2. HYPERTENSIVE HEARTHYPERTENSIVE HEART
DISEASEDISEASE
• End Organ Damage as a consequence of systemicEnd Organ Damage as a consequence of systemic
hypertension.hypertension.
• Chronic systemic pressure overloadChronic systemic pressure overload
3. HYPERTENSIVE HEARTHYPERTENSIVE HEART
DISEASEDISEASE
• Systemic left sided hypertention heart diseaseSystemic left sided hypertention heart disease
• Pulmonary right sided heart diseasePulmonary right sided heart disease
7. DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA
• History or extra cardiac evidence ofHistory or extra cardiac evidence of
hypertensionhypertension
• Left ventricular hypertrophyLeft ventricular hypertrophy
(concentric)(concentric)
• Absence of other lesions that induceAbsence of other lesions that induce
cardiac hypertrophy (e.g aortic valvecardiac hypertrophy (e.g aortic valve
stenosis, aortic coarctation)stenosis, aortic coarctation)
8. PATHOGENESISPATHOGENESIS
Myocyte hypertrophic enlargementMyocyte hypertrophic enlargement
Thickened myocardiumThickened myocardium
-Left ventricular compliance reduced-Left ventricular compliance reduced
-diastolic filling impaired-diastolic filling impaired
-oxygen demand increase.-oxygen demand increase.
-Myocyte hypertrophy increase the distance for-Myocyte hypertrophy increase the distance for
oxygen and nutrient diffusion from adjacentoxygen and nutrient diffusion from adjacent
capillariescapillaries
Coronary atherosclerosis accompanying hypertensionCoronary atherosclerosis accompanying hypertension
add in ischemic element.add in ischemic element.
9. MORPHOLOGHYMORPHOLOGHY
• Left ventricular wall is thickened (>2cm)Left ventricular wall is thickened (>2cm)
• Heart weight increased (> 500gm)Heart weight increased (> 500gm)
• Myocytes and nuclei enlarged.Myocytes and nuclei enlarged.
• Long termLong term
-diffuse interstitial fibrosis-diffuse interstitial fibrosis
-focal myocyte atrophy-focal myocyte atrophy
-degeneration may develop-degeneration may develop
Leading toLeading to
-left ventricular chamber dilatation.-left ventricular chamber dilatation.
-wall thinning-wall thinning
13. CLINICAL FEATURESCLINICAL FEATURES
CHF is cause of death in 1/3 of hypertensive pts.CHF is cause of death in 1/3 of hypertensive pts.
Hypertensive hypertrophy increases risk of sudden cardiac death.Hypertensive hypertrophy increases risk of sudden cardiac death.
Remainder die of renal disease, stroke or unrelated disorders.Remainder die of renal disease, stroke or unrelated disorders.
Therapeutic control of blood pressure in time lead to regression of theTherapeutic control of blood pressure in time lead to regression of the
myocyte hypertrophy and to restoration of heart size.myocyte hypertrophy and to restoration of heart size.
14. PULMONARY RIGHT SIDEDPULMONARY RIGHT SIDED
HEART DISEASEHEART DISEASE
• Cor pulmonale is the right sided counter part to systemicCor pulmonale is the right sided counter part to systemic
hypertensive heart diseasehypertensive heart disease
• Pulmonary hypertensionPulmonary hypertension
-right ventricular hypertrophy or dilatation.-right ventricular hypertrophy or dilatation.
15.
16.
17. HYPERTENSIVE HEARTHYPERTENSIVE HEART
DISEASEDISEASE
• Acute cor pulmonale refers to right ventricular dilatation after massiveAcute cor pulmonale refers to right ventricular dilatation after massive
pulmonary embolizationpulmonary embolization
• Chronic cor pulmonale results from chronic right ventricular pressureChronic cor pulmonale results from chronic right ventricular pressure
overload.overload.
• hypoxemia and acidosis ( in the setting of pneumonia or pulmonary emboli)hypoxemia and acidosis ( in the setting of pneumonia or pulmonary emboli)
can cause vasoconstriction that exacerbates any baseline pulmonarycan cause vasoconstriction that exacerbates any baseline pulmonary
hypertention.hypertention.
18.
19. MORPHOLOGYMORPHOLOGY
• Right ventricular hypertrophy often > than 1cm dilatation orRight ventricular hypertrophy often > than 1cm dilatation or
bothare present.bothare present.
• Right ventricular dilatation can cause tricuspid regurgitation.Right ventricular dilatation can cause tricuspid regurgitation.
• Left side of the heart is essentially normal.Left side of the heart is essentially normal.
• Pulmonary arteriolar wall thickening and atherosclerosisPulmonary arteriolar wall thickening and atherosclerosis
occur secondary to the increased to the increased right sidedoccur secondary to the increased to the increased right sided
pressure.pressure.
20. CLINICAL FEATURESCLINICAL FEATURES
• Can precipitate cardiac decompensation with cardiacCan precipitate cardiac decompensation with cardiac
symptoms being masked by those of the underlying lungsymptoms being masked by those of the underlying lung
disease.disease.
