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Echocardiography

Echocardiography. Hypertensive Heart Disease. Hypertensive Heart Disease. End Organ Damage as a consequence of systemic hypertension. Chronic systemic pressure overload. Hypertensive Heart Disease. Results in LVH to maintain normal wall stress Initially impaired diastolic function

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Echocardiography

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  1. Echocardiography Hypertensive Heart Disease

  2. Hypertensive Heart Disease • End Organ Damage as a consequence of systemic hypertension. • Chronic systemic pressure overload

  3. Hypertensive Heart Disease • Results in LVH to maintain normal wall stress • Initially impaired diastolic function • Normal systolic function

  4. Hypertensive Heart Disease Long standing hypertension • Results in systolic dysfunction • LV dilation

  5. Hypertensive Heart Disease Other Findings • Aortic root dilation • Aortic valve sclerosis

  6. Hypertensive Heart Disease • Mitral annular calcification • Left atrial enlargment • Atrial fibrillation

  7. Hypertensive Heart Disease 2- Dimension/ M-mode • Concentric LVH • Increased wall thickness (> 11 mm) • Non-dilated chamber • Increased LV mass

  8. Hypertensive Heart Disease Diastolic function – Impaired Relaxation • Prolonged IVRT • Decreased E wave • Decreased early deceleration slope • Increased A wave

  9. Hypertensive Heart Disease Systolic Function • Preserved until late in the diseased. • Small hypertrophied ventricle – mid cavity obliteration at the end of systole may be seen with an associated Doppler high-velocity signal.

  10. Hypertensive Heart Disease Systolic Function • Signal is briefer (cf HCM) • Level of obstruction is mid ventricle • Obstruction exacerbated by hypovolemia or increased contractility.

  11. Hypertensive Heart Disease Other Echocardiagraphic findings • Aortic root dilation • Tortuosity of the ascending aorta, arch and descending aorta

  12. Hypertensive Heart Disease • Increased irregular echogenicity of the aortic walls – atherosclerosis • Aortic annulus is not dilated

  13. Hypertensive Heart Disease • Aortic valve leaflet shows calcification – aortic regurgitation. • Mitral annular calcification – mitral regurgitation. • LA dilation – due to MR and the chronically elevated LV-EDP.

  14. Hypertensive Heart Disease Clinical Utility • LV mass – strong predictor of clinical outcome. • LV mass – more accurate way of assessing the severity of the hypertension. • LV mass – efficacy of the medical therapy.

  15. Hypertensive Heart Disease

  16. Hypertensive Heart Disease

  17. Hypertensive Heart Disease

  18. Hypertensive Heart Disease Choice of Medical therapy • BP = CO x PR • CO = SV x HR • SV = CSA x VTI

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