Hypertensive Heart Hypertensive Heart

DiseaseDisease

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

• End Organ Damage as a consequence of systemic End Organ Damage as a consequence of systemic

hypertension.hypertension.

• Chronic systemic pressure overloadChronic systemic pressure overload

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

• Systemic left sided hypertention heart diseaseSystemic left sided hypertention heart disease

• Pulmonary right sided heart diseasePulmonary right sided heart disease

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

Long standing hypertensionLong standing hypertension

• Results in systolic dysfunctionResults in systolic dysfunction

• LV dilationLV dilation

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

Other FindingsOther Findings

• Aortic root dilationAortic root dilation

• Aortic valve sclerosisAortic valve sclerosis

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

• Mitral annular calcificationMitral annular calcification

• Left atrial enlargmentLeft atrial enlargment

• Atrial fibrillationAtrial fibrillation

DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA

• History or extra cardiac evidence of History or extra cardiac evidence of

hypertensionhypertension

• Left ventricular hypertrophy Left ventricular hypertrophy

(concentric)(concentric)

• Absence of other lesions that induce Absence of other lesions that induce

cardiac hypertrophy (e.g aortic valve cardiac hypertrophy (e.g aortic valve

stenosis, aortic coarctation)stenosis, aortic coarctation)

PATHOGENESISPATHOGENESIS

Myocyte hypertrophic enlargementMyocyte hypertrophic enlargement

Thickened myocardiumThickened myocardium

-Left ventricular compliance reduced-Left ventricular compliance reduced

-diastolic filling impaired-diastolic filling impaired

-oxygen demand increase.-oxygen demand increase.

-Myocyte hypertrophy increase the distance for -Myocyte hypertrophy increase the distance for oxygen and nutrient diffusion from adjacent oxygen and nutrient diffusion from adjacent capillariescapillaries

Coronary atherosclerosis accompanying hypertension Coronary atherosclerosis accompanying hypertension add in ischemic element.add in ischemic element.

MORPHOLOGHYMORPHOLOGHY

• Left ventricular wall is thickened (>2cm)Left ventricular wall is thickened (>2cm)

• Heart weight increased (> 500gm)Heart weight increased (> 500gm)

• Myocytes and nuclei enlarged.Myocytes and nuclei enlarged.

• Long termLong term

-diffuse interstitial fibrosis-diffuse interstitial fibrosis

-focal myocyte atrophy-focal myocyte atrophy

-degeneration may develop-degeneration may develop

Leading to Leading to

-left ventricular chamber dilatation.-left ventricular chamber dilatation.

-wall thinning-wall thinning

MYOCYTE AND NUCLEAR MYOCYTE AND NUCLEAR ENLARGEDENLARGED

CLINICAL FEATURESCLINICAL FEATURES

CHF is cause of death in 1/3 of hypertensive pts.CHF is cause of death in 1/3 of hypertensive pts.

Hypertensive hypertrophy increases risk of sudden cardiac death.Hypertensive hypertrophy increases risk of sudden cardiac death.

Remainder die of renal disease, stroke or unrelated disorders.Remainder die of renal disease, stroke or unrelated disorders.

Therapeutic control of blood pressure in time lead to regression of the Therapeutic control of blood pressure in time lead to regression of the myocyte hypertrophy and to restoration of heart size.myocyte hypertrophy and to restoration of heart size.

PULMONARY RIGHT SIDED PULMONARY RIGHT SIDED HEART DISEASEHEART DISEASE

• Cor pulmonale is the right sided counter part to systemic Cor pulmonale is the right sided counter part to systemic

hypertensive heart diseasehypertensive heart disease

• Pulmonary hypertension Pulmonary hypertension

-right ventricular hypertrophy or dilatation.-right ventricular hypertrophy or dilatation.

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

• Acute cor pulmonale refers to right ventricular dilatation after massive Acute cor pulmonale refers to right ventricular dilatation after massive

pulmonary embolizationpulmonary embolization

• Chronic cor pulmonale results from chronic right ventricular pressure Chronic cor pulmonale results from chronic right ventricular pressure

overload. overload.

• hypoxemia and acidosis ( in the setting of pneumonia or pulmonary emboli) hypoxemia and acidosis ( in the setting of pneumonia or pulmonary emboli)

can cause vasoconstriction that exacerbates any baseline pulmonary can cause vasoconstriction that exacerbates any baseline pulmonary

hypertention.hypertention.

MORPHOLOGYMORPHOLOGY

• Right ventricular hypertrophy often > than 1cm Right ventricular hypertrophy often > than 1cm

dilatation or bothare present.dilatation or bothare present.

• Right ventricular dilatation can cause tricuspid Right ventricular dilatation can cause tricuspid

regurgitation.regurgitation.

• Left side of the heart is essentially normal.Left side of the heart is essentially normal.

• Pulmonary arteriolar wall thickening and atherosclerosis Pulmonary arteriolar wall thickening and atherosclerosis

occur secondary to the increased to the increased right occur secondary to the increased to the increased right

sided pressure.sided pressure.

CLINICAL FEATURESCLINICAL FEATURES

• Can precipitate cardiac decompensation with cardiac Can precipitate cardiac decompensation with cardiac

symptoms being masked by those of the underlying lung symptoms being masked by those of the underlying lung

disease.disease.

THANK YOUTHANK YOU