Hypertensive Heart Disease

Question 1

About Hypertensive Heart Disease

Answer 1

• Hypertensive heart disease or hypertensive cardiomyopathy is the disease of the heart resulting from systemic hypertension of prolonged duration and manifesting by left ventricular hypertrophy.
• Even mild hypertension (blood pressure higher than 140/90 mmHg) of sufficient duration may induce hypertensive heart disease.
• It is the second most common form of heart disease after IHD.
• As already pointed out, hypertension predisposes to atherosclerosis. Therefore, most patients of hypertensive heart disease have advanced coronary atherosclerosis and may develop progressive IHD.

Question 2

Hypertensive Heart Disease; Pathogenesis.

Answer 2

Stimulus to LVH is pressure overload in systemic hypertension. Both genetic and haemodynamic factors contribute to LVH. The stress of pressure on the ventricular wall causes increased production of myofilaments, myofibrils, other cell organelles and nuclear enlargement. Since the adult myocardial fibres do not divide, the fibres are hypertrophied. However, the sarcomeres may divide to increase the cell width.

Question 3

Hypertensive Heart Disease; Gross Anatomy.

Answer 3

• The most significant finding is marked hypertrophy of the heart, chiefly of the left ventricle.
• The weight of the heart increases to 500 gm or more (normal weight about 300 gm).
• The thickness of the left ventricular wall increases from its normal 13 to 15 mm up to 20 mm or more.
• The papillary muscles and trabeculae carneae are rounded and prominent.

Initially, there is concentric hypertrophy of the left ventricle (without dilatation). But when decompensation and cardiac failure supervene, there is eccentric hypertrophy (with dilatation) with thinning of the ventricular wall and there may be dilatation and hypertrophy of right heart as well.