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Answer to your Health Question

Question (06/011/2013):

Title: Left atrial enlargement symptoms and treatment

My 2-D echocardiogram shows mild concentric left ventricular hypertrophy.

Mild left atrial enlargement.

Trace mitral valve insufficiency.

Normal rt ventricular systolic pressure 25mmHg with mild tricuspid valve insufficiency.

Trace pulmonic valve insufficiency.

What kind of symptoms may I experience with this problem?

And what kind of treatments has proven effective for this condition.

Thank you



Dear Brenda,

Thank you very much for your question.

Left ventricular hypertrophy usually develops gradually. You may experience no signs or symptoms, especially during the early stages of the condition. As left ventricular hypertrophy progresses and complications develop, you may experience these left ventricular hypertrophy symptoms:

Shortness of breath
Chest pain, often after exercising
Sensation of rapid, fluttering or pounding heartbeats (palpitations)
Dizziness or fainting

The enlargement is not permanent in all cases, and in some cases the growth can regress with the reduction of blood pressure and controlling excitements/emotions strictly.

LVH may be a factor in determining treatment or diagnosis for other conditions, because for example, it causes a patient to have an irregular ECG. Patients with LVH may have to participate in more complicated and precise diagnostic procedures, such as imaging, in situations where otherwise a doctor could give advice based on an ECG.

Treatment for left ventricular hypertrophy focuses on the underlying cause of the condition. Depending on the cause, treatment may involve medication or surgery.

Treating high blood pressure

Treatment for high blood pressure usually includes both medications and lifestyle changes, such as regular exercise; a low-sodium, low-fat diet; and no smoking.

In addition to lowering blood pressure, some high blood pressure drugs may prevent further enlargement of left ventricle muscle tissue and may even shrink your hypertrophic muscles. Blood pressure drugs that may reverse muscle growth include the following:

Angiotensin-converting enzyme (ACE) inhibitors widen, or dilate, blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).

ACE inhibitors cause an irritating cough in some people. It may be best to put up with the cough, if you can, to gain the medication's benefits. Discuss this side effect with your doctor. Switching to another ACE inhibitor or an angiotensin II receptor blocker may help.

Angiotensin II receptor blockers (ARBs), which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.

Thiazide diuretics act on your kidneys to help your body eliminate sodium and water, thereby reducing blood volume.

Beta blockers slow your heart rate, reduce blood pressure and prevent some of the harmful effects of stress hormones. These drugs include atenolol (Tenormin), carvedilol (Coreg), metoprolol (Toprol XL) and bisoprolol (Zebeta).

Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls. This lowers blood pressure. These drugs include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR, Tiazac), nifedipine (Procardia) and verapamil (Calan, Verelan, Covera-HS).

Treating sleep apnea

If you've already been diagnosed with sleep apnea, treating this sleep disorder can help shrink left ventricular hypertrophy. If you haven't been diagnosed with sleep apnea, but your partner tells you that you snore or that you stop breathing momentarily while you sleep, talk with your doctor about getting tested for sleep apnea. Treatment for sleep apnea involves using a machine that provides continuous positive airway pressure (CPAP) while you sleep. This keeps your airways open, allowing you to get the oxygen you need to keep your blood pressure at a normal level.

Aortic valve repair or replacement

If left ventricular hypertrophy is caused by aortic valve stenosis, you may have surgery to remove the narrow valve and replace it with either an artificial valve or a tissue valve from a pig, cow or deceased human donor. If you have aortic valve regurgitation, the leaky valve may be surgically repaired or replaced.

Cholesterol-lowering medications

Although they are not a treatment specifically for left ventricular hypertrophy, the cholesterol-lowering medications known as statins may help treat left ventricular hypertrophy. Clinical trials are currently being done to see if statins are a useful treatment for this disorder.

A person with a mildly enlarged heart may not have symptoms.

Symptoms of an enlarged heart may include:

Chest pain
Loss of appetite
Mild fatigue:
Fatigue during exercise
Urinary frequency:
Urinating more often at night
Moderate fatigue:
Worse with exercise
Nighttime cough
Difficulty breathing:
Shortness of breath when lying flat
Shortness of breath with exercise
Waking at night with shortness of breath
Leg swelling (bilateral):
Ankle swelling (bilateral)
Foot swelling (bilateral)

Treatment for an enlarged heart depends on the underlying cause. Treatment for an enlarged heart may include stop smoking, heart diet, low cholesterol diet, low salt diet, an exercise plan, weight reduction, and fluid restriction. Medications to treat an enlarged heart may include diuretics, beta-blockers, ACE inhibitors, aspirin, and potassium supplements.

Treatment for an enlarged heart may include:

Stop smoking.
Avoid exposure to secondary smoke.
Eat a healthy heart diet:
Low cholesterol diet
Low fat diet
Low salt diet
Fluid restriction:
As directed by your doctor
Elastic support stockings
Follow an exercise plan developed with your doctor.
Potassium supplements
Control of high blood pressure:
Beta-blocker medication
ACE inhibitor medication

Atrial Enlargement Diet

It is important to follow a healthy diet if you have cardiac enlargement.

Enlarged Heart Diet

Avoiding fad diets: a well-rounded diet is much better.
Limited fat intake to no more than 30% of total calories:
Some experts recommend no more than 20-25% fat.
Eating high-quality fats:
Using virgin olive oil and other unsaturated, low-cholesterol fats.
10% to 15% of total calories should be in the form of monounsaturated fatty acids (e.g. olive oil, canola oil, and peanut oil).
Eating less than 300 milligrams of dietary cholesterol a day.
Eating plenty of fresh fruit and vegetables.
Limited iron intake: too much iron can increase atherosclerosis.
Replacing animal protein with soy.
Reducing salt to no more than 3 grams per day. A doctor may lower this recommendation to no more than 2 grams for people with high blood pressure or congestive heart failure.
Emphasizing complex carbohydrates, such as starch and fiber. Whole grains and brown rice are good fiber sources. Other sources include:

The treatment of mitral regurgitation which is also known as mitral insufficiency, depends on the acuteness of the disease and whether there are associated signs of hemodynamic compromise.

In acute mitral regurgitation secondary to a mechanical defect in the heart (i.e. rupture of a papillary muscle or chordae tendineae), the treatment of choice is urgent mitral valve replacement. If the patient is hypotensive prior to the surgical procedure, an intra-aortic balloon pump may be placed in order to improve perfusion of the organs and to decrease the degree of mitral regurgitation.

If the individual with acute mitral regurgitation is normotensive, vasodilators may be of use to decrease the afterload seen by the left ventricle and thereby decrease the regurgitant fraction. The vasodilator most commonly used is nitroprusside.

Individuals with chronic mitral regurgitation can be treated with vasodilators as well to decrease afterload. In the chronic state, the most commonly used agents are ACE inhibitors and hydralazine. Studies have shown that the use of ACE inhibitors and hydralazine can delay surgical treatment of mitral regurgitation. The current guidelines for treatment of mitral regurgitation limit the use of vasodilators to individuals with hypertension, however. Any hypertension is treated aggressively, e.g. by diuretics and a low sodium diet. In both hypertensive and normotensive cases, digoxin and antiarrhythmics are also indicated. Also, chronic anticoagulation is given where there is concomitant mitral valve prolapse or atrial fibrillation.

There are two surgical options for the treatment of mitral regurgitation: mitral valve replacement and mitral valve repair. In the double orifice technique for mitral valve repair, the opening of the mitral valve is sewn closed in the middle, leaving the two ends still able to open. This ensures that the mitral valve closes when the left ventricle pumps blood, yet allows the mitral valve to open at the two ends to fill the left ventricle with blood before it pumps. The same idea can be used with a minimally-invasive catheter technique which installs a clip to hold the middle of the mitral valve closed.

There is also a non-surgical option for the treatment of mitral regurgitation. Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaeneous implantation of a clip that grips and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. Though it is less effective at reducing mitral regurgitation than conventional surgery, the procedure is marked by superior safety and similar improvements.


Indications for surgery for chronic mitral regurgitation include signs of left ventricular dysfunction

Signs and symptoms of mitral valve regurgitation depend on its severity and how quickly the condition develops. Mitral valve regurgitation signs and symptoms can include:

Blood flowing turbulently through your heart (heart murmur)
Shortness of breath, especially with exertion or when you lie down
Fatigue, especially during times of increased activity
Cough, especially at night or when lying down
Heart palpitations - sensations of a rapid, fluttering heartbeat
Swollen feet or ankles
Excessive urination

Mitral valve regurgitation is often mild and progresses slowly. You may have no symptoms for decades and be unaware that you have this condition.

Mitral valve regurgitation is often first suspected when your doctor hears a heart murmur. Sometimes, however, the problem develops quickly, and you may experience a sudden onset of severe signs and symptoms.

Mild cases of Pulmonic regurgitation usually do not cause any symptoms. Because pulmonic regurgitation is the result of other factors in the body, any noticeable symptoms are ultimately caused by an underlying medical condition rather than the regurgitation itself. However, more severe regurgitation may contribute to right ventricular hypertrophy, and in later stages, right heart failure.

A decrescendo murmur can sometimes be identified early in diastole, heard best over the left lower sternal border

Asymptomatic cases do not require treatment.

Pulmonic regurgitation is generally treated by addressing the underlying condition. In certain cases, the pulmonary valve may be surgically replaced.

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