Cardiac
How To Reverse My Left Ventricle Hypertrophy
- Zone 2 cardio, work up to 60 minutes continuous cardio 3 times a week
- Tirz
- Finerenone, if aldosterone is elevated
- Weight loss
- DMARDs for autoimmune inflammation
Working With Doctors
Many PCPs and cardiologists are eager to skip screening for diastolic heart failure even in patients who realistically may have it, preferring to write the symptoms off as being caused by weight, stress, or anxiety. This leads to many cases of progressing diastolic heart failure every year. Don't be a statistic.
Think of routine monitoring beyond what your insurance doc wants as something a healthy person does to take good care of their body.
Obesity
Yes, obesity can cause symptoms similar to heart failure, such as shortness of breath and peripheral edema, even in the absence of overt heart failure. This occurs because obesity independently contributes to cardiovascular alterations like left ventricular hypertrophy, diastolic dysfunction, and plasma volume expansion, which elevate cardiac filling pressures and lead to symptoms like dyspnea and swelling. These symptoms can be attributed to factors such as reduced lung compliance, increased metabolic demand during exercise, and impaired pulmonary vasodilation, particularly in individuals with obesity. The presence of excess visceral adipose tissue, including epicardial and pericardial fat, can trigger local inflammatory pathways and contribute to diastolic stiffness and atrial remodeling, further mimicking heart failure. Even asymptomatic individuals with obesity may exhibit lower levels of brain-natriuretic peptide (BNP) due to degradation by fat tissue, which is associated with increased aldosterone activity and low ventricular compliance—key factors in heart failure with preserved ejection fraction (HFpEF) pathophysiology. Therefore, the clinical presentation of obesity can closely resemble heart failure, making it crucial to differentiate between obesity-related symptoms and true cardiac dysfunction.
LV Hypertrophy
LVH can be present for many years without any symptoms, and it is frequently diagnosed incidentally through routine tests like an electrocardiogram (ECG). This asymptomatic phase means that a significant number of individuals have LVH without experiencing heart failure or other overt clinical manifestations.
posterior wall thickness is used to grade severity: mild (12–13 mm), moderate (>13–17 mm), and severe (>17 mm).
Stages of HF
Stage 1: Gasping for breath climbing stairs
Pseudonormal Diastolic HF
it is possible to have diastolic heart failure with a normal E/A ratio. This condition is classified as Grade II diastolic dysfunction, also known as pseudonormal. In this stage, the E/A ratio appears normal (typically between 0.8 and 1.5), but this is due to elevated left atrial pressure and reduced left ventricular compliance, which causes the E wave to be higher than normal. The normal appearance of the E/A ratio is misleading, and the true underlying diastolic impairment can be identified using additional tests such as a Valsalva maneuver, which causes the E/A ratio to reverse (E wave drops in amplitude), or by assessing the E/e' ratio, which is typically elevated. Structural heart disease, such as left atrial enlargement or left ventricular hypertrophy, is often present and serves as a key clue to the presence of pseudonormal filling patterns.
Pseudonormal diastolic dysfunction is characterized by a mitral inflow E/A ratio that appears normal, typically between 0.8 and 1.5. This pattern occurs in the context of elevated left atrial pressures due to advanced diastolic dysfunction, where increased left atrial pressure forces more blood into the left ventricle during early diastole, thereby increasing the E-wave velocity and normalizing the E/A ratio despite impaired relaxation. The deceleration time of the E wave is also normal, generally between 160 and 200 milliseconds. This pattern is pathological and not a true normal finding, often associated with structural heart disease such as left atrial enlargement, left ventricular hypertrophy, or systolic dysfunction. The presence of a normal E/A ratio in a patient with such structural abnormalities should raise suspicion for pseudonormalization. To differentiate pseudonormal from normal diastolic function, the Valsalva maneuver is used; in pseudonormal cases, the E/A ratio drops below 1 due to reduced left atrial pressure, unmasking the underlying impaired relaxation. Additionally, tissue Doppler imaging reveals a reduced mitral annular e’ velocity, leading to an elevated E/e’ ratio (>14), which further supports the diagnosis of pseudonormal diastolic dysfunction.
MV Pk E Vel 0.9 m/s (0.7 - 1.2)
LVPWd 1.2 cm (0.6 - 0.9)
MV Pk A Vel 0.6 m/s (0.4 - 0.7)
LV Mass 182.5 g (67 - 162)
MV E/A Ratio 1.40 (0.73 - 2.33)
AV index LV Mass / BSA 75.15 g/m2 (43 - 95)
MV PHT 44.3 ms (30 - 60)
Pulmonic LV FS (midwall) 33 % (15 - 23)
MV Decel Time 152.60 ms (138 - 194)
A major clue to the presence of grade II diastolic dysfunction vs. normal diastolic function is the presence of structural heart disease such as left atrial enlargement, left ventricular hypertrophy or systolic dysfunction.
Chronic heart failure occurs when either the left ventricle, the right ventricle, or both require elevated filling pressures to maintain cardiac output.
Early HF Symptoms
For years I had trouble walking distances without stopping to rest but thought of it as merely an inconvenience. And I'd had mildly swollen feet and ankles for years tho no one seemed excited about it.
i only noticed really getting out of breath during heavy exercise and getting winded when tying my shoe laces.
Shortness of breath, fatigue and struggling to walk flights of stairs without having to sit down (normally quite fit 5k a day and hit classes so seemed bizarre) mri caught heart failure
Advanced Routine Screening For Early Diastolic HF
Diastolic dysfunction is an indication of abnormal mechanical properties of the myocardium, characterized by slow or delayed myocardial relaxation, abnormal LV distensibility, and/or impaired LV filling.
cardiac magnetic resonance imaging (MRI) has the capability for differentiating between normal and abnormal myocardial relaxation patterns, and therefore offers the prospect of early detection of diastolic dysfunction. Although diastolic cardiac function can be assessed from the ratio between early and atrial filling peaks (E/A ratio), measuring different parameters of heart contractility during diastole allows for evaluating spatial and temporal patterns of cardiac function with the potential for illustrating subtle changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC8706325/
NT Pro-BNP
If you are a BMI X or lower, the NT Pro-BNP blood test is very accurate at ruling out heart failure, including early diastolic heart failure. [Is this true? How about diastolic dysfunction?]
Studies have shown that NT-proBNP levels are approximately 59% lower in obese patients with heart failure with reduced ejection fraction compared to non-obese patients. The underlying mechanisms are not fully understood but may include a larger plasma volume, increased peripheral degradation of natriuretic peptides due to elevated neprilysin activity in adipose tissue, altered glycosylation affecting assay detection, and reduced cardiac synthesis or release.
To compensate, lower cut-off values are recommended for obese patients to avoid missing cases of acute heart failure. For example, a study found that using a lower exclusionary cut-off of 300 ng/L for all age groups in obese patients still maintained a high negative predictive value, although the sensitivity and specificity were slightly lower than in non-obese patients. The diagnostic performance of NT-proBNP remains high in obese patients, with an area under the curve (AUC) of 0.89, indicating it is still the most accurate single clinical variable for diagnosing acute heart failure in this population.
weight loss interventions, particularly bariatric surgery such as sleeve gastrectomy, have been shown to increase NT-proBNP levels, suggesting a potential reversal of the "natriuretic handicap" state. This improvement may be linked to better metabolic control, as NT-proBNP levels were found to be inversely correlated with fasting glucose in euglycemic individuals, indicating a role for glucose homeostasis in regulating these peptides.
This study showed NT Pro-BNP cutoff of 300 to work well in obese patients for diagnosing acute HF. What about chronic HF? https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.2618
NT Pro-BNP Fingerstick
https://diagnostics.roche.com/global/en/products/instruments/lumiradx-ins-7781.html
https://www.1dropdx.com/healthtests/
Echocardiogram
Traditional Echo with E/A Ratio
From Brave AI:
an E/A ratio greater than 2.5, combined with a deceleration time less than 140 milliseconds and an IVRT less than 50 milliseconds, is characteristic of grade 3 diastolic dysfunction (restrictive filling). In contrast, a reduced E/A ratio (e.g., <0.8) may indicate impaired relaxation or early diastolic dysfunction.
Stress Echo with E/e’
It’s great if you might have pseudonormal hfpef!
Treatment
Tirzapetide
The structural improvement in the heart is thought to result from the drug's ability to reduce paracardiac adipose tissue, which contributes to inflammation and fibrosis, thereby alleviating the burden on the heart.
Finerenone
Hell yeah