From the Guidelines
A hyperdynamic ventricle is typically managed by treating the underlying cause rather than the hyperdynamic state itself, and beta-blockers such as metoprolol may be used to reduce contractility and heart rate in symptomatic cases. This condition is characterized by vigorous ventricular contractions and is often seen in states of high cardiac output such as fever, anemia, hyperthyroidism, anxiety, or early sepsis. On echocardiography, a hyperdynamic ventricle typically shows increased ejection fraction (often above 70%), enhanced wall motion, and more complete emptying of the ventricular chamber during systole.
The management of a hyperdynamic ventricle depends on the underlying cause, and treatment should focus on addressing the root cause of the condition. For example, treating anemia with iron supplementation, managing hyperthyroidism with medications like methimazole, or addressing anxiety with appropriate interventions. According to the European Heart Rhythm Association (EHRA) consensus document 1, beta-blockers should be used for the management of hypertension in the setting of coronary artery disease and heart failure.
In cases where symptoms like palpitations are bothersome, beta-blockers such as metoprolol (starting at 25mg twice daily) may be used to reduce contractility and heart rate. The hyperdynamic state itself is not necessarily pathological but rather represents the heart's compensatory response to maintain adequate tissue perfusion under certain physiological or pathological conditions. It is essential to note that the use of antiarrhythmic drugs should not be routine in patients with heart failure and asymptomatic ventricular arrhythmias due to safety concerns, as stated in the EHRA consensus document 1.
Key points to consider in the management of a hyperdynamic ventricle include:
- Treating the underlying cause of the condition
- Using beta-blockers to reduce contractility and heart rate in symptomatic cases
- Avoiding the routine use of antiarrhythmic drugs in patients with heart failure and asymptomatic ventricular arrhythmias
- Focusing on addressing the root cause of the condition rather than the hyperdynamic state itself.
From the FDA Drug Label
The Systolic Heart Failure Treatment with the I f Inhibitor Ivabradine Trial (SHIFT) was a randomized, double-blind trial comparing ivabradine and placebo in 6,558 adult patients with stable New York Heart Association (NYHA) class II to IV heart failure, left ventricular ejection fraction ≤ 35%, and resting heart rate ≥ 70 bpm
The diagnosis of a hyperdynamic ventricle is not directly addressed in the provided drug label. The treatment for a hyperdynamic ventricle (increased contractility of the ventricle) is not explicitly mentioned in the label, it only discusses the treatment of heart failure with ivabradine. Key points:
- The label discusses the treatment of heart failure with ivabradine.
- It does not provide information on the diagnosis or treatment of a hyperdynamic ventricle. 2
From the Research
Diagnosis of Hyperdynamic Ventricle
- A hyperdynamic heart is defined as a left ventricular (LV) with an ejection fraction (EF) above the normal range, typically above 70% 3.
- Echocardiography examinations can be used to evaluate the diastolic properties of subjects with a hyperdynamic heart and its impact on outcome 3.
- Subjects with a hyperdynamic heart are more likely to have hypertension, diabetes, and obesity, and may have a higher heart rate, smaller ventricular size, and higher relative wall thickness 3.
Treatment of Hyperdynamic Ventricle
- There is no specific treatment mentioned in the studies for a hyperdynamic ventricle, but treatment of underlying conditions such as hypertension, diabetes, and obesity may be necessary 4, 5.
- Beta-blockers, such as bisoprolol, metoprolol, and carvedilol, are commonly used to treat heart failure, but their effectiveness in treating a hyperdynamic ventricle is not specifically mentioned in the studies 4, 5.
- ACE inhibitors, such as enalapril, and ARBs, such as sacubitril/valsartan, may be used to treat heart failure, but their effectiveness in treating a hyperdynamic ventricle is not specifically mentioned in the studies 4, 5.
Clinical Outcomes of Hyperdynamic Ventricle
- Subjects with a hyperdynamic heart have increased prevalence of diastolic dysfunction and reduced survival 3.
- A hyperdynamic heart is associated with higher mortality in COVID-19 patients 6.
- The presence of hyperdynamic LVEF during a COVID-19 hospitalization is associated with an increased risk of 60-day mortality, the requirement for mechanical ventilation, vasopressors, and intensive care unit 6.