Hypertensive Heart Disease

Systemic (left sided) Hypertensive Heart Disease

 

• In hypertension hypertrophy of the heart is an adaptive response to pressure overload that can lead to;
  • Myocardial dysfunation
  • Cardiac dilation
  • Chronic heart failure
  • Sudden death
• The minimal criteria required for a diagnosis for systemic HHD are;
  • Left ventricular hypertrophy, usually concentric in the absence of other cardiovascular pathology that might have caused it
  • A history of pathological evidence of hypertension
• Even mild hypertension is sufficiently prolonged induces left ventricular hypertrophy

 

Morphology

• Left ventricular pressure overload leads to hypertrophy without dilation
• The LV wall may be over 2cm thick and the heart may weigh over 500g
• In time the thickness of the LV wall imparts a stiffness which impairs diastolic filling – this may then cause atrial thickening
• Microscopically the earliest change is an increase in the transverse diameter of myocytes
• At more advanced stages the cellular and nuclear enlargement becomes more irregular, with variations in cell size amongst adjacent cells and interstitial fibrosis

 

Clinical course

• May be asymptomatic and only detectable by ECG or ECHO indications
• May present with;
  • AF (due to atrial enlargement)
  • CHF
  • Cardiac dilation
• Depending on severity, outcomes may be;
  • Longevity and death from unrelated caused
  • Development of progressive IHD
  • Progressive renal failure or cerebrovascular stroke
  • Progressive heart failure
  • Sudden cardiac death