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07-SEPTEMBER-2008 03:17:44 - hypertrophy Ventricular hypertrophy Classification and external resources ICD-10 I51.7 ICD-9 429.3 Ventricular hypertrophy is the enlargement of ventricles lower chambers in the heart.12 Although left ventricular hypertrophy is more common, enlargement can also occur in the right ventricle, or both ventricles. Contents 1 Physiology 2 References 3 See also 4 External links Physiology The ventricles are the chambers in the heart responsible for pumping blood either to the lungs right ventricle3 or the rest of the body left ventricle4. Healthy cardiac hypertrophy physiologic hypertrophy or athlete's heart is the normal response to healthy exercise or pregnancy5, which results in an increase in the heart's muscle mass and pumping ability. Trained athletes have hearts which have left ventricular mass up to 60% greater than untrained subjects. Rowers, cyclists and cross-country skiers tend to have the largest hearts, with a left ventricular wall thickness of 1.3 centimeters, compared to 1.1 centimeters in normal adults. Heart wall thickness can be measured by ultrasound; computer tomography is more accurate though it is more expensive and has risks of exposure to radiation. Unhealthy cardiac hypertrophy pathological hypertrophy is the response to stress such as hypertension, heart muscle injury myocardial infarction or neurohormones. Pathological hypertrophy also leads to an increase in muscle mass, but the muscle does not increase its pumping ability, and instead accumulates scar tissue collagen. In pathological hypertrophy, the heart can increase its mass by up to 150%. Cardiac hypertrophy is dramatic and rapid. In the Burmese python, consumption of a large meal is associated with an increase in metabolic work by a factor of seven and a spectacular 40% increase in ventricular mass within 48 hours, both of which return to normal within 28 days.6 Aerobic training results in the heart being able to pump a larger volume of blood through an increase in the size of the ventricles. Anaerobic training results in the thickening of the myocardial wall to push blood through arteries compressed by muscular contraction.7 This type of physiologic hypertrophy is reversible and non-pathological, increasing the heart's ability to circulate blood. Chronic hypertension causes pathological ventricular hypertrophy. This response enables the heart to maintain a normal stroke volume despite the increase in afterload. However, over time, pathological changes occur in the heart that lead to a functional degradation and heart failure.8 If the precipitating stress is volume overload as through aerobic exercise, which increases blood return to the heart through the action of the skeletal-muscle pump, the ventricle responds by adding new sarcomeres in-series with existing sarcomeres i.e. the sarcomeres lengthen rather than thicken. This results in ventricular dilation while maintaining normal sarcomere lengths - the heart can expand to receive a greater volume of blood. The wall thickness normally increases in proportion to the increase in chamber radius. This type of hypertrophy is termed eccentric hypertrophy.9 In the case of chronic pressure overload as through anaerobic exercise, which increases resistance to blood flow by compressing arteries, the chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres. This is termed concentric hypertrophy.10 This type of ventricle is capable of generating greater forces and higher pressures, while the increased wall thickness maintains normal wall stress. This type of ventricle becomes stiff i.e., compliance is reduced which can impair filling and lead to diastolic dysfunction. References ^ Ask the doctor: Left Ventricular Hypertrophy ^ http://www.echoincontext.com/int2/skillI2_03.asp Right Ventricular Hypertrophy ^ Right ventricle definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms ^ Left ventricle definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms ^ Control Mechanisms for Physiological Hypertrophy of Pregnancy - Mone et al. 94 4: 667 - Circulation ^ Joseph A. Hill and Eric N. Olson, Cardiac Plasticity, New England Journal of Medicine, March 27, 2008, 358:1370-1380 ^ McMurray, Robert 1998. Concepts in Fitness Programming. CRC, 320. ISBN 978-0849387142. ^ Mechanisms and Models in Heart Failure: The Biomechanical Model and Beyond - Mann and Bristow 111 21: 2837 - Circulation ^ Hypertrophy ^ Hypertrophy See also Cardiac fibrosis Cardiology Cardiomegaly Cardiovascular disease Right ventricular hypertrophy External links Tutorial at University of Utah v d e Cardiovascular disease: heart disease - Circulatory system pathology I00-I52, 390-429 Ischaemic/ Acute coronary CHD: CAD - Coronary thrombosis - Coronary vasospasm - Coronary artery aneurysm Angina pectoris Prinzmetal's angina - Myocardial infarction heart attack Myocardial rupture - Dressler's syndrome Layers Pericardium Pericarditis Acute, Constrictive - Pericardial effusion - Cardiac tamponade - Hemopericardium Myocardium Myocarditis Cardiomyopathy: Dilated Alcoholic - Hypertrophic - Restrictive Loeffler endocarditis, Cardiac amyloidosis Arrhythmogenic right ventricular dysplasia Endocardium/ valves Endocarditis Subacute bacterial endocarditis, Libman-Sacks endocarditis, Nonbacterial thrombotic endocarditis mitral regurgitation, prolapse, stenosis - aortic stenosis, insufficiency - tricuspid stenosis, insufficiency - pulmonary stenosis, insufficiency Conduction/ arrhythmia Heart block AV 1°, 2°, 3° - Bundle branch Left, Right - Bifascicular/Trifascicular - Sinoatrial - Sick sinus syndrome - Adams-Stokes syndrome Pre-excitation syndrome Wolff-Parkinson-White - Lown-Ganong-Levine Tachycardia Paroxysmal - Supraventricular AV nodal reentrant, Accelerated idioventricular rhythm, Sinus - Ventricular Torsades de pointes, Catecholaminergic polymorphic Premature contraction Atrial - Ventricular Flutter/fibrillation Atrial flutter - Ventricular flutter - Atrial fibrillation Familial - Ventricular fibrillation Pacemaker Wandering pacemaker - Ectopic pacemaker - Parasystole Long QT syndrome Romano-Ward syndrome - Andersen-Tawil syndrome - Jervell and Lange-Nielsen syndrome Cardiac arrest Sudden cardiac death - Asystole Other Cardiomegaly - Ventricular hypertrophy Left, Right/Cor pulmonale Heart failure Cardiac asthma - Rheumatic fever See also congenital, neoplasia Retrieved from http://en..org/wiki/Ventricular_hypertrophy Categories: Cardiovascular diseases | Cardiomyopathy | Exercise physiology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Italiano This page was last modified on 21 August 2008, at 21:11
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