Hypertensive heart disease and cor pulmonale
- Lesion
Long-standing high blood pressure thickens the left ventricle; high pressure in the lungs thickens and dilates the right ventricle.
What it is
Systemic hypertensive heart disease is left ventricular hypertrophy caused by hypertension, without another cause. The wall thickens concentrically, the ventricle stiffens and diastolic filling suffers; later the heart may dilate and fail, and atrial fibrillation and ischemia are common. Cor pulmonale is right ventricular hypertrophy and dilation caused by pulmonary hypertension from lung or pulmonary vascular disease. It is acute after massive pulmonary embolism (dilation) and chronic with chronic lung disease, hypoxia or recurrent emboli (hypertrophy).
Structure
- Gross: thick LV wall that may encroach on the cavity; in cor pulmonale, the RV wall thickens toward the thickness of the LV and the septum bulges left.
- Microscopy: myocyte hypertrophy with large rectangular nuclei and interstitial fibrosis.
Left versus right hypertensive heart disease
| Disease | Cause | Changes in the heart |
|---|---|---|
| Systemic hypertensive heart disease | Long-standing systemic hypertension | Concentric LV hypertrophy, stiff ventricle, left atrial dilation, later dilation and failure |
| Cor pulmonale | Pulmonary hypertension from lung, airway or pulmonary vascular disease | RV hypertrophy (chronic) or acute RV dilation (massive embolism); tricuspid regurgitation |
Clinical notes
- Hypertensive heart disease can stay compensated for years; it predisposes to atrial fibrillation, heart failure and sudden death.
- Treating hypertension can make the hypertrophy regress.
Test yourself
Think of the answer, then tap the question to see it.
What are the criteria for systemic hypertensive heart disease?
Left ventricular hypertrophy, usually concentric, in a person with hypertension and no other cause of hypertrophy.
What is cor pulmonale?
Right ventricular hypertrophy and/or dilation caused by pulmonary hypertension from disease of the lungs or pulmonary vessels.
Why does the right ventricle dilate rather than thicken after massive pulmonary embolism?
The rise in pressure is sudden, so the thin-walled right ventricle has no time to hypertrophy and simply dilates.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hypertensive heart disease: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Pulmonary Hypertension | PH | MedlinePlus (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.