[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Heart](https://durgical.com/en/general-pathology/areas/heart/) › Hypertensive heart disease and cor pulmonale # 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. Updated Nov 12, 2026 ## Key points - Definition of hypertensive heart disease: left ventricular hypertrophy with a history of hypertension and no other cause. - Concentric hypertrophy: thick wall, small cavity, reduced compliance, diastolic dysfunction, left atrial enlargement. - Myocytes: enlarged with boxcar nuclei and interstitial fibrosis. - Chronic cor pulmonale causes: COPD, interstitial lung disease, obstructive sleep apnea, obesity hypoventilation, recurrent thromboemboli, pulmonary arterial hypertension. - Acute cor pulmonale: massive pulmonary embolism; the thin right ventricle dilates without time to hypertrophy. - Right heart failure from pulmonary disease is cor pulmonale; from left heart failure it is not. ## 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](https://durgical.com/en/conditions/hypertensive-heart-disease/) | Long-standing systemic hypertension | Concentric LV hypertrophy, stiff ventricle, left atrial dilation, later dilation and failure | | [Cor pulmonale](https://durgical.com/en/conditions/pulmonary-hypertension-and-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. ## Memory aid High pressure in the body thickens the left; high pressure in the lungs strains the right. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/hypertensive-heart-disease-and-cor-pulmonale/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Physiology of hypertension](https://durgical.com/en/physiology/physiology-of-hypertension/) ## Connections ## Related 6 - [Hypertrophy: physiologic and pathologic](https://durgical.com/en/general-pathology/hypertrophy-physiologic-and-pathologic/) - [Heart failure: hypertrophy and remodelling](https://durgical.com/en/general-pathology/heart-failure-hypertrophy-and-remodelling/) - [Hypertension: mechanisms](https://durgical.com/en/general-pathology/hypertension-mechanisms/) - [Pulmonary hypertension](https://durgical.com/en/general-pathology/pulmonary-hypertension/) - [Pulmonary thromboembolism: where it comes from and what it does](https://durgical.com/en/general-pathology/pulmonary-thromboembolism-where-it-comes-from-and-what-it-does/) - [Emphysema](https://durgical.com/en/general-pathology/emphysema/) ## Related conditions 8 - [Hypertensive heart disease](https://durgical.com/en/conditions/hypertensive-heart-disease/) - [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/) - [Pulmonary hypertension and cor pulmonale](https://durgical.com/en/conditions/pulmonary-hypertension-and-cor-pulmonale/) - [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/) - [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/) - [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/) - [Interstitial lung disease](https://durgical.com/en/conditions/interstitial-lung-disease/) - [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) [← All of general pathology](https://durgical.com/en/general-pathology/) 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](https://medlineplus.gov/ency/article/000163.htm) (MedlinePlus, US National Library of Medicine, 2025); [Pulmonary Hypertension | PH | MedlinePlus](https://medlineplus.gov/pulmonaryhypertension.html) (MedlinePlus, US National Library of Medicine, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/hypertensive-heart-disease-and-cor-pulmonale/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/hypertensive-heart-disease-and-cor-pulmonale/