Which histologic feature best characterizes hypertensive heart disease in the left ventricle?

Which histologic feature best characterizes hypertensive heart disease in the left ventricle?

• A. Arteriolosclerosis of small coronary arteries
• B. Concentric LV hypertrophy with myocyte enlargement and interstitial fibrosis; arteriolosclerosis of small coronary arteries.
• C. Myocyte disarray with interstitial and replacement fibrosis
• D. Dilated left ventricle with systolic dysfunction

Answer: (B)

Hypertensive heart disease in the left ventricle is best seen as concentric LV hypertrophy driven by chronic pressure overload, with myocyte enlargement and interstitial fibrosis, along with arteriolosclerosis of small coronary arteries. The heart adapts to higher afterload by adding sarcomeres in parallel, so the wall thickens to reduce wall stress (the law of Laplace). This concentric remodeling makes the ventricle stiffer over time, contributing to diastolic dysfunction, and the surrounding small vessels undergo arteriolosclerosis, limiting blood supply and promoting interstitial fibrosis. This pattern fits hypertension-related changes, unlike myocyte disarray with interstitial fibrosis seen in hypertrophic cardiomyopathy, or a dilated left ventricle with systolic dysfunction seen in dilated cardiomyopathy or ischemic damage, which are not the classic hypertensive changes.

Hypertensive heart disease in the left ventricle is best seen as concentric LV hypertrophy driven by chronic pressure overload, with myocyte enlargement and interstitial fibrosis, along with arteriolosclerosis of small coronary arteries. The heart adapts to higher afterload by adding sarcomeres in parallel, so the wall thickens to reduce wall stress (the law of Laplace). This concentric remodeling makes the ventricle stiffer over time, contributing to diastolic dysfunction, and the surrounding small vessels undergo arteriolosclerosis, limiting blood supply and promoting interstitial fibrosis.

This pattern fits hypertension-related changes, unlike myocyte disarray with interstitial fibrosis seen in hypertrophic cardiomyopathy, or a dilated left ventricle with systolic dysfunction seen in dilated cardiomyopathy or ischemic damage, which are not the classic hypertensive changes.