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Cardiovascular Block: Cardiology (Karen) > Ventricular Hypertrophy > Flashcards

Ventricular Hypertrophy Flashcards

1
Q

What hormones are important in embryonic myocardial hyperplasia (growth)?

A

GH, Insulin GF, Thyroxine

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2
Q

What are the determinants of normal heart size?

A
  • Body size & surface area
  • genetics
  • athletic conditioning (~larger)
  • BP
  • Angiotensin II
  • Catecholamines
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3
Q

What is hypertrophy?

A

Increase in LV mass relative to body size

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4
Q

What is relative wall thickness?

A

LV wall thickness/LV chamber size

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5
Q

What is remodeling?

A

increased relative wall thickness without increased LV mass

(looks thicker but the heart gets smaller)

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6
Q

Concentric Hypertrophy

A
  • Increased LV mass & increased relative wall thickness
  • Walls thickened, no enlargement
  • tf decreased volume
  • usually due to pressure overload (high afterload)
  • more sarcomeres in parallel
  • thickened wall to reduce wall stress
  • to maintain systolic function e.g. CO, LVEDP
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7
Q

Eccentric Hypertrophy

A
  • Increased LV mass, normal relative wall thickness
  • overall enlargement - large dilated heart
  • increased volume
  • often due to volume overload (leaky mitral, aortic; ventricular, septal shunt; high preload)
  • myocyte stretching - more sarcomeres in series
  • maintain SV by +LVEDV, +EF (i.e. gets larger to pump a bigger SV each beat)
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8
Q

Dilated heart is analagous to

A

Eccentric hypertrophy

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9
Q

Thickened heart is analagous to

A

Concentric Hypertrophy

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10
Q

Laplace’s Law

A

Thicker wall reduces or normalizes wall stress - e.g. in concentric hypertrophy due to pressure overload

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11
Q

Decompensation

A
  • long term, failure of compensation
  • LV dilation to +SV
  • +LVEDV
  • +LVESV
  • -EF
  • -SV
  • -CO
  • eventual heart failure
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12
Q

What are the environmental causes of LVH?

A

Environmental:

  • Concentric: P overload (high afterload) from HT, aortic stenosis
  • Eccentric: V overload (high preload) from mitral or aortic regurge, ventricular septal defects
  • Post-MI
  • Post-cardiac injury e.g. myocarditis
  • Obesity
  • Diabetes
  • Renal failure
  • Infiltration by proteins e.g. amyloidosis (dep in ECM)
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13
Q

What are the genetic causes of LVH?

A
  • Hypertrophic cardiomyopathy
  • Fabry’s disease: x-linked enzyme deficiency
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14
Q

What are the clinical signs of LVH?

A

Forceful apex beat

S3 & S4 sounds present

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15
Q

What are the ECG indicators of LVH?

A

tall volatages

inverted T waves

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16
Q

What are the signs of LVH on chest x-ray (CXR)?

A

large heart if Eccentric LVH

normal size if Concentric LVH

17
Q

What tests are ordered for diagnosis of LVH?

A
  • ECG
  • CXR
  • Echo
  • MRI
  • CardioCT
18
Q

LVH increases risk of:

A
  • ischaemic heart disease
  • cardiac failure
  • atrial fibrillation
  • stroke
  • diastolic dysfunction (doesn’t fill well)
19
Q

Left ventricular remodeling following MI involves

A
  • Increased LV volume, more spherical shape
  • myocyte hypertrophy and apoptosis
  • interstitial fibrosis (scar tissue, collagen)
20
Q

What are the consequences of LVH remodeling?

A
  • Increased heart failure
  • Mortality [-EF, +EDV, larger infarct segment length]
21
Q

What are the causes of RVH?

A

Congenital

  • transposition (switched anatomy) of great arteries i.e. RV pumps into systemic, LV pumps into pulmonary - RVH to cope

Pulmonary Hypertension (creates a high P pulm circuit)

  • lung disease
  • pulmonary embolus
  • chronic left HF

Right heart valves (less common than left)

  • Pulmonary stenosis or regurge
  • Tricuspid regurge
22
Q

Hypertrophic Cardiomyopathy

A
  • Genetic condition, autosomal dominant
  • Mutation in genes for sarcomere proteins
    • Beta cardiac myosin heavy chain
    • cardiac myosin binding protein
    • cardiac troponin I & T
23
Q

What are the characteristics of HCM (hypertrophic cardiomyopathy)?

A
  • Asymmetrical hypertrophy of LV, especially septum
  • Cellular hypertrophy
  • myocyte disarray
24
Q

What is the main issue of HCM?

A
  • Muscle is prone to abnormal rhythms
  • it is NOT that the cavity is reduced tf -filling
25
Q

Dilated Cardiomyopathy is caused by

A
  • cytotoxic drugs
  • alcohol
  • idiopathic - most causes unknown
  • may be genetic
    • sarcomere proteins –> HT
    • desmosomes –> dilation
    • cytoskeleton “
    • cellular connections “
26
Q

Athlete’s Heart

A
  • Similar to HCM on echo but more eccentric
  • common in elite athletes
  • normal cardiac function
  • regresses with deconditioning
  • wall thickness <14mm
27
Q

What is the significance of RVH in athlete’s heart?

A
  • does not regress on deconditioning
  • can lead to arrhythmia, sudden death
  • e.g. Lisa Kerry-Kenny, Australian triathlete has a pacemaker for this condition

Cardiovascular Block: Cardiology (Karen) (4 decks)

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