1- HYPERTENSIVE HEART DISEASE.pptx

HYPERTENSIVE HEART DISEASE DR: OMER ELTAHIR  Hypertensive heart disease includes: Left ventricular hypertrophy. Coronary artery disease. Conducting system diseases. Systolic/diastolic dysfunction. Hypertensive heart disease can present as: Angina Myocardial infarction Cardiac...

HYPERTENSIVE HEART DISEASE DR: OMER ELTAHIR  Hypertensive heart disease includes: Left ventricular hypertrophy. Coronary artery disease. Conducting system diseases. Systolic/diastolic dysfunction. Hypertensive heart disease can present as: Angina Myocardial infarction Cardiac arrhythmias Congestive heart failure Acute elevation of blood pressure, which can lead to accentuation of underlying disease.  Left ventricular hypertrophy Mechanism: Myocyte hypertrophy occur as a compensatory response to the increased afterload. Mechanical & neuro hormonal stimuli lead to activation of myocardial cell growth. Action of angiotensin 2 leads to growth of interstitium & cell matrix components.(interstitial fibrosis) Left atrial hypertrophy Others: Valvular disease: chronic & severe hypertension can cause aortic root dilatation leading to significant aortic insufficiency. Myocardial ischemia:. angina can occur in the absence of coronary artery disease.  Types of hypertensive heart disease: Systemic (Left-Sided) Hypertensive Heart Disease Morphology of systemic hypertensive heart disease: Circumferential hypertrophy without dilation of the left ventricle. Left ventricular wall thickness may exceed 2 cm, & the weight may exceed 500 grams thickness cause stiffness that impairs diastolic filling, then the left atrium may become enlarged.  concentric thickening of the left ventricular wall causing reduction in lumen size Clinical Features & complicatios Asymptomatic Left ventricular Hypertrophy can lead to : myocardial dysfunction, cardiac dilatation, congestive heart failure : because of: 1. hypertrophic myocytes fail to contract efficiently 2. vascular supply is inadequate for hypertrophied muscle left atrial dilation sudden death Vey late : ventricular dilation  The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.  A. Left ventricular hypertrophy. B, Left ventricular hypertrophy with and without dilation, viewed in transverse heart sections. Compared with a normal heart (center),  The usual thickness of the free wall of the right ventricle is 0.3 to 0.5 cm, and that of the left ventricle 1.3 to 1.5 cm. Greater heart weight or ventricular thickness indicates hypertrophy, an enlarged chamber size implies dilation. An increase in cardiac weight or size or both (resulting from hypertrophy and/or dilation) is termed cardiomegaly.  Pulmonary Hypertensive Heart Disease—Cor Pulmonale  Right sided hypertrophy, dilation & potentially failure secondary to pulmonary hypertension Cor pulmonale : right ventricular hypertrophy + dilation +right heart failure caused by pulmonary hypertension Types: Acute cor pulmonale: can follow massive pulmonary embolism. Chronic cor pulmonale: which is secondary to prolonged pressure overload owing to (obstruction of pulmonary arteries or arteriols or compression or obliteration of septal capillaries). Disorders predisposing to cor pulmonale: 1. Diseases of the pulmonary parenchyma: a. COPD 1. b. Diffuse interstitial pulmonary fibrosis Pulm c. Pneumoconiosis a. onary a Met b. abo rterial c H l d. Cystic fibrosis c. ypoxe ic acido onstrict e. Bronchiectasis Chro mia sis ion: d. nic alt Obs itud truc e sic tion kne 1. Diseases of the pulmonary vessels: to m ss a. Recurrent pulmonary thromboembolisms ajor b. Pulmonary hypertension airw c. Pulmonary arteritis ays. d. Drugs & toxins e. Pulmonary tumor micro-embolism 1. Disorders affecting chest movement: a. Kyphosis b. Marked obesity c. Neuromuscular disorders MORPHOLOGY Hypertrophy & dilation of both the right ventricle and the right atrium tricuspid regurgitation The right ventricle is markedly dilated and hypertrophied