"Mild Left Ventricular Hypertrophy"

[jyl]

Interested in the docs' thoughts on my recent medical issues.

I've had essential hypertension for my adult life. When it was first diagnosed, at age 35, my BP was 150/100 and resting pulse 100 bpm. Was put on atenolol, a beta blocker, which took my BP to 140/80 and resting pulse to 80 bpm.

Fast forward to a few years ago, I was cycling a lot and found my pulse upon first waking was 40 bpm, which seemed too low. I went off the beta blocker and my BP stayed 145/85 average over the day, resting pulse 60 bpm. Higher in the mid afternoon, lower in the morning and evening. My other labs were a little off, LDL and TG moderately high, HDL moderately low.

Fast forward to now, and I find myself going to the doctor because I'd noticed my BP was way high. Like 180/110 mid day, never lower than 160/100, and my resting HR was around 65 bpm. Also had gained about 5 lb and was cycling a little less, still the daily bike commute but sort of cruising more and hammering less, and being less diligent about the weekend rides.

My doctor asks me a bunch of questions and does a physical exam, that was obviously designed to look for signs of a stroke. None. He does an EKG, which suggests left ventricular hypertrophy. He sends me for an echocardiogram, which reports back "mild left ventricular hypertrophy" but no sign of "hypertrophic cardiomyopathy". Puts me back on HBP meds, this time lisinopril, an ACE inhibitor. BP is back down to 150/90 and resting pulse 55 bpm. We are still adjusting the dose higher, a little at a time and currently 20 mg/day, but I may not want to go to a much higher dose because now if I get up suddenly from the couch, I am sometimes slightly light headed. Surprisingly to me, all my other labs are fine - lipid panel, metabolic panel, blood sugar, TSH, serum uric acid are all well within normal ranges.

He tells me there is no need to restrict activity, so my plan for the summer is to ride more, drop 5-10 lb, spend a few hours a week at 150-180 bpm. Oh, and I've checked my life insurance and made sure my wife knows the policy info and all the passwords to all the accounts and so on. I'm 52 y/o.

What should I think about this? Should I be concerned, worried, anxious, freaked?

[pavulon]

I think you earned your mild hypertrophy on your bike. Take your bp med, wear your helmet and be happy.

Originally Posted by jyl

What should I think about this? Should I be concerned, worried, anxious, freaked?

[bivenator]

The heart is a muscle. Your left ventricle is larger because it is working hard, could be from exercise or the effect of having elevated BP. Docs will maintain the BP with meds. Curious what the ejection fraction was on the echo?

I second pavulons advice.

[ckelly78z]

Originally Posted by jyl

Puts me back on HBP meds, this time lisinopril, an ACE inhibitor. BP is back down to 150/90 and resting pulse 55 bpm. We are still adjusting the dose higher, a little at a time and currently 20 mg/day, but I may not want to go to a much higher dose because now if I get up suddenly from the couch, I am sometimes slightly light headed. ?

I'm on Lisinopril also along with Coreg, Simvistatin, and digoxin for heart failure that was a result of one of my past chemotherapy drugs. My problem was always that my BP was very low (i've seen 60/40), and I experienced the lightheadedness of getting off the couch too quickly even when my BP was normal. I believe that the lisinopril is the one causing that side effect also, but I have learned not to take the pills until I eat something substantial (not just toast or a bagel) in order to lessen the effect.

I wish you good luck and good health in the hopes you can figure this out, I seem to have mine regulated now, but still need to take a diuretic 2-3 times a month if I have too much sodium.

I just saw bivenator's post about ejection fraction and thought I would share....Mine is now still low in the 45% range, but when I went into the hospital for heart failure, the EF was 13% and my EKG showed virtually no upward "R" movement. That night after a diuretic was administered, I lost 17 lbs of fluid on a 180 lb frame.....no wonder I couldn't breathe.

[sc_rufctr]

Try not to get stressed... That's not good for anyone.

Stress has been a huge part of my life and just letting go has worked wonders for me.
And if you think about it not everything is your problem to fix. I've become really good at letting my kids make their own mistakes.

Listen to your doc and keep going. I hope you get on top of things soon.

[Tobra]

Originally Posted by pavulon

I think you earned your mild hypertrophy on your bike. Take your bp med, wear your helmet and be happy.

I am with anesthesia on this one.

As you get older, you lose compliance, think stretchiness, in your blood vessels. When you cut someone open and watch their heart beat, the vessels expand as the heart contracts, storing some of the energy from the compression and moderating the pressure.
You are getting older

[J P Stein]

The main problem with living is that you keep getting older. Stuff quits working lke it use'ta.......BTDT. You can fight it, but you will loose. The alternative really sucks, I think......time will tell.

I had Crohns disease for 30 odd years, but out grew it.
The exceptions are too few & far between.

[jyl]

Thanks, all.

I've asked for the echo report to be posted to the online system and will revert if it is. I'm curious, have never read an echo report before.

[Tobra]

You can get a lot of info from an echocardiogram, like an ultrasound study of your heart. Check out the video of the 3D echo about halfway down the page, pretty cool

Echocardiography - Wikipedia, the free encyclopedia

[John Rogers]

Sounds like you need a heart doctor who also races or is a serious bike rider/runner/etc. In 1982 to 1984 in the work up for the L.A. Olympics our cycling club, the LaJolla Cycling Club had several nationally ranked riders, one being Mark Gorski and as such we were lucky to have several specialist including a heart doctor who would monitor our training and how we did in races and training rides. I was followed since although a 35+ class rider, I had smoked for years and they wanted to see how my body was reacting to training and racing. During my track work outs I could get my heart rate to 200+ BPM for short periods but my B/P was staying high, 190/110 even though my resting pulse was 40 or so. They finally got me on meds that lowered the B/P to 145/85 on average and it stayed that way until I had a mini-stroke in Sept of 2013. Now it is 130/70 and the doctors are much happier.

I found that this is why it is called "practice medicine" as unless the doctor has a background in exercise then they are probably making educated guesses!

[jyl]

I finally got the echocardiogram report. Here is what looks to me like the salient parts:

" Final Impressions
The LV ejection fraction is normal
The left ventricular cavity size is normal
Interventricular septal thickness is increased at 1.3 cm consistent with mild LVH
LV mass indexed to BSA is however normal at 95 g/m2 (N<102 g/m2)
The right ventricular size is normal

Description of Findings

Cardiac Rhythm: Normal sinus rhythm
Left Ventricle: The left ventricular cavity size is normal. Visually estimated left ventricular ejection fraction is 60-65%. The LV ejection fraction is normal. LV ejection fraction is normal at 65.7% using biplane Simpson's method.
Left Ventricular Wall Motion: Left ventricular systolic thickening is normal in all segments.
Right Ventricle: The right ventricular size is normal. Global RV systolic function is normal. TAPSE measures 2.14 cm. The RV TDI s' velocity is 10.6 cm/sec.
Aortic Valve: The aortic valve is normal in structure and function.
Mitral Valve: The mitral valve is normal in structure and function.
Tricuspid Valve: The tricuspid valve is normal in structure and function.
Trace tricuspid regurgitation. The tricuspid regurgitatnt velocity is 2.07 m/s and with an assumed right partial pressure of 3 mmHg, the estimated right ventricular systolic pressure is normal at 20.1 mmHg.
Pulmonic Valve: The pulmonic valve is normal in structure and function.
Aorta: Ascending aorta 3.6 cm.
Venous: Inferior vena cava is normal with normal inspiratory collapse.
Pericardium: No pericardial effusion is seen. "

Then there are various measurements. "2D" and "Doppler". I haven't typed them in, but can do so.

Anyone know what all this means? I see the word "normal" repeated a lot.

[pavulon]

Good news: Normal = Normal!!

Better news: Hundreds of thousands of people would pay early 911 money plus to have their name on your echo report.

Best news: Your name is on that echo report!! Get Happy!!

[rusnak]

I think it means that you can go on wearing skinny jeans. On second thought, don't.

[bivenator]

Looks good, normal. Little thick in the wall that separates the lower chambers of the heart but nothing fatal.

[Racerbvd]

My last echo came back saying I have a thick heart, muscles growing blocking the flow.

[Dgpoff]

So I own a Porsche and frequent the boards, and really learn something here every day!
My last physical I had an EKG and the doc said that is simple terms my test says at some point I had a heart attack of some type.
I cycle a bunch. 11,000 miles in the last 5 years, including a Canada to Mexico trip a couple of years ago for 1680 miles in 30 days.
So this news did not make sense to me. Been studying the topic. Have a consult with a cardio doc in a week or so.

And go figure, the cycling and heart connect the dot issue was best explained right here on a P car forum. Who would have thunk?

Don
Spokane, WA
1976 RoW 911

[jyl]

Thanks, guys. Interesting stuff for me.

[aigel]

Originally Posted by Dgpoff

My last physical I had an EKG and the doc said that is simple terms my test says at some point I had a heart attack of some type.

I would not worry about this until you had a full exam by a cardiologist, including stress EKG and stress Echo. The resting EKG is not an exact measurement at all, with high chances of false positives for cardiovascular disease and tough read as well. Many GPs actually rely on the EKG machine's analysis of the signal. It usually spits out "ok" and if it is abnormal and "not ok", they err on the safe side and send you to the cardiologist. Even if the resting EKG was done at the cardiologist, they will assume the worst as well, just for liability reasons. They also don't take into account the patient and how he/she presents. If you had a heart attack, you very likely would have noticed a drop in performance, angina pain etc. when exercising. While there is exceptions, note when you go to the cardiologist how the average heart patient looks like. Not a lot of athletes ...

G

[creaturecat]

150-180 seems a bit high for continual cycling. 150 not as bad, obviously.
i would think 160-170 should be your max, no?
you are running in the anaerobic zone, yes? makes it harder to burn fat, no?
in the long run, i would think the high rpm would be detrimental to the heart.
mind you, my knowledge base is limited. : )

[Racerbvd]

Originally Posted by Dgpoff

So I own a Porsche and frequent the boards, and really learn something here every day!
My last physical I had an EKG and the doc said that is simple terms my test says at some point I had a heart attack of some type.
I cycle a bunch. 11,000 miles in the last 5 years, including a Canada to Mexico trip a couple of years ago for 1680 miles in 30 days.
So this news did not make sense to me. Been studying the topic. Have a consult with a cardio doc in a week or so.

And go figure, the cycling and heart connect the dot issue was best explained right here on a P car forum. Who would have thunk?

Don
Spokane, WA
1976 RoW 911

And all this time I figured my riding should be helping..