Features November 2012 Issue

Right Ventricular Hypertrophy Can Often Be Prevented

Untreated, RVH can lead to a weakened heart or even heart failure

When the muscle thickens around one of the heart’s lower chambers, it is a condition known as ventricular hypertrophy. The thicker heart muscle loses elasticity over time, causing the heart to work harder to effectively pump blood to the lungs, brain and the rest of the body.

And eventually, the result can be heart failure (HF), as a weakened heart can no longer meet the demands of the body. The most common ventricular hypertrophy occurs on the left side, but a recent study published in the journal Circulation found that right ventricular hypertrophy (RVH) is associated with an increased risk of heart failure and cardiovascular death in patients without clinically diagnosed heart disease at the start of the study. Those with RVH had double the risk of heart failure or death, compared to those subjects with normal right ventricle size. Researchers also determined that about one in 10 heart failure events and cardiovascular deaths may be attributed to thickening of the right ventricle.

Cleveland Clinic cardiologist Corinne Bott-Silverman, MD, notes that any abnormality with the right ventricle can be a sign of health problems ahead. She explains that RVH usually stems from one of three causes: congenital heart conditions, such as Tetralogy of Fallot or ventricular septal defects; pulmonary arterial hypertension; or pulmonary venous hypertension.

Pulmonary venous hypertension, which is high blood pressure related to the inability to effectively carry blood away from the lungs, can usually be traced to problems with the heart’s left side. Pulmonary arterial hypertension,  which occurs when the arteries in the lungs contrict abnormally, is associated with chronic lung diseases and conditions such as obstructive sleep apnea (OSA).

“Almost anything that can cause right ventricular hypertrophy can be treated if you’re aware of that underlying cause,” Dr. Bott-Silverman says. “I don’t know that there’s anything that can reverse it, but you can keep it from getting worse. It’s kind of the end result of a lot of different insults to the heart. The risk you run is that if the insult isn’t taken care of, the muscle weakens over time.”

Identifying Causes
Typically, RVH isn’t identified until the condition is causing you to have symptoms, such as shortness of breath or swelling (edema), due to fluid build-up. But these are also early signs of heart failure, and Dr. Bott-Silverman urges anyone with HF risk factors to start to address them promptly.

The most obvious first step you can take is to quit smoking, if you currently smoke, and to seek out smoking cessation aids and other forms of assistance from your physician. Maintaining good respiratory health is a key to preserving right ventricular health.

But among the most common, yet largely under-identified risk factors is sleep apnea. Anyone can have OSA, but carrying extra weight, especially around the neck, does raise your risk of the condition. The most obvious signs are snoring and gasping for breath while sleeping—characteristics only a partner may notice. In addition, if you often get tired during the day, you may have OSA.

“If you’re obese with sleep apnea, and you don’t take care of it, you can get right heart failure,” Dr. Bott-Silverman says.

In addition, if you have been diagnosed with left ventricular hypertrophy, there is a chance the condition can eventually lead to a thickening on the other side. The left ventricle has received the most attention in clinical research, largely because it is easier to image and it’s more strongly associated with common conditions like hypertension, according to the study’s author, Steve Kawut, MD, of the University of Pennsylvania.

“These findings run counter to the traditional belief that for otherwise-healthy adults, the right ventricle plays a limited role in heart failure,” he says. So if you have LVH, and have questions about RVH or other prospects related to your heart, share your concerns with your physician.

Diagnosis and Treatment
Swelling of the right ventricle can be seen in an electrocardiogram or echocardiogram, Dr. Bott-Silverman says. But magnetic resonance imaging (MRI) is the most reliable, she adds.

As she noted earlier, treating RVH usually involves treating the causes of the ventricular abnormality. Blood pressure medications and a heart-healthy lifestyle are important, but certain other drugs are specifically aimed at treating pulmonary hypertension. If that’s the problem, your doctor may prescribe blood vessel dilators or vasodilators, such as epoprostenol (Flolan). Research has also shown that common erectile dysfunction drugs such as sildenafil (Viagra) and tadalafil (Cialis) can also be effective at opening up the pulmonary arteries.

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