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LEFT VENTRICULAR HYPERTROPHY
(LVH)NOOR HAFIZAH BINTI HASSAN
2007287236
INTRODUCTION
Changes in the heart following uncontrolled HT:Myocardial structureCoronary vasculatureConduction system of the heart
Increase BP change cardiac structure:↑ afterload (directly)Neurohormonal & vascular changes (indirectly)
LVH, left ventricular hypertrophy; MI, myocardial infarction; CHF, chronic heart failure.Vasan RS and Levy D. Arch Intern Med. 1996;156:1789-1796.
Progression From Hypertensionto Heart Failure
Hypertension
Smoking
Dyslipidemia
Diabetes
Obesity
Diabetes
MI
LVH
LVF
Normal LV Structure
and Function
LV Remodeling
Subclinical LV Dysfunction
Overt Heart Failure
DiastolicDysfunction
Systolic Dysfunction
Adaptive response to maintain pump performance in the ↑ of afterload
↓Concentric hypertrophy: thickening of intraventricular
septum & free wall of LV
Cardiac myocyte hypertrophy
Deposition of extracellular matrix
PATHOPHYSIOLOGY OF LVH IN HT
Continue..
Cardiac myocyte hypertrophy↓
Frank-Starling’s law↓
Hypertrophy can no longer compensate for ↑ afterload
↓LV dilatation (eccentric LVH)
Deposition of ECM around the hypertrophied myocyte
↓Inhibit the heart from
contracting and relaxing normally
The Normal Heart, Left Ventricular Hypertrophy in Hypertension, and Heart Failure in HypertensionDouglas L. Mann, MD, James L. Pool, MD, and Addison A. Taylor, MD, PhDHypertensiononline.org.
Harrison’s Principle of Internal Medicine 16th ed, page 1369
NEJM 15 MAY 2003
CLINICAL PRESENTATION• ASYMPTOMATIC UNTIL THEY DEVELOP LV DIASTOLIC
DYSFUNCTION AND HEART FAILURE
• PHYSICAL SIGNS:
– Abnormal apical impulse: sustained + diffuse (>3 cm
diameter) + displaced from
midclavicular line
– S4 gallop: best heard with the bell of stethoscope in left
lateral position. Palpable occasionally.
: decrease elasticity of the hypertrophied
ventricle during late diastole
INVESTIGATION
1. ECG:– Provide information on rhythm disturbance,
hyperkalemia, PR interval, and QT interval – Suggest a diagnosis or alteration of treatment
2. ECHOCARDIOGRAPHY: – LV wall thickness– LA size– LV function– Wall motion abnormalities
• LA enlargement is the earliest changes seen in hypertensive heart disease
• Terminal portion of P wave has a duration of 0.04 sec, and depth of 1 mm or more
• LVH with ‘strain pattern’• Framingham study: LVH with strain pattern carries a poor prognosis
OTHER MODALITIES• CARDIAC MRI
• CT
• ABPM – White coat HT– Resistant HT (140/90 mmHg) on more than 3 anti-HT
regimens, one of which is diuretics– Evaluation of suspected hypotension s/sx– Establishing the D.O.A of new drugs in clinical trial
PHARMACOLOGICAL MX
• Treatment of HT will lead to regression of LVH, improvement of LV function and reduction of cardiovascular morbidity.
• All classes of antihypertensive agents have been shown to cause regression of LVH.
MOH CPG on Management of Hypertension, 3rd ed, 2008
NON PHARMALOGICAL MX• ↓ weight• ↓ sodium intake• Avoidance of alcohol intake• Regular physical exercise• Healthy eating• Cessation of smoking• Others: stress mx, micronutrient
alteration, supplementation with fish oil, K+, Ca2+,Mg2+, and fibre
MOH CPG on Management of Hypertension, 3rd ed 2008
LVH, left ventricular hypertrophy; MI, myocardial infarction; CHF, chronic heart failure.Vasan RS and Levy D. Arch Intern Med. 1996;156:1789-1796.
Progression From Hypertensionto Heart Failure
Hypertension
Smoking
Dyslipidemia
Diabetes
Obesity
Diabetes
MI
LVH
CHF
Normal LV Structure
and Function
LV Remodeling
Subclinical LV Dysfunction
Overt Heart Failure
DiastolicDysfunction
Systolic Dysfunction
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