Left Ventricular Hypertrophy diagnosis

40 plus year endurance cyclist here. Just received a LVH diagnosis. Has anyone else been diagnosed with this? I’m not finding a lot of information about how this condition affects in athletes specifically. My cardiologist told me I have no restrictions, but not feeling confident with his advice. Anyone? Thanks!


I’m 58 years old and had my yearly physical in early July. At that time, the doctor found Left Ventricular Hypertrophy, Left Atrial Enlargement, Right Atrial Enlargement, and Sinus Bradycardia. He said it’s because I’m an endurance athlete and that he isn’t concerned about it.


You don’t want any smoke on the right side due to the direct connection to the lung’s vascular system

What do you mean by “smoke”? Like literal smoke or is that slang I don’t understand. The only smoke I might inhale would come from bbq or one of the many wildfires this summer.

I find this concerning that your doctor isn’t worried. Are you symptomatic? I have been having palpitations quite often and am not as energetic.

I have no negative symptoms. It was just found in my routine yearly ECG. I’m no physician so I won’t try to give my interpretation of what I’ve read on the internet but my takeaway is that I’m fine.

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I was in for a colonoscopy, and someone rushed out to talk to my wife about them needed emergency care because my heart rate was ‘dangerously low’. At that point, it was not at all unusual for my heart rate to get as low as the top 40’s while sleeping. I mean that freaked me out one night when I was listening to the beats in my ears and it got really slow. It tends to freak docs out that it is low. I had to warn the techs for my subsequent surgeries that my rate could dip pretty low.

Heck, I ‘failed’ a stress test because my rate didn’t reach the level they were expecting for the effort they were subjecting me to. The cardiologist rode it over the horizon though by ordering a bunch of tests and finding out that I was perfectly fine for a ‘very active’ athlete. At 55. He said I’d outlive him. (Although they did find a smaller vessel ont he back of my heart

Unless it’s really out of scale, and there are other issues they find, I wouldn’t freak out about it. Let THEM do the freaking out. I had a needless liver operation because some stupid doc freaked out about a ‘complicated looking cyst’, and now have an abdominal wall hernia that is being held together by who knows what.

Surgeons live to cut. Psychiatrists love to sell drugs. Cardiologists love to sell pacers and implantable defibrillators, etc.

Don’t worry, be happy you are in such good shape, and relax about medical terms. Hyper means larger, trophy means size so hypertrophy roughly means bigger size. You earned it.

EDIT: I suppose it could be too big, but I’m sure they will find that out. Just beware of docs that are looking for something to do. Like my liver surgeon. They didn’t need to go after that, but they were the second opinion, the ‘expert’, and now hindsight is 20/20. To robinm1369: Take good care of yourself. My uneducated but experienced idea is you fine, but that is common…


When we hear about left ventricular hypertrophy (LVH), as occurs in pathological conditions such as hypertension (high arterial blood pressure), it is not a good thing. In hypertension the left ventricle has to work harder to eject blood from the heart and pump it through the rest of the body… since pressure in the vasculature is higher the heart has to create more pressure (i.e. has to contract more forcefully) to get the blood out during its contraction phase, resulting in concentric (muscle shortening) hypertrophy. Hypertrophy simply means the muscle has gotten bigger. Think bicep curls… your arm curls your biceps contracts (gets shorter…concentric muscle contraction) and over time your biceps get bigger and bigger and bigger (i.e., hypertrophies) in response to overload. In the heart this usually results in growth (i.e., cardiac remodeling) that encroaches on the left ventricular volume (inward remodeling). This isn’t good as it can lead to impaired cardiac function and make coronary perfusion more difficult. In contrast in athletes the growth of the left ventricle (LVH) is outward and is the result of eccentric stretching of the heart… during exercise venous return to the heart is so high the left ventricle is stretched to a degree that it induces remodeling as a result of eccentric hypertrophy. This is good as the heart is strengthened and the volume the left ventricle can pump with each beat of the heart (stroke volume) is increased… the ability of the heart to systemically pump more blood per minute (maximal cardiac output) is one of the primary variables underlying improvements in VO2 max with training. So as athletes we should welcome good cardiac remodeling resulting in eccentric hypertrophy of the left ventricle if we hope to improve athletic performance on the bike. Basically in both eccentric and concentric hypertrophy LVH is the bodies way of maintaining left ventricular wall stress. Short term this is good in both states, but in the pathological process long term the remodeling is bad as stated above as cardiac function starts to decline and things like heart failure start to become an issue. Generally, eccentric hypertrophy is not an issue short or long term. This is why cardiologists don’t get concerned about LVH seen on an EKG in endurance athletes who are otherwise healthy. The key to the doctor is whether LVH is from eccentric or concentric hypertrophy. An echo can discern this and EKG cannot. In an EKG LVH (more left ventricular tissue both from eccentric as well as concentric hypertrophy) creates a bigger electrical signal when the left ventricle contracts and this electrical signal is what is measured to diagnose LVH from an EKG. So if LVH is seen in a EKG, but your are normotensive and healthy and tell the Dr. you ride your bike or run 10 hours a week and are an endurance machine they likely will shrug off the LVH as a result of your lifestyle (endurance training) rather than a pathological process (years of being hypertensive, overweight, and smoking). If they are concerned that something more sinister is at play they will get an echo and/or do further testing to further delineate whether your LVH is of the good (eccentric hypertrophy) or bad (concentric hypertrophy) variety and go from there.


One of the tests they did was a ‘CTA’, and he said ‘You’re fine’… That was a test where they prescribed me a couple of pills to slow my heart down enough so the CT machine could catch the beats, but it worked fine.

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That’s exactly how it went for me. My blood pressure has always been rock solid. My doc knows about my cycling. And my resting heart rate was 43 on that day. Yours was a great explanation that I didn’t feel comfortable attempting as a layman.

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It is probably athletic heart syndrome as the first poster said. I have the same thing, as well as some other stuff that came up abnormal on the EKG. They did a full workup including wearing a holter and an ultrasound. Low heart rate reading of 32 on the holter, but doctors said they weren’t worried about my heart.

Can’t run at 150 bpm for 2 hours and not expect your heart to make physical changes.


Wow! What a great reply. So much information and easy to understand. Thanks for this. I do have hyptertension…have had it for at least 5 years but it’s always been something I’ve watched and it’s been well controlled. Maybe LVH is just an incidental finding? I am having a ton of palpitations and that’s why I saw cardio doctor. Am on a 7 day holter and have an echo scheduled. It’s very unnerving to have heart issues or feel like something isn’t right. To be honest, I get really nervous working out now. I’ve done a lot of z 2 work in the past few weeks and just a few hiit workouts. Time will tell, I guess. Again, thanks for explaining all of this so well. Much appreciated.

Personally, I started having palpitations when I started training harder. I got them in runs that did scare me. It all culminated in me seeing my doc who referred me to cardiology. I got with a group with a bunch of docs that also run and ride/ train. They said that it’s ‘kind of normal’ for athletes to have some, and they would check it all out, which started with the stress test that I failed. (My FP prescribed a really stupid, and expensive, monitor that didn’t stay stuck for long, and said that I was doing great, and came with a really rather large bill too. My insurance didn’t cover it apparently)

They checked me over really well, echo, CTA, enzymes, etc, and said everything was great. They said that I might have more on recovery days because of ‘irritable heart’, but I didn’t research that very far. The palpitations come and go, and are more numerous and less numerous at random, although might be tied to stress possibly.

I feel fine. I want to go on a walk…

Zone 2 seemed to condition my heart. It seemed to me that when I started really pushing, and skipping zone 2 and 3, I had more, but I never had an issue where I felt unsafe/near death. It was just weird…

It’s good that you are getting worked up. They found my smaller vessel, so that was what was limiting me. My workup answered a lot of questions. I’m glad I went through it all.

If you are training a lot and have high blood pressure, that might put you into another level too. The echo should see any odd enlargement. They did a CTA to check my plumbing and the actual speeds and pressures inside the heart, and watched the valves working. I had zero plaque and no blockages. Yippee!! That was great news. I have no family info so don’t know what I’m potentially predestined for.

Good luck…

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My Eco came with this passage:

hyperdynamic left ventricular systolic function.

Which my cardiologist explained as “very efficient, normal”.

I found this article, but it seems that the population of that study is not representative or healthy athletes.

Awesome news!

Thanks for the info and very interesting. Guess I will have to wait to see how my echo turns out and hope for the best. Do you plan on doing any more testing or are you comfortable with cardiologists response?

I’m comfortable based on my own reading of the literature and my overall health and markers.

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I have these too for the last several years. I’ve checked in with a cardiologist once or twice a year and been through a ton of testing, with all results indicating it’s nothing to worry about, which is great news. That said, they still drive me absolutely crazy!


Oddly, since I took some time off to try to get a better PSA result, and now getting back into hard(er) training, I haven’t had any to speak of. Strange… Well, either that, or I’ve just gotten used to them, but I don’t think so. I usually noticed them. In college, I used to get them a whole lot, like ‘runs’ of 5 or 6 at a time. and several times an hour. I was worked up and they all decided it was ‘college stress’, and that I was training for a 5 day century ride, and should cut down on the caffeine. I was put on nitros and procardia. The nitros sucked for sure, but in a couple of months I ‘out grew’ the palpitations.

I did, at the time, cut down on caffeine and the ride was a success, mostly. I’m still here, so I guess something worked…

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