HYPERTENSIVE HEART DISEASE
NAEEM ULLAH
S e n i o r L e c t u r e r M LT N W I H S , P e s h a w a r
Phd In Medical Lab Sciences
M.Phil In Medical Lab Sciences (Gold Medalist)
B S M LT ( G o l d M e d a l i s t )
HYPERTENSIVE HEART DISEASE
2
Hypertension is a common disorder associated with considerable morbidity
and affecting many organs, including the heart, brain, and kidneys.
Myocyte hypertrophy is an adaptive response to pressure overload; there
are limits to myocardial adaptive capacity, however, and persistent
hypertension eventually can culminate in dysfunction, cardiac dilation,
CHF, and even sudden death.
Although hypertensive heart disease most commonly affects the left side of
the heart secondary to systemic hypertension, pulmonary hypertension
also can cause right-sided hypertensive changes—so-called cor
pulmonale.
Dr. Naeem Ullah
Systemic (Left-Sided) Hypertensive
3 Heart Disease
The criteria for the diagnosis of systemic hypertensive heart disease
are
left ventricular hypertrophy in the absence of other cardiovascular pathology (e.g.,
valvular stenosis), and
a history or pathologic evidence of hypertension.
The Framingham Heart Study established unequivocally that even
mild hypertension (above 140/90 mm Hg), if sufficiently prolonged,
induces left ventricular hypertrophy.
Roughly 25% of the U.S. population suffers from at least this degree
of hypertension.
Dr. Naeem Ullah
MORPHOLOGY
4
Systemic hypertension imposes pressure overload on the heart and is
associated with gross and microscopic changes somewhat distinct from those
caused by volume overload.
The essential feature of systemic hypertensive heart disease is left
ventricular hypertrophy, typically without ventricular dilation until very
late in the process.
The heart weight can exceed 500 g (normal, 320 to 360 g), and the left
ventricular wall thickness can exceed 2.0 cm (normal, 1.2 to 1.4 cm).
With time, the increased left ventricular wall thickness imparts a stiffness that
impairs diastolic filling and can result in left atrial dilation.
Dr. Naeem Ullah
MORPHOLOGY
5
In long-standing systemic hypertensive heart disease leading
to congestive failure, the ventricle typically is dilated.
Microscopically, the transverse diameter of myocytes is
increased and there is prominent nuclear enlargement and
hyperchromasia , as well as intercellular fibrosis.
Dr. Naeem Ullah
6
Hypertensive heart disease. A, Systemic
(left-sided) hypertensive heart
disease. There is marked concentric
thickening of the left
ventricular wall causing reduction in
lumen size. The left ventricle and left
atrium are on the right in this four-
chamber view of the heart. A pacemaker
is present incidentally in the right
ventricle (arrow). Note also the left atrial
dilation due to stiffening of the left
ventricle and impaired diastolic
relaxation, leading to atrial volume
overload
Dr. Naeem Ullah
7
Hypertensive
heart disease
A, Systemic (left-sided)
hypertensive heart disease.
There is marked concentric
thickening of the left
ventricular wall causing reduction
in lumen size.
The left ventricle and left atrium
are on the right in this four-
chamber view of the heart.
A pacemaker is present
incidentally in the right ventricle
(arrow).
Note also the left atrial dilation
due to stiffening of the left
ventricle and impaired diastolic
relaxation, leading to atrial volume
overload
Dr. Naeem Ullah
Clinical Features
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Asymptomatic
Elevated blood pressure on routine physical exams
ECG or echocardiographic findings of left ventricular
hypertrophy.
Heart failure
coronary atherosclerosis
renal damage
cerebrovascular stroke
heart failure. The risk of sudden
cardiac death also is increased
Dr. Naeem Ullah
Pulmonary Hypertensive Heart
Disease—Cor Pulmonale
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Cor pulmonale consists of right ventricular hypertrophy and dilation—
frequently accompanied by right heart failure— caused by pulmonary
hypertension attributable to primary disorders of the lung
parenchyma or pulmonary vasculature
Right ventricular dilation and hypertrophy caused by left ventricular
failure (or by congenital heart disease) is substantially more common .
Cor pulmonale can be acute in onset, as with pulmonary embolism, or
can have a slow and insidious onset when due to prolonged pressure
overloads in the setting of chronic lung and pulmonary vascular
disease
Dr. Naeem Ullah
MORPHOLOGY
10
In acute cor pulmonale, the right ventricle usually shows only
dilation; if an embolism causes sudden death, the heart may even be of
normal size.
Chronic cor pulmonale is characterized by right ventricular (and
often right atrial) hypertrophy. In extreme cases, the thickness of the
right ventricular wall may be comparable with or even exceed that of
the left ventricle .
Dr. Naeem Ullah
MORPHOLOGY
11
When ventricular failure develops, the right ventricle and
atrium often are dilated.
Because chronic cor pulmonale occurs in the setting of
pulmonary hypertension, the pulmonary arteries often contain
atheromatous plaques and other lesions, reflecting
longstanding pressure elevations.
Dr. Naeem Ullah
12
Chronic cor
pulmonale
The right ventricle (shown
on the left side of this
picture) is markedly
dilated
and hypertrophied with a
thickened free wall and
hypertrophied trabeculae.
The shape and volume of
the left ventricle have been
distorted by the enlarged
right ventricle.
Dr. Naeem Ullah
Thank you!
Dr. Naeem Ullah 13
