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23 with left ventricular hypertrophy
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23 with left ventricular hypertrophy

Ive had hypertension since 21 and just recently an ekg showed mild LVH and an echo showed mild LVH but the nephrologist said it was harder to see than on the EKG.

1.  Can I still play soccer with my LVH?
2.  Will this lower my life expectancy?
3. Can this explain my erectile dysfunction?

I take Losartan 100, Toprol 12.5 and HCTZ for hypertension
Avatar_dr_m_tn
Hi dale25,

These are all reasonable questions, particularly for a young active man who wants to enjoy life to the best of his abilities. You describe a 2 year history of hypertension and the presence of mild left ventricular hypertrophy on ECG and confirmed with echocardiogram (‘echo’). You also mention a nephrologist – to properly answer your question I would be interested to know whether you have significant kidney disease as this is also an important consideration when discussing hypertension, LVH, and treatment options.

Before answering your specific questions I would like to review some of the basics relevant to your case. Hypertension results in an increased workload for the heart which over time leads to thickening (“hypertrophy”) of the main pumping chamber (the left ventricle). This is called left ventricular hypertrophy (“LVH”). Evidence of LVH can be found on EKG, although these days it is standard practice to confirm this with echocardiogram. Echocardiogram has the advantage of being able to measure the severity of LVH, the areas of the left ventricle that are affected, and also the function of the heart valves and pump function. In addition to knowing the degree of LVH (which in your case is mild) it would be good to know whether the walls of the left ventricle are uniformly affected and whether the function of the valves and the ventricle are normal.

Young patients with hypertension often have an underlying reason for having increased blood pressure. In addition to kidney disease, this may include obesity (& sleep apnea), hormonal abnormalities (thyroid disease, excess steroid production), interrupted blood flow in the aorta (due to a rare condition called “aortic coarctation”), drugs that increase blood pressure (i.e. cocaine, amphetamines, steroids). Salt and alcohol intake can contribute to hypertension also. If tests for all of these things are negative then we call it “essential” or “primary” hypertension, meaning a specific cause can not be identified. Optimal blood pressure control varies depending upon associated conditions and risk profile but should generally target <120/80mmHg.

Now that I am confident that you understand LVH and hypertension I can answer your questions.

(1) Playing sport has lots of health benefits, including establishing cardiovascular fitness and reducing blood pressure in the long-term. Patients with isolated mild LVH can still play sports without being at high risk of dangerous rhythm disturbances or cardiac arrest. This assumes that you don’t have a family history of cardiac arrest. It also assumes that your heart function is normal. If you do have a family history of cardiac arrest and/or abnormal heart function, you should discuss your specific risks with your family physician, a cardiologist, or a sports medicine specialist.

(2) Your question about life expectancy is an important one. The short answer is that there are a number of studies (including the “Framingham Heart Study”) that have reported increased mortality or risk of dying in patients with LVH. However, the answer is really a lot more complex than LVH = short life span. Other risk factors for heart disease are also important in modifying your risk, including family history, smoking, cholesterol, diabetes, kidney disease (and severity), and the presence of reduced ventricular function, to name a few. So your risk needs to be assessed in the context of these other factors, not simply based upon LVH alone. Having said that it is still important to monitor the LVH and ensure that it is not progressing. The most common reason for worsening LVH is poorly controlled hypertension and this should trigger a re-evaluation of your medications, your adherence with taking them, and alternative treatment options. If patients continue to have uncontrolled hypertension despite taking them as prescribed, secondary causes should again be considered, and referral to a hypertension specialist may be indicated. Your nephrologist may already have this expertise but other hypertension specialists have a background in internal medicine (general), endocrinology, or cardiology.

(3) I am pleased that you have the confidence to discuss your erectile dysfunction. It is very common and many men suffer in silence. Erectile dysfunction can be linked to hypertension and LVH through the common mechanism of vascular dysfunction. However, vascular dysfunction leading to erectile dysfunction would be more common in patients with longstanding disease such as many years of uncontrolled hypertension or poorly controlled diabetes. I find that most men have a number of factors contributing to erectile dysfunction and this is why we screen for psychological issues (anxiety/depression/’stage-fright’), vascular disease, neurologic disease, hormonal imbalance, medication side effects. A key question is whether you wake up in the morning with an erection (so called ‘morning glory’). If the answer is yes, then it suggests the equipment works but other factors are interfering with your erectile function. If you’re not getting any answers from your family physician or specialist, it may be worthwhile scheduling an appointment with a urologist who specializes in this area. Beta-blockers, such as Toprol, can cause erectile dysfunction so it is worth discussing this with your nephrologist to determine whether an alternative medication could be used in your case. Sometimes even a switch to an alternative beta-blocker can make a difference. If you perform a literature search you will also find reports of diuretics being associated with sexual dysfunction, but this is more common with non-thiazide diuretics (i.e. it’s not common with the thiazide diuretic you’re taking). When discussing erectile dysfunction, men will commonly ask whether they can take Viagra. Ideally this should be discussed with your primary physician. People who can not take Viagra include those taking nitrates, those with chest pain due to coronary disease, and those with a prior allergic reaction. The dose also needs to be adjusted in those with significant kidney disease.

I hope this information helps dale25. Keep kicking your goals in soccer and good luck!


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