Hypertrophy is an increase in the size and weight of the heart muscle (myocardium). It develops as an adaptive response to an increased pressure load on the heart.

Myocardial hypertrophy can be:

• Concentric hypertrophy: thickening of the ventricular wall without chamber dilation
• Eccentric hypertrophy: thickening of the ventricular wall with chamber dilation

Either or both ventricles may be involved.

Concentric hypertrophy is caused by increased afterload (the pressure the ventricle must pump against), as seen in hypertension, aortic stenosis, and hypertrophic cardiomyopathy.

Eccentric hypertrophy is caused by increased preload (increased filling/volume load), as seen in mitral and aortic regurgitation, left-to-right shunts, etc.

In concentric hypertrophy, the ventricular lumen is smaller than normal. In eccentric hypertrophy, the lumen is dilated.

Features of hypertensive heart disease

• Seen in untreated hypertension of long duration
• Predisposes to IHD
• Concentric LVH
• Eccentric hypertrophy in severe cases
• Arrhythmias (AF, ventricular tachycardia, PVCs)
• Cardiac Failure
• Diastolic dysfunction
• Aortic insufficiency