mild concentric hypertrophic without high blood pressure

[kat61393]

First I have a strong family history of HCM.  I have mentioned this to my doctor's several times.  I almost never have high blood pressure.  It usually runs 120's to mid 130's systolic and 60's to 70's diastolic.  (I take it almost daily because I am curious)  The few times that it has ever gotten close to high was during times in which I was very sick. (pneumonia & bronchitis)  I have had several ECHO's and the results always read mild left concentric hypertrophic, systolic anterior movement of my mitral valve, moderate MR and LAE.  The cardiologist that reads the echo says its related to my high blood pressure.. again, I do not have high blood pressure and no one seems to listen.  The strange thing is that high blood pressure is never mentioned in my records, and every time they take it for my office visit it is always in the normal range.  My mitral valve is elongated and I understand that this may be the reason for the MR and the LAE.  This is my question.  Is concenteric left ventricular hypertrophy any indication that I may have HCM?  My father had several MI's in his 30's.  He had arrythmia's all the time and had a CVA at the age of 48.  He died of CHF at the age of 66.  We found out at his funeral that his sister was diagnosed with IHSS and died the following year of CHF.  He had another sister who also had a CVA and died in her early 60's of CHF, and his brother had a CVA and died of CHF at the age of 62.  My aunt (father's sister) family have been tested (ECHO)  three of the six children have HCM.  I have another cousin who died (not of HCM) during autopsy they noted left ventricular hypertrophy.  With this strong of a family history I don't want my doctors brushing this off, and I feel this is exactally what they are doing.   Please any advise will be appreciated.  Should I seek a second opinion?

[Mom2four85]

Thanks Kat61393; pretty much what I've been suffering from also for about 5 - 6 years  SoB, CP & Dizziness, but my exercise intolerance didn't start until last year.  what is SAM's? I can't find it in anything about HCM, but I'm still reading.

I had a 2-D Echo; that's why I asked if you had a 2 or  3D to see if a 3D was recommended.  

My ECHO results were pretty much the same as yours - it revealed concentric left ventricular hypertrophy with a normal EF of 55-60% on 7/6/09; it also showed mild Tricuspid and MVP insufficiency and the septal thickness, posterior wall thickness and left atrium were enlarged. I had a cardiac catherization on 8/28/09 revealed Non-Ischemic Cardiomyopathy with an ejection fraction of 40%.

I've been to so many doctors trying to find an answer and none have been able to give me any other than test results and a possible diagnosis.  I've had blood testing for some genetics; tested for ARVD; kinks, clots, plaque etc; referred to the founder of Brugada, and a couple of other things, so hopefully when I mention HCM to my dr he will check this out and explain it to me.

With your strong family history I would def seek a 2nd opinion and hope you get some answers also.

[grendslori]

You do NOT have to have a diagnosis of HBP in order to have a diagnosis of Concentric Hypertrophic Cardiomyopathy. My daughter NEVER had HBP and she had concentric HCM, one of the worst cases they have seen in this country. You may not know if your family has a history of this disease, has anyone ever died early from a heart attack (which was probably due to an arrhythmia and not from a clogged artery)? Knowing your family history MAY help. No one in our family had this disease and they say if it is genetic, it doesn't skip generations, so one of the parents has to have this disease if it's genetic. Having said that, it can also be sporadic; neither my husband nor myself have this disease and our daughter had it so bad she was one of the 5% who needed the transplant to live. Keep after this!  

[kat61393]

It was found on an ECHO last year.  I was having SOB, exercise intollerance, chest pain and dizziness.  They ran another ECHO this year after I mentioned the family history and esentially it was the same.  So I am not sure what it really is.  

[Mom2four85]

Kat61393
How did you find out it's concentric? 2 or 3 d echo or is there another test?

I had an echo last July that showed Mild Concentric left ventricular hypertropy; but was told the same thing you were - it wasnt anything to worry about because I've never had high BP. At the end of August, I was dx with a disorder that causes my bp to be low, so that may have something to do with it since mine stays around 90/60 even with meds.

I've researched and was thought concentric LVH was just in the LV, until reading here; so that's something at my next appt I'll bring up.  My original dx pointed to ARVD, I had a cardiac MRI that said inconclusive but my EP said he was unsure but it could be.

good luck, please post if you find anything else out

[kat61393]

Hi Lisa,
You can always get genetic testing, but that can be expensive.  I guess its a matter of the doctors checking everything and to rule out what it's not before they come to a conclusion of HCM.  I think what is messing my cardiologist up is that my hypertrophy is concentric.  I think most people who have concentric left ventricle hypertrophy have high blood pressure.  But I do not have nor as far as I know have never had high blood pressure.  Some times it's even sort of low.  I took it today and it was 110/58 and my pulse was 99.  I have had the systolic even drop into the 90's.  It seems to me the stronger and faster my pulse the lower my BP.  (not always, but there does seem to be a trend with that.)

[Mom2four85]

thanks for all who posted so much info here; I have a couple of questions that kat61393 brought up - because this title could have been mine

how do you get this checked out for HCM if you don't know your family history? I am still searching for answers to what's wrong with me and what is causing my problems, and alot of what's here is on my testing & surgery paperwork but they told me not to worry about anything because didn't have HBP; but that was before they dx me with ANS dysfunction

maybe I'm just grasping at straws trying to find my answers =)

[kenkeith]

QUOTE: "Thanks for all the responses, my obstruction is due to something called SAM's.  I really don't understand it, but I know it has something to do with the mitral valve".


For some insight:  Yes, you are correct.  Approximately 35% of cases of HCM, there is also obstruction to the flow of blood as it leaves the heart. This obstruction can be due to the thickening of the ventricular septum or to a condition known as systolic anterior motion of the mitral valve (SAM). With SAM, the mitral valve moves forward and gets in the way of blood that is heading toward the aortic valve to leave the heart.

QUOTE: "hyperdynamic LV with ejection fraction >70%"

Normal EF is 50 to 70%.  When the EF is higher than normal, that indicates the heart is pumping a greater percentage of blood into circulation with each stroke.  This happens normally when the system compensates to maintain a balance of blood flow between the right and left side, and other compensating features are heart rate and blood pressure.  If the underlying cause for hyperdynamic left ventricle is not corrected, there will be over-compensation causing the heart to enlarge (dilate) to the extend the heart will lose its contractility.  The phenomonon is the Frank/Starling mechanism ...for analogy stretching a hand spring will cause it to recoil more forcefully, but over stretch the heand spring will become flaccid.

Your condition is compensating with slightly higher than normal EF and a fast heart rate (but not dangerously high)....usually there would also be high blood pressure to compensate as well. The vast and rapid compensation abilities of the autonomic nervous system allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states.

Take care.

[kat61393]

Thanks for all the responses, my obstruction is due to something called SAM's.  I really don't understand it, but I know it has something to do with the mitral valve.  Again, my blood pressure is normal.  Today when I was at my primary doctor's office my bp was 128/66, and my pulse was 94.  I looked at my ECHO again and also noted that the cardiologist stated that I have hyperdynamic LV with ejection fraction >70%.  I think that means my heart beats hard and fast???  I do have a high pulse normally. It usually runs in the 90's and maybe 80's when at rest.

[kenkeith]

From Wikipedia, the free encyclopedia:
Unhealthy cardiac hypertrophy (pathological hypertrophy) is the response to stress or disease such as hypertension, heart muscle injury (myocardial infarction) or neurohormones. Valvular heart disease is another cause of pathological hypertrophy.

Chronic hypertension causes pathological ventricular hypertrophy. This response enables the heart to maintain a normal stroke volume despite the increase in afterload. However, over time, pathological changes occur in the heart that lead to a functional degradation and heart failure.

In the case of chronic pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing arteries), the chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres. This is termed CONCENTRIC hypertrophy.[11] This type of ventricle is capable of generating greater forces and higher PRESSURES, while the increased wall thickness maintains normal wall stress. This type of ventricle becomes "stiff" (i.e., compliance is reduced) which can impair filling and lead to diastolic dysfunction.

For those interested in EKG...The axis of the heart shifts towards the hypertrophied ventricle for two reasons: 1. far more muscles exist on the hypertrophied side, which allows excess generation of electrical potentials on this side. 2. more time is required for the depolarization to travel to the hypertrophied ventricle compared with the normal.  Can cause arryhthmia.

It seems to me the issue discussed is patholological hypertrophy, and to fine tune the discussion one would go to the sarcomere heart cells. When heart cells are injured they lose there ability to expand and contract (hypokineses). The cells line up differently for patholgical hypercardiomyopathy when compared to an athlete's heart (non-pathological.

It is true there is a genetic component for concentric cardio enlargement and that would/may have a different pathological impact to the sarcomere heart cells of the wall tissue but I believe the heart's dysfunction and limitations would be the same.  Also, treatment options may differ, etc..

Thanks for sharing your view point...

[kevk]

I have LV concentric hypertrophy with midwall obstruction HOCM. It`s been a while but I think they called mine symmectrical meaning one side of the heart. The other term was asymmetrical meaning both sides, I may have them confused. I may be totally wrong but there is a term to separate the two.

With your family history I would want a second and third opinion. You show some classic signs of HCM and  As grendslori mentions HCM can be very serious and something you need to stay on top of.  You may even want to talk to the HCMA to help you. If there is anything I can do to help let me know.

[grendslori]

"In terms of the heart, concentric LV hypertrophy means that the muscle of the left sided pumping chamber of the heart has increased in size and thickness".

It has been our experience with our daughter, having a Concentric form of cardiomyopathy, that they referred to it as being 'concentric' because ALL of the heart walls, in both left and right ventricles were hypertrophied. LVH is not always referred to as being the same as having the concentric form of the disease. Most people do not have the concentric form.

Ken you have listed some reasons for the hypertrophy, however in true hypertrophic cardiomyopathy, genetics are generally the reason for the presents of this disease. Sometimes it's sporadic as in my own daughter's case, but that's rare. My daughter did not have high blood pressure, hers always ran low to normal, although her diastolic levels were always low. She also had no obstructions even though her walls were 4+cm thick at the time of her transplant and all of her valves leaked, but that only became severe in the very end. HCM in the truest sense is really genetic in nature and therefore treatments are only geered toward relieving symptoms with about 5% of patients needing to be transplanted. maybe I'm missing something here but these were the things we were told for years about the Concentric form of this type of cardiomyopathy.
  

[kenkeith]

QUOTE: My mitral valve is elongated and I understand that this may be the reason for the MR.and the LAE.  This is my question.  Is concenteric left ventricular hypertrophy any indication that I may have HCM".
"I forgot to mention I also have LV outflow tract gradient of 35 mm Hg, and Grade 2 diastolic LV dysfunction with normal LA pressure.  Don't know if this is any help"
__________________________

The pressure your doctor may be refering to is the intraventricular pressure caused by tract gradient pressure.  The Left ventricle systolic (pumping) pressure elevation can cause concentric hypertrophy leading to diastolic (filling phase) dysfunction with preserved pumping functionality.

Hypertrophy in medical terms means enlargement of the size and concentric means all round. In terms of heart, concentric LV hypertrophy means that the muscle of the left sided pumping chamber of the heart has increased in size and thickness. This usually occurs because of either high blood pressure or any obstruction to the outflow of blood from the left heart chamber (causing high LV pressure). Commonest example of latter is narrowing of the aorta valve (aortic valve...output tract). I suppose only your doctor can tell you as to the real reason of this LV hypertrophy. Remedial measures can only be taken once you know the cause of LV hypertrophy.
Hope this helps, and if you have any further questions you are welcome to respond.  Thanks for sharing and take care.

[grendslori]

You need say no more. You have HCM based on what you have written on here. AND you have a strong family history of it. Concentric Hypertrophic Cardiomyopathy means that you have more than one wall affected which is a rarer form of the disease. HCM is generally genetic in nature, but can be sporadic. You need to see a doctor who deals with HCM patients. Cleveland Clinic, the Mayo Clinic, the NIH (National Institutes of Health in Maryland) the University of Michigan those are a few places who see patients with this disease. A BP of 130/whatever, is not high enough to cause your walls to thicken. Get yourself an appointment with a doctor who will take this seriously; it's a serious disease.

[kat61393]

I forgot to mention I also have LV outflow tract gradient of 35 mm Hg, and Grade 2 diastolic LV dysfunction with normal LA pressure.  Don't know if this is any help.