Ventricular Hypertrophy and Consequences

Question 1

Cardiac hypertrophy definition

Answer 1

An increase in the mass of the heart

Can be from pathological or physiological stimuli, or normal growth

Question 2

1. Concentric
2. Eccentric
   hypertrophy

Answer 2

1. From pressure overload, RWT increases

2. From volume overload, RWT decreases

Question 3

Relative wall thickness

Answer 3

Ratio of LV wall thickness to diastolic diameter

Question 4

How does cardiac remodelling cause concentric hypertrophy

Answer 4

Pressure overload
Increased peak systolic stress
Parallel replication of sarcomeres
Wall thickening
Concentric hypertrophy

Question 5

How does cardiac remodelling cause eccentric hypertrophy

Answer 5

Volume overload
Increased end diastolic stress
Series replication of sarcomeres
Chamber enlargement
Eccentric hypertrophy
There is also some elements of wall thickening in eccentric hypertrophy

Question 6

Pressure or volume overload in

1. Aortic stenosis
2. Aortic regurgitation
3. Mitral regurgitation

Answer 6

1. Pressure
2. Both
3. Volume

Question 7

4 clinical consequences of aortic stenosis

Answer 7

Angina
Syncope
Heart failure
Sudden death
Onset of symptoms is a poor prognostic factor

Question 8

Aortic regurgitation

Answer 8

Typically a long asymptomatic period
Progressive LV dysfunction leading to HF
Arrhythmias, sudden death, chest pain
Severity of symptoms may correlate poorly with degree of contractile and hemodynamic impairment
Once symptoms occur, clinical status may deteriorate rapidly although it may not be as ominous as for aortic stenosis

Question 9

Mitral regurgitation

Answer 9

Natural hx of patients with MR is quite variable (b/c a lot of conditions cause it)
May remain asymptomatic for prolonged periods
The degree of LV dysfunction actually present may not be readily appreciated
Progressive LV dysfunction eventually leads to HF
Palpitations due to afib
Dyspnea, orthopnea, and paroxysmal nocturnal dyspnea are common with progression