Lvh

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. 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 Hypertension
to Heart Failure
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
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

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. 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 Hypertension
to Heart Failure
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