,
Four months ago, I had an echocardiography that showed left ventricle hypertrophy. I recently did another echocardiography, which now shows left and right ventricle hypertrophy with RAE (I have attached the new and old echocardiography reports). I am concerned about this progression and would like to know how fast this typically progresses to heart failure.
I understand controlling blood pressure is the goal, though my blood pressure is not that high. What would cause the right ventricle to enlarge in such a short time? How serious is this in the long term? What is the prognosis time frame for this progress? I have a family history of heart disease, but I am only 38. So far, they are saying there is no heart failure yet. Are there statistics on timeliness for progression? I am asymptomatic, but this is very stressful, and I need to fully understand the seriousness.
Do I need cardiac magnetic resonance imaging? Everyone is different, but my doctor is not taking this seriously. They advised 12.5 mg of Losartan because more than that could lower my blood pressure. How is this affecting the right side now? Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I have gone through the reports (attachments removed to protect the patient's identity).
Echocardiography is a very operator-dependent test, and the value may vary from operator to operator, even with the same operator, over different times. Your overweight and obesity itself can cause left ventricular hypertrophy and dilatation. The most common cause of left ventricular hypertrophy is hypertension. Severe left ventricular hypertrophy causes diastolic heart failure. Symptoms are shortness of breath, cough, etc. You have been diagnosed with N- N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in the blood. You do not have symptoms, so you do not have heart failure.
Moreover, your echocardiogram does not show signs of diastolic dysfunction. I suggest losing weight and maintaining normal blood pressure near 120/80 mmHg. A better assessment can be done if you can answer the following questions. Can you tell me what your family history is? Who had a heart issue in the family? What did they actually have?
Also, please share your electrocardiogram report. I hope I have answered your query.
Please revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I have attached an echo report from a couple of days ago. Both my dad and his dad had heart attacks in their 50s, and both had congestive heart failure. My dad is still alive at 63, and his dad died in the 80s. I understand the LVH; I do not understand why the right side is now enlarged in both the RV and RA. Is that not showing that I am rapidly progressing the wrong way, as four months ago, the right side was normal?
Also, I need to understand the statistics on progressing to heart failure from these issues. Is that something that can happen in six months, one year, or five years? It is hard for me to lose weight, and I am a highly stressed individual, so even though my blood pressure is fine at rest, it spikes when worried or moving out because I am unfit. Please tell me why my right side would now be affected, and if things stay the same, how long it takes to progress into heart failure? I see very grim things online and need the truth, even if it hurts. As you see, my ECG has its issues; how severe do you see my case at my age?
Thank you.
Hi,
Welcome back to icliniq.com.
Right ventricular enlargement has many causes, including chronic obstructive pulmonary disease, smoking, pulmonary embolism, sleep-disordered breathing, which is common in obese people, and pulmonary hypertension. Your echocardiogram report tells that you have a fascicular block.
Blocks plus left ventricular hypertrophy can occur in cardiac sarcoidosis, which can be diagnosed on cardiac biopsy or cardiac magnetic resonance. Signs of right ventricular failure are abdominal distension, feet swelling, and neck vein engorgement. The corrected QT interval is prolonged, probably due to the right bundle branch block; I do not know if they have also corrected it for the bundle branch block or just for heart rate. An echocardiogram report needs to be seen to comment on it.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I do not have any of the mentioned issues that would cause an enlarged RV, which is why I am concerned. If I were your patient with everything I have presented to you, what would be your current diagnosis? And what would you say about the likelihood of this becoming heart failure shortly? I have had the bifascicular block for five or six years; everything else is new.
Thank you.
Hi,
Welcome back to icliniq.com.
Sir, as you are asymptomatic, I would have done nothing now. I would have suggested lowering your weight, controlling blood pressure, and repeating echocardiography after six months. If you had symptoms or signs of cardiac issues or, worsening heart block or cardiac dysfunction, I would have suggested cardiac magnetic resonance imaging for suspected cardiac sarcoidosis.
Your echocardiogram shows only moderate right ventricular enlargement, normal right ventricular function, and tricuspid annular plane systolic excursion of 29 mm is normal (less than 17 mm is abnormal). Your echocardiogram also shows mild to moderate left ventricular wall thickening, but left ventricular function is normal. At this stage, my approach would be just to wait and watch.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
So, the fact that the RV and RA have dilated in the last four months does not concern you as far as this matter progresses quickly? Can I have a dilated RV or hypertrophic LV for a long time before symptoms occur, or does this typically progress fast to HF? Thank you for all your answers.
Thank you.
Hi,
Welcome back to icliniq.com.
Yes, symptoms may occur late. However, cardiac size often returns to normal. There are many causes of right ventricular dilatation, including a history of myocarditis, pulmonary embolism, pulmonary hypertension, arrhythmogenic right ventricular cardiomyopathy, etc. I suggest you take antihypertensive medicines that reduce blood pressure and also prevent cardiac remodeling. However, if a patient is anxious, I suggest cardiac magnetic resonance imaging.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
Is Diovan an effective drug for left ventricular hypertrophy?
ECG shows RBBB and marked left ventricular hypertrophy. What does it mean?
How can you confirm the diagnosis of left ventricular hypertrophy?
Please interpret MRI taken for lower abdominal pain and gas problem.
I have multiple itchy lesions all over my body. What can they be?
Is locked-in syndrome treatable?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.