– Left Ventricular Hypertrophy

The left ventricle is the chamber of the heart that pumps blood to the rest of the body. When it is enlarged, it can be associated with increased risk for heart attack, stroke and death.

When the muscular walls of the left ventricle get thicker than they should be, this finding is termed left ventricular hypertrophy (LVH).

While some ventricular hypertrophy may occur normally as a reaction to aerobic exercise and strength training, the term is most often used when it refers to a pathological reaction to some sort of cardiovascular problem.

The type and degree of LVH determines the amount of excess mortality risk. Enlargement might be noted on a physical exam, chest X-ray, or electrocardiogram (ECG).

It is most reliably demonstrated and measured on the echocardiogram, which is an outpatient test that uses sound waves to image the heart and great vessels.

The echocardiogram is a safe, straightforward, non-invasive procedure; furthermore, it is more convenient and less expensive than many other cardiac tests.

LEFT VENTRICULAR HYPERTROPHY: WHEN THE MUSCULAR WALLS OF THE LEFT VENTRICLE IN THE HEART CHAMBER BECOME THICKER THAN THEY SHOULD BE. WHEN IT IS ENLARGED, IT CAN BE ASSOCIATED WITH INCREASED RISK FOR HEART ATTACK, STROKE AND DEATH.

Causes:

This can be caused by a number of conditions, including: uncontrolled hypertension, valvular disease, cardiomyopathy, endocrine disorders and nutritional impairments. Generally anything that creates pressure or volume overload on the left side of the heart, causing it to work harder, will eventually make the muscles grow larger and produce LVH.

Diagnosis and treatment:

The echocardiogram not only accurately measures the dimensions of the heart, but also gives precise information regarding its function. It is an ideal means to follow LVH, which can worsen over time, or sometimes improve with treatment of the underlying condition and remodeling of the heart. Current and serial echocardiograms often allow better clarification of the life risk and may permit a better offer. Because test results can vary over time, and particularly with different machines, operators, and interpreters, additional follow-up testing often provides better clarification of the actual risk and allows us to make the best offer possible.

Case Studies:

Applicant 1 is a 44 year old man who enjoys competitive bicycling and has no adverse cardiac risk factors. Increased voltage suggestive of LVH was noted on a routine ECG done for life insurance. An echocardiogram showed only mild symmetrical increases in the size of the walls of his left ventricle with normal function. This case can be Preferred Plus.

Applicant 2 is a 52 year old man who went to see a cardiologist at his wife’s urging because his father and two brothers had all died suddenly and unexpectedly prior to age 55. An echocardiogram was done, which showed massive and asymmetric enlargement of his left ventricle consistent with a hereditary cardiomyopathy. After further testing, including an abnormal ECG and stress test, he was referred for electrophysiology studies which demonstrated the need for an implantable cardiac defibrillator. This case is a decline.

Applicant 3 is a 62 year old woman with a history of poorly controlled hypertension that has recently improved with medication. A heart murmur was noted by her physician on a recent exam, and he ordered an echocardiogram to better assess this finding. The murmur was found to be due to mild aortic valve sclerosis without stenosis, but moderate LVH was noted on the study. This case can proceed with a Table 2 rating. Overtime, if her LVH improves with continued good control of her hypertension, she may qualify for a rating reduction.

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