Hypertensive heart disease (HHD) is a hypertrophic adaptive response of the heart to hypertension that can progress to myocardial dysfunction, cardiac dilatation, congestive heart failure, and sudden death if not controlled. The degree of hypertrophy varies depending on the underlying cause, ranging from 350-1000 grams. The pattern of hypertrophy also reflects the stimulus, with pressure overload causing a concentric thickening pattern and volume overload a dilation with increased ventricular diameter. Chronic cor pulmonale is characterized by a markedly dilated and hypertrophied right ventricle secondary to prolonged pulmonary hypertension from obstruction or compression of the lungs.

1. Hypertensive Heart
Disease (HHD)
Dr. Usman Shams

3. HHD
 Hypertrophic adaptive response of the heart,
which can progress:
• Myocardial dysfunction
• Cardiac dilatation
• CHF
• Sudden death

4. EXTENT OF HYPERTROPHY
o The (measured by heart weight) varies for different
underlying causes:
• Pulm. hypertension 350 to 600 gm
• Systemic hypertension 400 to 800 gm
• Aortic stenosis 600 to 1000 gm
• .
4

5. PATTERN OF HYPERTROPHY
o Reflects the nature of stimulus:
o Pressure overloaded ventricles – concentric pattern
o Volume overloaded ventricles – dilation with increased
ventricular diameter

8. HHD with marked concentric thickening
of the left ventricular wall causing
reduction in lumen size.

9. 9
Chronic cor pulmonale,
characterized by
a markedly dilated and
hypertrophied right ventricle.
12-21
RV
LV

10. 10
LV
RV
12-20 12-21
LV
RV
Concentric thickening of the
left ventricular wall in
systemic hypertension
(Depostion of sarcomeres is parallel
to the long axes of cells with increase
in diameter but not in cell length)
Markedly dilated and
hypertrophied right ventricle in
Cor Pulmonale.
(Deposition of sarcomeres increses
both length and width of cells)

11. Pulmonary Hypertensive Heart Disease:
Cor Pulmonale
 Acute cor pulmonale can follow massive pulmonary
embolism. (Marked dilation of Rt ventricle without
hypertrophy changes the normal crescentic shape to
dilated ovoid).
• Chronic cor pulmonale usually implies right ventricular
hypertrophy (and dilation) secondary to prolonged
pressure overload caused by obstruction of the pulmonary
arteries or arterioles or compression or obliteration of
septal capillaries (emphysema).

12. HISTOPATHOLOGY
 INCREASED FIBER (MYOCYTE) THICKNESS
 INCREASED nuclear size with increased “blockiness”
(boxcar nucleus)