What Is A Hyperdynamic Left Ventricle?

In this article, we will take a close look at the medical condition known as hyperdynamic left ventricle, characterized by an ejection fraction above the normal range. We will explore its causes, which include hypertension, hypertrophic cardiomyopathy, and diabetes. We will also understand the diagnosis and treatment options for this condition.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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What is a Hyperdynamic Left Ventricle?

A hyperdynamic left ventricle is a condition where the left ventricle has a higher-than-normal ejection fraction. The ejection fraction is the percentage of the blood that leaves the left ventricle with every heartbeat.

One might think that a hyperdynamic left ventricle is beneficial since it means that the heart is pumping more blood. However, studies indicate that this is not the case. [1]

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A hyperdynamic left ventricle can be caused by several factors. It can occur in association with hyperdynamic left ventricular contraction and changes in cardiac loading conditions, even in a structurally normal or near-normal heart. Anemia-induced systolic anterior motion of the mitral valve can also result in a hyperdynamic left ventricle [1]. Additionally, conditions such as hypertension, diabetes, and obesity have been associated with a hyperdynamic heart [2]. Furthermore, hypovolemia combined with a hyperdynamic state resulting from increased catecholamines may result in the development of a hyperdynamic left ventricle [3,4].

Diastolic dysfunction is diagnosed through a combination of clinical evaluation and imaging tests. Clinical signs and symptoms of heart failure, such as shortness of breath and fatigue, are assessed. Imaging tests, particularly echocardiography, are used to evaluate the function of the heart. Echocardiography measures parameters such as the transmitral flow pattern, tissue Doppler imaging, and pulmonary venous flow velocities to assess diastolic function. Other imaging techniques, such as cardiac magnetic resonance imaging (CMRI), can also be used to evaluate diastolic dysfunction [1, 2, 3, 4, 5 ,6 ,7 ,8 ,9].

Patients with hyperdynamic left ventricles have a higher prevalence of diastolic dysfunction. This is a condition in which the filling of the heart is impaired [1]. Diastolic dysfunction can reduce the life expectancy of patients and is associated with: [1].

  • aortic stenosis, often linked to left ventricular hypertrophy [2],
  • heart failure: around 50% of heart failure patients have diastolic dysfunction [3],
  • coronary artery disease and left ventricular hypertrophy [4],
  • hypertension and diabetes, particularly in elderly individuals [5],
  • cardiac fibrosis [6].

Hyperdynamic heart conditions usually occur in:

  • older patients
  • women
  • obese people,
  • patients with diabetes,
  • people with hypertension

What Causes a Hyperdynamic Left Ventricle?

One of the primary causes of a hyperdynamic left ventricle is hypertension. The increased blood pressure leads to left ventricular hypertrophy. As the heart has to pump harder, it grows bigger. Such an increase in cardiac muscle is referred to as left ventricular hypertrophy and can lead to hyperdynamic states [1].

Another significant cause is hypertrophic cardiomyopathy. This is a genetic disease in which a gene mutation in the heart causes thickening of the cardiac muscle. An abnormally big heart can have problems pumping blood properly. To function effectively, it will have to pump harder, leading to a hyperdynamic left ventricle [7, 8].

Also, diabetes and obesity are associated with a hyperdynamic left ventricle. In both of these conditions, the structure and function of the heart can change. This can lead to an increased heart rate and changes in the size of the heart’s chambers, resulting in hyperdynamic states [1].

Lastly, there is a strong association between age and a hyperdynamic left ventricle. The higher occurrence indicates that older age is also a factor in hyperdynamic left ventricle [1].

Are Hyperdynamic Left Ventricles Serious?

Yes, hyperdynamic left ventricles can be serious. This condition is not a normal function of the heart and is associated with increased mortality [1].

Patients with a hyperdynamic heart are often found to have diastolic dysfunction. Their hearts have a larger atrial size, the left ventricles have an increased mass, and the end diastolic volumes are higher. All those characteristics make the survival rates in this group lower. Compared to patients with a normal ejection fraction, patients with a hyperdynamic left ventricle have an increased risk of death by 56% [1].

A hyperdynamic heart does not increase the death risk only in individuals with cardiac disease. A hyperdynamic left ventricle more than doubles the risk of death in patients with COVID-19 [9].

Short-term mortality is also increased in septic patients with hyperdynamic left ventricles [10].

How is a Hyperdynamic Left Ventricle Diagnosed?

The diagnosis of a hyperdynamic left ventricle is based on imagining. Primarily used is echocardiography. This technique allows assessment of the systolic and diastolic functions and the ejection fraction [11, 12].

In atypical cases or when echocardiography is not optimal, cardiac magnetic resonance can be used. The cardiac picture acquired during this method allows the doctors to measure the volume and mass of both ventricles. Cardiac MRI also shows certain characteristic properties of the cardiac tissue [13].

Treatment of a Hyperdynamic Left Ventricle

The treatment of a hyperdynamic left ventricle often involves managing the underlying condition, such as hypertrophic cardiomyopathy. First-line treatment usually includes:

  • antiplatelets,
  • beta-blockers,
  • angiotensin II receptor blockers,
  • diuretics [14].

In specific cases, interventional treatment can be considered. When the patient does not respond to therapy or when an obstruction is found in the left ventricle, a septal myectomy or alcohol septal ablation can be used [15, 16].

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A septal myectomy is a surgical procedure used to treat hypertrophic cardiomyopathy (HCM), a condition where the heart muscle becomes abnormally thick. During a septal myectomy, the surgeon makes an incision in the chest and cuts through the breastbone to access the heart. They then remove the thickened part of the heart's septum, which is the wall between the heart's chambers. This helps improve blood flow and relieve symptoms caused by the thickened septum. The procedure is performed under general anesthesia and requires the use of a heart-lung machine to keep the patient alive during the surgery [1, 2].

Alcohol septal ablation is a minimally invasive procedure used to treat hypertrophic obstructive cardiomyopathy (HOCM). During the procedure, a small amount of absolute alcohol is injected into a specific branch of the coronary artery that supplies the thickened septum of the heart. The alcohol causes a controlled infarction (tissue death) in the targeted area, leading to a reduction in the obstruction of the left ventricular outflow tract. This helps improve blood flow and alleviate symptoms in patients with HOCM [1, 2].

However, the therapy should be tailored individually. For every patient, factors like the characteristics of the condition, lifestyle, age, and the doctor’s expertise should be taken into account [16].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.