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  • Hypertension can lead to LVH, diastolic or systolic dysfunction and heart failure. Progression from hypertension to LVH is due to the macro and micro changes in the ventricle (LV remodeling). This remodeling can lead to diastolic dysfunction without clinical signs or symptoms of heart failure. This emphasizes the importance of treatment in some patients prior to development of overt heart failure. Hypertension, in conjunction with other risk factors for atherosclerosis may lead to myocardial infarction. LV remodeling again takes place, but does so differently, leading to systolic dysfunction. Again, remodeling is taking place within the ventricle in response to the injury but may not lead to overt heart failure. Progression will lead to heart failure, with decreasing ejection fractions.
  • Hypertension can lead to LVH, diastolic or systolic dysfunction and heart failure. Progression from hypertension to LVH is due to the macro and micro changes in the ventricle (LV remodeling). This remodeling can lead to diastolic dysfunction without clinical signs or symptoms of heart failure. This emphasizes the importance of treatment in some patients prior to development of overt heart failure. Hypertension, in conjunction with other risk factors for atherosclerosis may lead to myocardial infarction. LV remodeling again takes place, but does so differently, leading to systolic dysfunction. Again, remodeling is taking place within the ventricle in response to the injury but may not lead to overt heart failure. Progression will lead to heart failure, with decreasing ejection fractions.
  • Transcript

    • 1. LEFT VENTRICULAR HYPERTROPHY (LVH) NOOR HAFIZAH BINTI HASSAN 2007287236
    • 2. INTRODUCTION
      • Changes in the heart following uncontrolled HT:
        • Myocardial structure
        • Coronary vasculature
        • Conduction system of the heart
      • Increase BP change cardiac structure:
        • ↑ afterload (directly)
        • Neurohormonal & vascular changes (indirectly)
    • 3. Progression From Hypertension to Heart Failure LVH, left ventricular hypertrophy; MI, myocardial infarction; CHF, chronic heart failure. Vasan RS and Levy D. Arch Intern Med. 1996;156:1789-1796. Hypertension Smoking Dyslipidemia Diabetes Obesity Diabetes MI LVH LVF Normal LV Structure and Function LV Remodeling Subclinical LV Dysfunction Overt Heart Failure Diastolic Dysfunction Systolic Dysfunction
    • 4.
      • 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
    • 5. 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 Hypertension Douglas L. Mann, MD, James L. Pool, MD, and Addison A. Taylor, MD, PhD Hypertensiononline.org.
    • 6. Harrison’s Principle of Internal Medicine 16 th ed, page 1369
    • 7. NEJM 15 MAY 2003
    • 8. 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
    • 9. INVESTIGATION
      • ECG:
        • Provide information on rhythm disturbance, hyperkalemia, PR interval, and QT interval
        • Suggest a diagnosis or alteration of treatment
      • ECHOCARDIOGRAPHY:
        • LV wall thickness
        • LA size
        • LV function
        • Wall motion abnormalities
    • 10.
      • 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
    • 11. 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
    • 12. 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, 3 rd ed, 2008
    • 13. 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 + , Ca 2+ ,Mg 2+ , and fibre
      MOH CPG on Management of Hypertension, 3 rd ed 2008
    • 14. Progression From Hypertension to Heart Failure LVH, left ventricular hypertrophy; MI, myocardial infarction; CHF, chronic heart failure. Vasan RS and Levy D. Arch Intern Med. 1996;156:1789-1796. Hypertension Smoking Dyslipidemia Diabetes Obesity Diabetes MI LVH CHF Normal LV Structure and Function LV Remodeling Subclinical LV Dysfunction Overt Heart Failure Diastolic Dysfunction Systolic Dysfunction

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