3/7/2014 Hypertensive Heart Disease

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Hypertensive Heart Disease

Author: Kamran Riaz, MD; Chief Editor: Yasmine Subhi Ali, MD, MSCI, FACC, FACP more...

Updated: Dec 5, 2013

Other Studies

Histology

Gross findings

LVH (concentric) occurs without dilatation of the LV (see the image below). The ratio of wall thickness to theradius of the ventricular chamber increases. LV wall thickness may exceed 2cm, and the heart weight exceeds500g. Dilatation of the ventricular chamber, thinning of the walls, and enlargement of the external dimensions of theheart occur with the onset of decompensation.

Gross specimen of the heart w ith concentric left ventricular hypertrophy.

Microscopic findings

The earliest changes in hypertensive heart disease include myocyte enlargement, with an increase in themyocytes' transverse diameters. At a more advanced stage, cellular and nuclear enlargement (with variation in cellsize), loss of myofibrils, and interstitial fibrosis occur. (See the images below.)

Histologic section of the myocardium show ing a cross-section of coronary artery affected by atherosclerosis and myocyte hypertrophy.

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Histologic section of the heart show ing the hypertrophied myocytes and f ibrosis accompanying left ventricular hypertrophy.

Histologic section of an autopsy myocardial specimen from a patient w ith long-standing hypertension and associated coronary artery

disease. The slide show s myocardial hypertrophy, contraction bands (typical of left ventricular hypertrophy), and "car box" nuclei.

Cardiac catheterization

Cardiac catheterization is used for the diagnosis of coronary artery disease and helps to assess the severity ofelevated pulmonary artery pressure in patients with heart failure.

Sleep evaluation

Sleep evaluation and additional tests for excluding other secondary causes of hypertension may be indicated.

Contributor Information and DisclosuresAuthorKamran Riaz, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Cardiology,Wright State University, Boonshoft School of Medicine

Kamran Riaz, MD is a member of the following medical societies: American College of Cardiology, AmericanCollege of Physicians, American Society of Echocardiography, Ohio State Medical Association, and RoyalCollege of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)Aqeel Ahmed, MD Resident Physician, Department of Pathology, University of Missouri-Kansas City Schoolof Medicine

Aqeel Ahmed, MD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Chief EditorYasmine Subhi Ali, MD, MSCI, FACC, FACP President, Nashville Preventive Cardiology, PLLC; AssistantClinical Professor of Medicine, Vanderbilt University School of Medicine

Yasmine Subhi Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American Collegeof Cardiology, American College of Physicians, American Heart Association, American Medical Association,

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National Lipid Association, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Additional ContributorsAlan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director,Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital

Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College ofCardiology, American College of Physicians, American Heart Association, American Medical Association,American Society of Hypertension, and Phi Beta Kappa

Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employeewith no personal profit; Speakers Bureau Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical CenterCollege of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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