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Will heart enlargement regress by itself?
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Will heart enlargement regress by itself?

Hi,
My hunsband had mild chest discomfort in sept 2009 and we did echo cardiogram , it came to be normal with mild left ventricular hipertrophy and the doctor said it will reverse by itself if BP is well controlled.

He has hypertension and diabetes.

We did an echo april 2010 and no more left ventricular hypertrophy..
But looking at his report, the measurement of IVSD and PWD have decreased to 0.9 from 1.2.
But the over all chamber size of LV and LA has increased from 2009 to 2010 as below.

in sept 2009
LV diast 4.0
LV syst 2.2
LA 2.3

in april 2010
LV diast 4.1
LV sys 3.5
LA 3.7

Im afraid about the increase rate in one year. He has family history of cardiomyopathy(Not his parents or siblings but cousins), though he does not have it.
his EF remains same at 60% from 2009 and 2010.

Is he at the risk of developing any kind of cardiomyopathy?
Will the LV and LA size get back to normal? what ways can we control it? He changed the BP medicine in between these 2 echos from Enalapril to Cardace.But changed back to Enalapril now.

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15 Comments Post a Comment
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612551_tn?1247839157
High blood pressure is causal for heart enlargement, so controlling that is key to size reduction.  I don't understand the ongoing enlargement, you say your husband is on BP medication, is it working?  What is his normal BP?

It may be somewhat age dependent, i.e., younger is better than older, but I believe heart enlargement reversal is possible, even likely, if the causes for the enlargement are abated.

I have an enlarged left atrium due to a leaky mitral valve.  I also have atrial fibrillation.  I have had the mitral valve repaired through surgery, but the left atrium has not shrunk back in the two+ years since.  My cardiologist says the ongoing atrial fibrillation prevents the shrinking... as best I understand him.  So, I give an example of enlargement not shrinking, but I can also say it is no longer growing larger, a key accomplishment for my longevity.
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520292_tn?1232039450
There are many forms of an enlarged heart, but this most common is Dilated cardiomyopathy .  Dilated cardiomyopathy is not reversible but treated to prevent and cure the underlying cause of the cardiomyopathy.  Once treated properly the condition improves greatly but the enlargement will not shrink back to normal size.
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Avatar_f_tn
Thanks for your reply. Since my husband is taking BP medicine, its well controlled between 100- 120 / 70-75 all the time.

He also has *trace* of mitral valve leak, rest all perfectly fine.

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Avatar_f_tn
Thanks for your reply. As per the cardiologist, my husband does not have any kind cardiomyopathy at this point of time. My concern is will the heart enlargement cause dilated cardiomyopathy?
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520292_tn?1232039450
No the enlargement will not cause cardiomyopathy.  My grandmother has had an enlargement of her heart for almost 15 years.  With the proper management it never digressed into anything more than that.  Your hubby is fine as long as he does with the doctor tells him, which sometimes is tough cause men can be stubborn  :P
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995271_tn?1408549100
Wouldn't the BP meds cause a change in systolic volume?  I say this because BP meds work by reducing the contraction of the heart muscle, correct?

ANother thing to think of, +/- .5cm on a heart echo is in the noise.  It's about the average error rate on the measurements.  I think this is because you are measuring something that is constantly moving, hence the measurement can vary from beat to beat.
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612551_tn?1247839157
On the mitral valve leakage, my mitral valve was repaired through heart surgery, not saying your husband needs any such thing.  I suffered from a leaky valve for several years, maybe much longer before surgery was recommended.  In my case the leaky valve was causing, or at least contributing to, the enlargement of my left atrium.  The leak became severe enough that the "back pressure" from the left ventricle through the mitral valve was causing the left atrium to enlarge.
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Avatar_f_tn
ok, thanks. But right now his mitral valve leakage is reported as trivial.
And his age is 33. Hope things get better soon.
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612551_tn?1247839157
You have taken my input correctly.  Given the age and diagnosis of the leaky valve it may never need correction, and if it does it may be 25 years or more in the future.  As I said I have no idea how long I had a leaky Mitral valve as I had my first echocardiogram at about the age of 57, and even then the leak was not considered serious enough to require surgery.  In my case another 10 years did bring on that need.  Yes, I was 67 when I had the surgery done, and all went very well.  

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Avatar_m_tn
I was in permanent atrial fibrillation and my left atrium had grown to 60mm in Dec. 2011.  I was started on TIKOSYN and returned to Normal Sinus Rhythm at that time. My left atrium is now about 54mm. and hopefully will continue to shrink.  At 50 mm. or under, I think I will opt for catheter ablation in order to stop taking the drugs. Fingers crossed.  I would like to hear of others with enlarged left atriums who have seen shrinkage back to or towards normal size.
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Avatar_f_tn
My left atrium has shrunk to normal size after treatment of atrial fibrillation which lasted for six months.
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1569985_tn?1328251082
When not in afib, my echo showed my left atrium with "mild" enlargement.  When I was in afib for several days they did an TEE and it showed "severe" enlargement.  The technician said to discuss this with the ep because it did not make sense to her.  The ep said everyone's left atrium would be enlarged while in afib.  Mine is now around 43 mm. and I was told by one ep that it was not terrible and would not rule out an ablation.  I have persistent intermittent afib.  I have been in nsr -- except for some tachycardia, pvcs, pacs here and there which is normal for me -- for nearly 5 months now on an increased dose of Norpace.  I am fairly stable at this point but have trouble making plans as I never know how I'm going to feel.  Hard to plan vacations, or basically any outing.  It is wonderful that you are back in nsr.  I would be interested to know how this goes for you.  It is my understanding that the longer one is in afib, the harder it is to fix.  So it is great that after 6 mos. you were able to go back to normal rhythm.  I am considering ablation to get off the drugs as you are, but also I would like to just get the afib behind me once and for all.  Good luck to you on this.  Keeping you in my thoughts and hoping you continue to do well.  
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Avatar_f_tn
When the first cardioversion failed, then doctors left me alone, although I tried to contact them several times. I knew that it could be difficult to retain normal sinus rhythm after six months. I am still angry due to the long waiting for cure in 2010.

Since that I have had two two-month episodes of atrial fibrillation. I have had to queue electric cardioversion, which could usually be done after three week's blood anticoagulation. At the last time it was difficult to get back the nsr (after only two months). I am still in normal sinus rhythm but I have SVTs sometimes. I am taking Tenoblock (atenolol) 25 + 20 mg daily. On the next week I'll have exercise ultrasonography to see whether I have coronary artery disease or not.

I hope that you torontoafibguy and DeltaDawn23 could have the ablation. Doctors have sometimes mentioned it also to me, but I am afraid of it and maybe I am too old.
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1569985_tn?1328251082
Have you considered an anti-arrythmic drug?  Norpace has worked pretty well for me and I take Atenolol also.  I don't know how old you are, but I have read that it is safe to do ablations into the 60's and 70's.

I have read yoga reduces the episodes of afib.  Meditation helps me, and moderate exercise seems to help me feel better and have more energy.

I am also afraid of the ablation, but more afraid of even more problems from permanent afib.  I get a rapid ventricular heart rate with it, so that cannot be sustained for long.  Did they give you drugs to keep your heart rate down or do you not have the rvr with your afib?

Just curious -- How does your health system there work?

Thank you for your kind thoughts.  Wishing you luck and sending you good thoughts.  
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Avatar_f_tn
Thanks for your wishings!

I am 65. When I had afib in 2010, I had appointments of several private cardilogists. I got different proposals: Multaq, Multaq plus electric cardioversion, Amiodarone plus electric cardioversion, pacemaker and rhythm lowering medicine. I did not want to take Amiodarone, because I had thyroid disease and respiratory difficulties (Amiodarone contraindicated). I had high heart rates and low heart rates and pauses at night. I at first got  atenolol and a calcium channel blocker and digoxin. I had to decrease the doses of the calcium blocker and digoxin and then stop taking them. During the six-month period I had infections, anitibiotics diarrhea, respiratory problems, gallstones, and then got symptoms of muscular dystonia (diagnosed later). When I, at last, got to contact with a cardiologist in a public hospital, she planned Multaq and electric cardioversion for me. It succeded easily. Later, because I had weird symptoms, I had to decrease Multaq and stop taking it.

I don't know why I sometimes get atrial fibrillation. Maybe infections are partly involved. The third period of AF was at the beginning of this year. The success of cardioversion was not as good as in 2010 but still succeded. I may get another AF period at any time, but I am not always thinking of it. If I got permament AF, it would be, I think, a disaster.

As to my heart function now, I am managing well for the present. Today I had the stress test with echo. I got through it very well. And had no SVT. No indication of coronary artery disease. I use to work fairly hard in our garden for a few hours almost on every day. That is why my stress test went well. Although I have lost much strength from my hands (I dont know why). I have not yet got written results about the test. My condition is, however, very variable, possibly due to other diseases and disorders. Even today I tried to stress to the doctor that my metabolic disturbances (eg. hypothyroidism, fluid and electrolyte disturbances may affect my heart and other condition. Those should be taken into consideration.

I am sitting at the computer for many hours of the day, and I have many other activities. Because I have other diseases and am usually very busy,  I have a slight fear of how this could affect my health later on. Meditation could help, but how to take the time for it or how to relax for it?  I may have a too busy habit of life. I have lots of plans for the future.

I wish you a good life.
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