Which histologic finding is not characteristic of hypertensive heart disease?

Which histologic finding is not characteristic of hypertensive heart disease?

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

Answer: (B)

Hypertensive heart disease shows changes driven by pressure overload: the left ventricle develops concentric hypertrophy with enlargement of myocytes and increased interstitial fibrosis, and there is arteriolosclerosis of small coronary vessels. These features reflect the heart adapting to sustained high afterload and the accompanying vascular damage. Myocyte disarray is not part of this pattern. It indicates a primary cardiomyopathy, most classically hypertrophic cardiomyopathy, where fibers are disorganized and interstitial fibrosis can be present as a consequence of myocyte stretching and damage. Seeing disorganized myofibers points away from hypertensive heart disease and toward a genetic cardiomyopathy. The other described patterns fit hypertensive heart disease: concentric left ventricular hypertrophy with myocyte enlargement and interstitial fibrosis, and arteriolosclerosis of small coronary arteries, or myocyte hypertrophy with concentric fibrosis.

Hypertensive heart disease shows changes driven by pressure overload: the left ventricle develops concentric hypertrophy with enlargement of myocytes and increased interstitial fibrosis, and there is arteriolosclerosis of small coronary vessels. These features reflect the heart adapting to sustained high afterload and the accompanying vascular damage.

Myocyte disarray is not part of this pattern. It indicates a primary cardiomyopathy, most classically hypertrophic cardiomyopathy, where fibers are disorganized and interstitial fibrosis can be present as a consequence of myocyte stretching and damage. Seeing disorganized myofibers points away from hypertensive heart disease and toward a genetic cardiomyopathy.

The other described patterns fit hypertensive heart disease: concentric left ventricular hypertrophy with myocyte enlargement and interstitial fibrosis, and arteriolosclerosis of small coronary arteries, or myocyte hypertrophy with concentric fibrosis.