Left ventricular hypertrophy / ST horizontal segment

[ssnova]

Hello,

I want know if my LVH is "atheletic" and not an indication of artery disease.

Thank you
------------------------------------------------

Details/factors below:

Stress test result
--------------------------
Bruce protocol test showed 1.2 to 2.2 ST horizontal in III-AVF and V6.
Test results:  stage 4, ;  11 min,25 sec ; 12.9 METS , 100% target heart rate. No arrythmia, or high bp.
Resting heart rate 73 ;
Resting bp 124/80 ;
Resting EKG: Normal sinus rythm ; left ventricular hypertophy.

Exercise factor:
----------------------
I think this LVH/ST depression was due to my 2-year intensive work out on elliptical -- "atheletic LVH"

Workout:
60 to 65 min on elliptical, 5--6 times/week ; 3 mile jogging if I miss elliptical, sometimes.
6.4 miles/750 cal burnt per workout;
loses about 3--4 lb per workout ( monitored weight before/after workout for about 1.5 years )
Lost about 18 lb in 6 months and maintained it for 1.5 years.
( from 175 lbs to 154--158 lbs; ht 5ft 9in ; perfect BMI -- not obese)

Other factors:
--------------------
Vegetarian, no smoking/alcohol ; outdoor person (hiking/biking);
Non-fat milk, "brown" food, no soft drinks, etc...

[XFACTOR2009]

There a\re a number of factors  on ECG,  something called  voltage  critieria can be  used  to estimate  whether or not LVH  exists, but  ultimately it is  diagnosed by  echocardiogram  
ECG is more  concerned with the electrophysiology of the heart  and the echocardiography  the structure and dynamic  functioning
There  are lots of articles online and tutorial  videos  in youtube  that show you  what physicians  look for, some are more  layperson friendly  than others

[RICHARD566]

What differences on an ECG indicate LVH?
  

[XFACTOR2009]

LVH  can  arise  in non  elite  athletes  but is  less likely.  However, in the case  of  regular intense  exercisers  it is likely  that the ventricle  walls  will thicken  and  the  cavity won't  enlarge.    'Athletes  Heart'  tends to be where  the ventricle  becomes  bigger  as well as  the walls
the heart muscle  thickens  to some extent in anyone  as a result of regular intense  workouts   However  ECG LVH is  more often than not an indicator  that LVH really  exists  and would be  confirmed on echo
The common  scenareos  are  high blood pressure   (not evident in your  case)    Hypertrophic  Cardiomyopathy   (needs  an  echo  to see, and  check  family  history)   or exercise  (physiological  LVH)   and  that is complex  to assess,  the simplest is to ask a patient to stop training for so many months and  then  do a repeat  echo.  
LVH on  ECG ought not  simply  be  ignored,  your  docs  should  at least  seek  to  rule  out  HCM

[ssnova]

Dear Erijon,

Thank you for the clarification.
I thought so too - I am not a world class athelete.

A research paper from Institute of sports medicine (Italy) mentioned that LVH can result from " an innocent consequence of chronic exercise conditioning" -- hence my suspicion.

Inspite of good diet/active style, I do have higher cholesterol level 224 for about 3 years -- plus family history of heart problems.

So, I should take additional tests ( nuclear stress test was recommened) and pay attention.

Thanks very much.

[erijon]

Probably not, only very highly conditioned, world class athletes have LVH due to exercise. You have a very active lifestyle, but the kind of athletes with exercise induced LVH usually perform much higher on the Bruce Protocol, making it to atleast stage six and over 15 mets. Your work out is very good, but not really excessively intense. Much depends on the mets you achieve during your work out along with you heart rate. I do approx 60 mins EVERY day on either a treadmill or stationary bike and burn 750 cals as well and I would never consider myself a world class athlete.

Having said that, the best way to determine if some one has LVH is by an echo, not a stress test. You should consider requesting one for confirmation.