Hypertensive heart disease is the response of the heart to the increased demands induced by systemic hypertentsion. Pulmonary hypertension also causes heart disease and is referred to as right sided hypertensive heart disease or corpulmonale. Systmic (left-sided) Hypertensive heart disease The minimal criteria for the diagnosis of systemic hypertensive heart disease are the following: (1) left ventricular hypertrophy (usually concentric) in the absence of other cardiovascular pathology that might have induced it and (2) a history or pathologic evidence of hypertension. The Framingham heart study established unequivocally that even mild hypertension (levels only slightly above 140/90) mm Hg) if sufficiently prolonged induces left ventricular hypertrophy. Approximately 25% of the U.S. population suffers from hypertension of at least this degree. In hypertension, hypertrophy of the heart is an adaptive response to pressure overload which can lead to myocardial dysfunction, cardiac dilation , congestive heart failure and sudden death. Compensated systemic hypertensive heart disease may be asymptomatic and suspected only in the appropriate clinical setting by ECG or echocardiographic indications of left ventricular enlargement. As already emphasized, other causes for such hypertrophy must be excluded. In many causes for such hypertrophy must be excluded. In many patients, systemic hypertensive heart disease comes to attention by the onset of atrial fibrillation (owing to left atrial enlargement) or congestive heart failure with cardiac dilation or both. Depending on the severity of the ypertension its duration the adequacy of therapeutic control and underlying basis, the patient may enjoy normal longevity and die of unrelated causes, may develop progressive IHD owing to the effects of hypertension in potentiating coronary atherosclerosis, may suffer progressive renal damage or cerebrovascular accident, or may experience progressive heart failure or sudden cardiac death. There is substantial evidence that effective control of hypertension can prevent or lead to regression of cardiac hypertrophy and its associated risks. Pulmonary (Right-sided) Hypertensive heart disease (cor pulmonale) Cor pulmonale, as pulmonary hypertensive heart disease is frequently called, constitutes right ventricular hypertrophy, dilation, and potentially failure secondary to pulmonary hypertension caused by disorders of the lungs or pulmonary vasculature and is the right sided counterpart of left sided(systemic) hypertensive heart disease. Although quite common, right ventricular thickening and dilation caused either by congenital heart disease or by disease of the left side of the heart and the resultant pulmonary venous hypertension owing to postcapillary obstruction to blood flow are exclude from this definition of cor pulmonale. Based on the suddenness of development of pulmonary hypertension, cor pulmonale may be acute or chronic Acute cor pulmonale can follow massive pulmonary embolism. Chronic cor pulmonale usually implies right ventricular hypertrophy and dilation) secondary to prolonged pressure overload owing to obstruction of the pulmonary arteries or arterioles or compression obliteration of septal capillaries (e.g., owing to primary pulmonary hypertension or emphysema)
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