Echocardiograms (ultrasound of the heart), carotid ultrasound, CT heart scans, and electrocardiograms (EKGs) are common tests that provide insight into various aspects of heart health. If a murmur is heard upon examination of the heart, for example, an echocardiogram can reveal why there is turbulent flow causing audible sounds. An EKG can tell you something about the condition of the heart muscle. CT heart scans are designed to image calcium in coronary arteries, of course, but reveal details about other parts of the heart and other organs in the chest. In other words, these simple tests can yield plenty of important information about health, especially whether blood pressure has taken a toll on heart structures. Such findings cannot only tell you whether your heart has been stressed by exposure to high blood pressure, but it can tell you that trouble may be ahead and that you should do something about it as soon as detected to avert long-term trouble.

So it is all the more puzzling why such findings are rarely reported to the patient by the doctor. The ascending portion of the thoracic aorta, for example, the first portion of this largest artery of the body that emerges from the heart, is normally around 2.8 to 3.2 centimeters (cm) in diameter. High blood pressure over several years can cause this artery to enlarge and can be measured by echocardiogram, CT heart scan, as well as conventional chest CT or MRI. Should it enlarge to, say, 4.2 cm, it tends to accumulate atherosclerotic plaque that, being exposed to high pressure blood flow ejected from the heart, can fragment and shower debris to the brain and other organs. This is a common source of “mini-strokes.” If allowed to enlarge further to 5.5 cm, it then meets the definition of a thoracic aortic aneurysm with risk for rupture or internal tear of the lining of the vessel, both catastrophic. But had you been told years earlier that your thoracic aorta was mildly enlarged, you could have taken action to prevent accumulation of atherosclerotic plaque and further enlargement. Despite the fact that your doctor may have been given this early warning sign, rarely is action taken, rarely is this conveyed to their patients. And that’s wrong.

So here is a list of common findings on tests that are widely performed that you should be aware of, findings that tell you that high blood pressure has had an effect on heart structures. NEVER accept “Everything is okay” from the doctor in relaying the results of these tests. ALWAYS insist on obtaining the written report, the narrative that describes and quantifies the findings. (By Federal law, they cannot refuse your request, even though ignorant healthcare staff will sometimes say something like “Oh, no, that’s the doctor’s property.” The paper may be the doctor or clinic’s property, but not the information contained—that is yours.)

  • Enlargement of the thoracic aorta—As I mentioned above, a normal ascending thoracic aorta measures 2.8 to 3.2 cm, smaller in people with smaller body size (e.g., females), larger in larger people (e.g., males over 6 feet tall). Once enlarged, the aorta typically expands by 1-2 mm per year, or 0.1-0.2 cm per year. This means that a thoracic aorta that measures 4.2 cm will reach aneurysm proportions in 7-13 years.
  • Calcium in the thoracic aorta—This signifies that atherosclerotic plaque is developing, putting you at risk for stroke.
  • Enlarged left atrium—This very common finding also reflects higher internal heart pressure. When enlarged, you are more prone to heart rhythm disorders such as atrial fibrillation, which can pose major hassles and repeated tangles with the healthcare system. While there are a number of ways to measure the left atrium, the most common is a simple left atrial diameter that should be no more than 4.0 cm.
  • Left ventricular hypertrophy—Just as doing bicep curls gives you big biceps, so a heart pumping against high blood pressure will cause the main pumping chamber, the left ventricle, to hypertrophy. This can be detected by EKG or by echocardiogram, though only echocardiography is quantitative and can be tracked.
  • Aortic valve calcification—This is common in people in their 60s and 70s and can lead to aortic valve stenosis, i.e., the three leaflets that open and close with each heart beat become stiff and impede blood flow. The effective opening of the three leaflets can be tracked with echocardiogram. While a normal aortic valve area is around 3.0 cm, when it is reduced to around 1.0 cm and starts to cause symptoms such as chest pain, breathlessness, or losing consciousness, all brought on initially with physical activity, then it is time to get a prosthetic valve, a major undertaking. While most of my colleagues are unaware of this, getting your vitamin D blood level to around 70 ng/ml has, in my experience, slows or stops the otherwise expected 0.1-0.2 cm per year progression once the valve starts to calcify.
  • Mitral anular calcification—The mitral valve has a frame that the leaflets are attached to. This “frame” can accumulate calcium, also, and can sometimes interfere with valve function that leads, once again, to surgical valve replacement. Like aortic valve calcification, this can respond to vitamin D.

These are among the most common “incidental” findings that are usually not reported to people. There are others that are less common. But it really helps to obtain the original narrative report to examine yourself. If you don’t know what something means and you’d like some feedback, post the result on my Forum where we have several hundred thousand posts discussing such topics. Should you join the discussion, you will see that, if any of the above findings apply to you, we do not “treat” the high blood pressure to stop the progression of these phenomena. Instead, we address the common underlying causes of high blood pressure, a path that is superior to using prescription drugs to reduce blood pressure. You will find full discussion of these strategies in, as well as my Super Gut, Wheat Belly, and Undoctored books.