BY DR.UZMA TALIB

Defination: Left ventricular hypertrophy is defined as an increase in

the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both

Causes: Hypertension Hypertrophic cardiomyopathy Aortic stenosis Athelitic training

Risk factors for left ventricular hypertrophy include the following:

Age Gender High blood pressure, a blood pressure reading greater

than 140/90 mm Hg, is the greatest risk factor. Aortic stenosis, narrowing of the main valve through

which blood leaves the heart, may increase the left ventricle's workload.

Obesity can cause high blood pressure and increase your body's demand for oxygen, factors that may lead to left ventricular hypertrophy.

Genetic factor

 The development of LVH is a relatively early response to hypertension,

Ambulatory BP monitoring has suggested that there may be two additional risk factors for LVH:

The daily BP load (the percentage of pressures above 135/85 during the day and 120/80 mmHg at night

Nocturnal hypertension (in which the expected nighttime reduction in BP is not seen)

maximal daytime blood pressure or peak exercise blood pressure are most predictive of the level of hypertrophy .

There is also evidence that left ventricular mass may be increased prior to the development of overt hypertension.

High BP LV wall stress Wall stress 1/ wall thickness LV wall thickening wall stress Myocyte hypertrophy and collagen matrix .The same factors, such as angiotensin II, norepinephrine,

epinephrine, increased peripheral and cardiac sympathetic drive and endothelin, promote both hypertension and LVH. The tendency to LVH may be an inherited trait that predisposes to the development of hypertension

› To diagnose LVH you can use the following criteria*: R in V5 (or V6) + S in V1 (or V2) >

35 mm, or avL R > 13 mm

Symptoms: Shortness of breath Chest pain palpitations Dizziness Fainting Rapid exhaustion with physical activity Fatigue Syncope Some time patient shows no symptoms

Signs: systolic murmur best heard between the apex and left sternal border - increases in intensity with maneuvers that decrease preload (Valsalva, squatting to standing position). - does not radiate to the carotid arteries

• sustained apical impulse• S4• bisferiens pulse (carotids, femoral arteries)

Complications that can occur as a result of these problems include:

Inability of your heart to pump enough blood to your body (heart failure)

Abnormal heart rhythm (arrhythmia) Insufficient supply of oxygen to the heart (ischemic heart

disease) Interruption of blood supply to the heart (heart attack) Sudden, unexpected loss of heart function, breathing and

consciousness (sudden cardiac arrest)

Defination: right ventricular hypertrophy is the enlargement of heart’s

right ventricle Right ventricular hypertrophy, or simply RVH, is considered

to be one of the rare diseases of the heart. Unlike the left ventricle, which tends to overwork itself when it detects abnormalities, the right ventricle dilutes itself. This is the reason why left ventricular hypertrophy is way more common than right ventricular hypertrophy.

Pulmonary hypertension Fallot tetralogy Pulmonary valve stenosis Ventricular septal defect (VSD) High altitude Cardiac fibrosis Chronic obstructive pulmonary disease (COPD)

Chest pain and tightness Palpitation Dizziness Loss of consciousness Light headedness Edema of feet,leg,ankle

To diagnose RVH you can use the following criteria: Right axis deviation, and V1 R wave > 7mm tall

POTASSIUM MAGNESIUM CALCIUM

Hyperkalemia Hypokalemia Hyperkalemia: affects Na channels and causes

depolarizaion . Na channels inactivate and refractory. Ventricular fibrillation and asystole. At the same time increases activity of

potassium channels and increases memb. repolarization.

Causes:

Renal insufficiencyMedicationBlood transfusion, Massive hemolysisAddison's diseasecongenital adrenal hyperplasiaBurns,necrosis,tumor lysis syndromePotassium containg dietary supplements

Hyperkalemia:causes hyperpolarization of RMP.Greater than normal stimulus is required to generate A.P. Opposite in case of heart and it become hyperexcitable. Lower A.P in atria may cause arrhythmias.Causes:Inadequate intakePostemetic,DiarrheaDiureticAlkalosisRenal artery stenosisTumors of adrenal gland

Hypermagnesemia Hypomagnesemia Hypomagnesemia required for Na/K ATPase. Normal Mg

inhibits release of K . In hypo more K is released so cells depolarize causing tachyarrhythmias

Causes: Alcohol abuse Delirium tremens Ch.Diarhea Thiamine deficiency Diuretics Aminoglycoside Gentamycin,tobramycin Cisplatin,cyclosporin

Hypermagnesemia: Acts as physiological Ca channel blocker. Causes arrhythmias such as A/F, interventricular conduction delay.

Causes: Antacids Vitamins Acute renal failure Maternal eclampsia Tumor hypoparathyoidism Iatrogenic Sis syndrome Milk alkali syndrome Hypothyroidism

Hypercalsemia Hypocalsemia Hypercalsemia: rarely too high to effect heart but may cause heart to fail to

relax during diastole and eventually stops in systole(Ca rigor). Causes: Hyperparathyroidism Sarcoidosis Iatrogenic Breast cancer Phaeochromocytoma Hyperthyroidism Post renal transplant Adrenal insufficiency

Hypocalsemia: exact mech. nt known but ECG changes are seen. Cause : Hypoparathyroidism Sepsis Alcoholism Renal failure Pacreatitis Hyperphosphatemia Phosphate enemas Malnutrition

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