What Is Ventricular Dyssynchrony?

Ventricular dyssynchrony is a condition in which the ventricles (the lower two chambers) of the heart fail to beat in a coordinated manner. This condition can cause blood to become stuck in the heart and not effectively move to the rest of the body. There are many diagnostic tests and treatments available for people living with ventricular dyssynchrony. 

This article focuses on the types, symptoms, causes, diagnosis, and treatments of ventricular dyssynchrony.

healthcare provider holding heart

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Definition

Ventricular dyssynchrony is used to describe when the chambers of the heart fail to beat in a coordinated pattern.

The chambers of the heart need to fill with blood and pump in order to effectively move blood to the rest of the body. When the chambers get out of sync, then the heart is moving inefficiently, and as a result, it cannot pump as effectively.

You can think of a heartbeat like a carefully choreographed dance routine—if even one step is misplaced, then it can throw off the entire process. Similarly, the heart muscle must activate and pump in a very coordinated process in order to push blood to the rest of the body. 

The most significant problems occur when the ventricles of the heart—which are responsible for moving blood to the organs of the body—are unable to coordinate their contractions. When the ventricles are uncoordinated, this is called ventricular dyssynchrony and can disrupt blood flow in the heart.

The heart beats and causes the ventricles to contract together to push blood to the rest of the body. If the timing of ventricular contractions is out of sync, then the ventricles are unable to efficiently move blood to the rest of the body and blood can build up in the heart. When blood builds up within the heart, it can lead to a problem known as congestive heart failure. 

Since ventricular dyssynchrony can sometimes present in heart failure with systolic dysfunction, it can be treated with therapies that regular congestive heart failure patients do not receive. While the two conditions share much overlap, people with ventricular dyssynchrony may also benefit from additional treatments like cardiac resynchronization therapy. 

Types of Ventricular Dyssynchrony

Ventricular dyssynchrony is divided into several types; some types are based on the anatomic location of the dyssynchrony. These include:

  • Intraventricular dyssynchrony: Most commonly seen on an echocardiogram when there is an abnormal movement within the left ventricle. In many cases, a portion of the left ventricle is activated early while another part is delayed, resulting in an imbalance in the force that can be generated within the ventricle.
  • Interventricular dyssynchrony: This form of dyssynchrony occurs when the right and the left ventricle are contracting separately from one another. The right and left ventricles are usually timed to work together to push blood to the other organs of the body. When the movement of the two ventricles is mistimed, then their ability to pump blood can be reduced.
  • Diastolic dyssynchrony: The diastolic period of the cardiac cycle occurs when the heart fills with blood. Dyssynchrony during this portion can cause abnormalities during the filling phase.
  • Systolic dyssynchrony: The systolic period occurs when the heart is ejecting blood to the other organs in the body. Abnormalities in the movement of the heart during this period are called systolic dyssynchrony. 

Ultimately, the different types of dyssynchrony often result in blood not effectively moving to the rest of the body. However, understanding the specific type of dyssynchrony can be useful for doctors to better manage the disease.

Ventricular Dyssynchrony Symptoms

The most common symptom of ventricular dyssynchrony is fatigue.

You might notice some difficulty with going on long walks or problems catching your breath when climbing stairs. Some people will commonly experience swelling that is noticeable in their feet and ankles. You may also notice a persistent cough. Some people notice difficulty with breathing when lying down flat in bed. These are all signs of heart failure, which can be the result of ventricular dyssynchrony. 

In some cases, you may not notice any significant symptoms, but a diagnostic test called an echocardiogram may still show evidence of ventricular dyssynchrony. In this case, your doctors may want to monitor your heart and check to see if any symptoms develop.

Causes of Dyssynchrony

The most common causes of ventricular dyssynchrony are diseases that damage the heart muscle. The most common condition that can lead to dyssynchrony is a prior myocardial infarction—or heart attack.

In some cases, abnormal heart rhythms, or arrhythmias, can lead to the development of ventricular dyssynchrony. Additionally, some genetic disorders like hypertrophic obstructive cardiomyopathy can lead to the development of ventricular dyssynchrony. However, it may not always be clear what causes dyssynchrony in some people. 

Heart Failure and Ventricular Dyssynchrony

Heart failure and ventricular dyssynchrony are linked together. Risk factors for heart failure—such as high blood pressure, high cholesterol, and diabetes—are also risks for the development of ventricular dyssynchrony.

Diagnosing Dyssynchrony

To diagnose ventricular dyssynchrony, healthcare providers will need to evaluate the heart with an echocardiogram, or an ultrasound of the heart.

Usually, a cardiologist will review the images from the echocardiogram and determine if there are abnormal segments of the ventricle that exhibit signs of ventricular dyssynchrony.

These are areas where the heart muscle is slow to activate and contract. If these segments are seen on an echocardiogram, they may be further evaluated with additional tests such as a magnetic resonance imaging (MRI) or positron emission tomography (PET) scan. In some cases, a cardiologist may want to perform a catheterization of the heart in order to evaluate the vessels in the heart.

All these tests are used to evaluate the severity of ventricular dyssynchrony and determine potential causes. These tests are critical because quantifying and understanding ventricular dyssynchrony can help your physician decide on the optimal treatments. 

Treatments

Medications used to treat heart failure may also improve ventricular dyssynchrony. These include:

  • Beta-blockers: These medications slow the heart down and allow it to pump more effectively.
  • Antihypertensives: Medications to reduce your blood pressure may be used.
  • Diuretics: These medications that reduce the fluid levels in your body are often prescribed. 
  • SGLT2 inhibitors: Medications that control the glucose levels in your body may be used to treat your heart failure. 

This may sound like a lot of medications, but together all these medications work in combination to support the heart and help it to pump more effectively.

In addition, one of the best treatments for ventricular dyssynchrony is called cardiac resynchronization therapy. This uses a device called a pacemaker to coordinate the electrical signals that tell the ventricles to pump. The pacemaker works to help coordinate electrical signals in the heart and tell the ventricles when to beat. The resynchronization helps the ventricles pump more efficiently and can help improve symptoms from heart failure caused by dyssynchrony. 

The procedure for cardiac resynchronization therapy, or CRT, is performed by a specialized cardiologist who will use minimally invasive catheters to position wires inside the chambers of the heart. Once the wires are in place, they are connected to a pacemaker. The pacemaker is then programmed to retime the ventricles and improve your heart’s ability to pump blood. The procedure is performed in a hospital, and your doctor may have you stay in the hospital for monitoring after the procedure. In some cases, the pacemaker may need to be reprogrammed in order to be more effective.  

The best treatments for ventricular dyssynchrony combine several approaches, including:

  • Medications
  • Dietary adjustments
  • Devices to treat ventricular dyssynchrony

Dietary changes such as eating a diet that is low in sodium and rich in fibers, plants, and omega-3 fatty acids can help promote a healthy heart. 

Prognosis

Ventricular dyssynchrony is a form of heart failure and should not be taken lightly. However, working with heart disease specialists such as a cardiologist, heart failure navigator, and your primary care doctor can improve your quality of life when living with ventricular dyssynchrony. Some people can live for years with ventricular dyssynchrony.

Importantly, other diseases such as infections can be even more serious for people living with ventricular dyssynchrony. If you do not feel well or become sick, do not hesitate to reach out to your doctor. 

Frequently Asked Questions

Is ventricular dyssynchrony a life-threatening condition?

Ventricular dyssynchrony is a serious medical condition and should be evaluated by a medical professional. There are a number of treatment options available that can help improve the lives of people with ventricular dyssynchrony.

What are the symptoms of ventricular dyssynchrony?

The most common symptoms are shortness of breath, difficulty climbing stairs or exercising, and swelling that is notable in the feet and ankles. You may also notice difficulty lying flat in bed or a persistent cough that won’t go away. All these are signs of ventricular dyssynchrony and should be evaluated by a healthcare professional. 

How is ventricular dyssynchrony diagnosed?

To diagnose ventricular dyssynchrony, an echocardiogram, or ultrasound of the heart, must be performed. The ultrasound can show doctors images of the heart muscle as it is beating. By evaluating the different segments or regions of the heart, doctors can determine if there are regions that are out of sync with one another.

How is ventricular dyssynchrony treated?

Ventricular dyssynchrony is first treated with medications to help the heart pump more effectively, such as a class of medications called beta-blockers. In addition, cardiac resynchronization therapy, which uses a cardiac pacemaker, may be used to treat dyssynchrony.

What is electrical dyssynchrony?

The heart beats as a result of an electric signal in the heart. If the electrical signals in the heart are out of sync, then the heart muscle may beat abnormally. This can lead to electrical dyssynchrony. Commonly, arrhythmias such as bundle branch blocks, atrial fibrillation, and ventricular tachycardia are known to be linked to ventricular dyssynchrony.

What is septal dyssynchrony?

Septal dyssynchrony is used to describe when a specific portion of the heart, the septum that divides the right and left ventricle, is unable to beat in a coordinated manner. When the septum beats and moves abnormally, this can cause blood to flow in an abnormal way within the heart.

A Word From Verywell

Ventricular dyssynchrony is an increasingly common heart condition and is linked to heart failure. Fortunately, many treatments are available. Connecting with a cardiologist, a physician who specializes in heart disease, is critical in order to treat and manage ventricular dyssynchrony. 

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