Published on March 12, 2014
Hypertensive Heart DiseaseHypertensive Heart Disease
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
HYPERTENSIVE HEARTHYPERTENSIVE HEART DISEASEDISEASE • Systemic left sided hypertention heart diseaseSystemic left sided hypertention heart disease • Pulmonary right sided heart diseasePulmonary right sided heart disease
HYPERTENSIVE HEARTHYPERTENSIVE HEART DISEASEDISEASE Long standing hypertensionLong standing hypertension • Results in systolic dysfunctionResults in systolic dysfunction • LV dilationLV dilation
HYPERTENSIVE HEARTHYPERTENSIVE HEART DISEASEDISEASE Other FindingsOther Findings • Aortic root dilationAortic root dilation • Aortic valve sclerosisAortic valve sclerosis
HYPERTENSIVE HEARTHYPERTENSIVE HEART DISEASEDISEASE • Mitral annular calcificationMitral annular calcification • Left atrial enlargmentLeft atrial enlargment • Atrial fibrillationAtrial fibrillation
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)
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.
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
MYOCYTE AND NUCLEARMYOCYTE AND NUCLEAR ENLARGEDENLARGED
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.
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.
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.
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.
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.
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