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Chest CT showed left ventricular hypertrophy, no breathlessness or congestion. Any advice about my condition?

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Cardiologist, Interventional
Practicing since : 1996
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Hi, I just had a CT of chest w/contrast to follow-up on 2 lung nodules...

There was a finding of left ventricular hypertrophy, but no specifics.I understand what this is.
.I had off and on control of BP for several years, with Diltiazem, terozosin and propranalol,

a few months ago my blood pressure went from slightly high with meds, to
getting very low....Dropped all meds except proprananalol...BP nowt
100-120 to 120-87...No symps of hyotension. I supplement with fish oil and
lots of EV olive oil every day. Is such normalization BP common...no changes..weight loss,
diet etc.

From what I'd read, I have no symptoms of LVH....no breathlessness, congestion.
Just re-started running 5 days a week slow and fast....no difference in endurance
prior to 3 years ago, fast walked-ran for 20 years. I do have times of
extra systoles...a day or 2, then not for sometimes months. Have XXXXXXX hx since I was 20.
echos EKG at 20, again 10 years ago.

Any advice about my condition would be appreciated.

Also, would chest ct w/contrast (without calcium score) show degree or exstence of, occlusion,if any,
in coronary arteries? Would that normally be noted on the radiologist's report?

Thank You XXXXXXX
Posted Sat, 21 Apr 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Raja Sekhar Varma 9 hours later
Hello Mr XXXXXXX XXXXXXX

Thank you for your query.

You have indicated that you have left ventricular hypertrophy. As you said, this is indeed related to your Hypertension. The increase in the left ventricular muscle mass and thickness is the response of the heart to its increased workload of having to pump blood against a higher blood pressure. This is somewhat similar to the increase in your biceps when you lift weights.

When you keep your BP under control 24 x 7, there will be a gradual reduction in the degree of left ventricular hypertrophy.

Propranolol is a beta blocker and a good drug for your extra-systoles as well as your BP. However, this is relatively short-acting and can have more side effects. You could discuss with your treating physician about the possibility of switching over to a highly specific beta blocker like Metoprolol succinate extended release preparation. Alternately, you could also consider an ACE (Angiotensin Converting Enzyme) inhibitor like Ramipril or Lisinopril to achieve good BP control, prevent kidney dysfunction and reduce the LVH.

I understand that your CT chest has been done with the primary aim of looking at the 2 nodules in your lungs. For the coronaries, you need a multi-slice ECG gated CT coronary angiogram to be able to fully delineate the coronary anatomy and establish the presence/absence of any blockages.

In view of your risk factors like diabetes and hypertension, you could also consider a stress test like treadmill exercise test, dobutamine stress echo or a nuclear perfusion imaging test like a stress thallium or stress technitium sestamibi test. These are non-invasive and will indicate the need for any further invasive coronary angiogram/other procedures.

I hope this answers your query. Feel free to contact me for any further clarifications.
Please accept my answer in case you have no further queries.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
 
Follow-up: Chest CT showed left ventricular hypertrophy, no breathlessness or congestion. Any advice about my condition? 13 hours later
With my lack of symtoms, and presenty good BP 110/70-80 indicate early stage LVH?

I've been on propranalol 20 years for panic attacks... Is there a drug that could be added to
help reverse LVH without further decreasing BP?

As I mentioned in last note, no symptoms...I run regularly....Sometimes running fairly fast,
my respiration does not make breathless of week....I cannot get my pulse over 120 (propranalol?)
and recovery is fast.

Also per last note, is there significance in my BP becoming normal after years of it being
normal to high while on Diltiazem and Terozosin..Dropped both, per doc and BP is great.
Occurred over a short period of time..no weight loss or other changes...Have you known of
BP dropping to normal spontaneously after needing meds for years to control? Lookingh
ahead, are there alternatives to bypass surgery?

Anything I can do personally to help normalize my LVH.

If you would kindly answer the above questions, I will immediately ACCEPT your answer.
I'm sorry to have taken so much of your time, for such little compensation. It is GREATLY
appreciated!

Thank you so much! Randy
Follow-up: Chest CT showed left ventricular hypertrophy, no breathlessness or congestion. Any advice about my condition? 3 hours later
With my lack of symtoms, and presenty good BP 110/70-80 indicate early stage LVH?

I've been on propranalol 20 years for panic attacks... Is there a drug that could be added to
help reverse LVH without further decreasing BP?

As I mentioned in last note, no symptoms...I run regularly....Sometimes running fairly fast,
my respiration does not make breathless of week....I cannot get my pulse over 120 (propranalol?)
and recovery is fast.

Also per last note, is there significance in my BP becoming normal after years of it being
normal to high while on Diltiazem and Terozosin..Dropped both, per doc and BP is great.
Occurred over a short period of time..no weight loss or other changes...Have you known of
BP dropping to normal spontaneously after needing meds for years to control? Lookingh
ahead, are there alternatives to bypass surgery?

Anything I can do personally to help normalize my LVH.

If you would kindly answer the above questions, I will immediately ACCEPT your answer.
I'm sorry to have taken so much of your time, for such little compensation. It is GREATLY
appreciated!

Thank you so much! Randy
 
 
Answered by Dr. Raja Sekhar Varma 5 hours later
Dear Mr. XXXXXXX XXXXXXX

Thank you for the follow-up.

The LVH (Left Ventricular Hypertrophy) can be related to the long-standing hypertension and may sometimes be related to increasing age also. Since the BP (Blood Pressure) is under good control now, there will be some regression of the LVH. If there are fibrotic changes, the regression of LVH may not be complete or may be slow.

Propranolol, as indicated earlier, is a non-selective beta blocker and has anti-hypertensive effects. It will bring down the BP and slow the heart rate also. Due to its non-selective nature and short duration of action, it is not the ideal drug for BP control. It is good for your panic episodes, however.

You could either switch over to a long-acting, beta-1 specific agent like metoprolol succinate or you could consider an ACE (Anti-Cholinesterase) inhibitor which has been shown in trials to cause regression of LVH. Do not stop propranolol suddenly. It has to be slowly tapered and stopped over a period of weeks.

Since you are asymptomatic and exercising regularly, your general fitness levels are likely to be good. The lack of increase in heart rate during exercise is related to the propranolol. This indicates a good and desirable effect of the drug.

BP levels do show some long term fluctuations. Though you needed 3 drugs initially for BP control, now the same effect is achieved with one drug. This is partly due to the long term effects of good beta receptor blockade by propranolol. It is also due in a major part to the positive effects of your lifestyle with adequate diet and appropriate exercise regimens. Changes in stress levels and the adaptations of the body can also contribute.

However, you need to keep on monitoring the BP. It might rise again after a period of time. These variations over a period of time are well known.

Keeping your BP at optimal values of <130/80 mmHg throughout the day and night over long periods of time is the best way to reduce the LVH. Since you may have only a mild LVH, and since you are asymptomatic, I don’t think you need to be excessively worried about it.

If you have undergone a stress test and found to be negative for inducible ischemia, you don't need to worry about bypass surgery. This surgery is for those with multiple severe and critical blockages in the coronary arteries. Nowadays, angioplasty with stenting is an effective alternative to surgery in many patients. Advances in the medicines that are available for medical management of diabetes, hypertension, high cholesterol and coronary artery disease also have resulted in good prevention of heart disease and reduced need for bypass surgery.

I hope this serves to clarify all the issues that you have raised. I wish you all the best for a happy and healthy life ahead.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
 
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