Hypertension/Enlarged Heart

[walkerro]

My 40 year-old wife in recent months has undergone a number of tests following some weight loss. It transpires that she is suffering from hypertension with her 24hr ambulatory readings averaging at 170/110. Further diagnostic tests (ECG, echo and cardiac MRI) were undertaken and her cardiologist told her that her heart is enlarged (moderate) with impaired function (I believe ejection fraction in the region of 45%) but has not been able to identify the root cause of the hypertension. She is asymptomatic and does not have any issues in terms of fatigue, breathlessness, swelling, etc.
She has been prescribed 5mg Amlodipine, 5mg Ramipril and 2.5mg Bisprolol. The Cardiologist has told her she will be on medication for longevity and that improving the condition will take a long time. Her blood pressure has already come down to 132/84 which the cardiologist was very pleased with. She will be seeing him again in 8/9 weeks with a follow up echo in 4/5 months.
In terms of the diagnosis, the cardiologist has referred only to hypertension but having read and aligned the symptoms of the enlarged heart and impaired function, is it not heart failure.....? Also, what is the prognosis for an enlarged heart caused by hypertension, especially in someone of 40 years of age.....can the enlarged heart and function return to normal over time with the medication?
Thanks for any insight.

[tacolino]

Hi there. I have had a very similar experience to your wife. 51 year old male. My bp went out of control 2 years ago I had a hypertensive crisis, over 250 mmhg Systolic. There was enlargement and my EF was less than 20%. Having controlled the BP, my situation improved. It takes time, but my EF is 45% now and my BP (On a fair number of meds) is average 114/65 . So you can have an improvement in the longer term. Im delighted your wife has had very positive results, her future is very bright, Best wishes

[achillea]

Having suffered briefly and years ago from mild cardiac enlargement due to hypertension, I found that I got back a normal heart once things were under control.  It has been more than a decade, so my experience is that yes, this happy state can continue or improve quite nicely.

Of course, a healthy lifestyle and some daily exercise couldn't hurt.

But congratulations to both of you on your wife's good news.

[walkerro]

Just following up on my most recent post on any further insight anyone may have? Thanks all for your help

[walkerro]

Thanks for your insight, very helpful.

Received an updated letter with more specifics from the cardiologist. It states the diagnosis as "hypertension with impaired left ventricle systolic function, ejection fraction around 40%, no left ventricular hypertrophy".He also states that if the blood pressure is well controlled, he will remove the amlodipine meds.

Is the prognosis of this diagnosis concerning, can it be reversed/cured over time with good blood pressure control?

[walkerro]

Update on my wife's condition. In December, she went for her six-monthly echocardiogram follow up. Results from her cardiologist were positive, EF has improved to 54% and the sizing of the heart has improved. He said wasn't expecting the sizing of the heart to have improved so much, good news. Blood pressure reading with meds 109/64, wants to see her again in 12 months, no change to meds at this point. In terms of long-term prognosis, should we expect this to improve further or at the least maintain at it's current level?
Clearly, good news!!!

[is_something_wrong]

It all depends on the hypertension and how well controlled it is. Changes in the heart made by a known issue (hypertension, infections or tachycardia to mention a few) tend to normalize as the underlying condition is treated.

The heart, like most organs, easily adapt to changed situations. In the case of hypertension, the heart walls grow to adapt to higher resistance. When such a change is no longer necessary, it often returns to normal.

Just think about exercise, how the heart may change when you are in good shape (causing lower resting heart rate because the heart is larger) and how fast this returns to "normal" when you stop exercising.

Perhaps her blood pressure optimally should be a bit lower than 132/84. To speed up the normalization, closer to 120/80 would be great. But her cardiologist must decide this. Anyway, it's great that she has a normal blood pressure now :-)