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Morphologic Compensatory Mechanisms in The Heart: Peter B. Baker, M.D
Morphologic Compensatory Mechanisms in The Heart: Peter B. Baker, M.D
Morphologic Compensatory Mechanisms in The Heart: Peter B. Baker, M.D
Remodeling General term that refers to changes in gross and/or microscopic morphology of the heart Hypertrophy Increased heart weight and size of myocardial cells in response to pressure or volume overload Myofibrils added in parallel Patterns of hypertrophy Concentric increased muscle mass with either no change, or small decrease in chamber volume Eccentric increased muscle mass which develops along with chamber dilation, so there are 2 things going on hypertrophy and dilation
Altered protein synthesis Synthesis of abnormal proteins Fibrosis Inadequate blood supply due to decreased capillary density Altered handling of intracellular calcium
These alterations may eventually lead to reduced myocyte contractility and CHF
Normal Myocytes
Hypertrophic Myocytes
Mi
My
Dilation Increase chamber size in response to increase volume or pressure/volume load Sarcomeres added in series Hypertrophy is always present with longstanding dilation Excessive dilation results in decreased wall thickness and increased wall tension
Compensated hypertrophy, dilation and physiologic mechanisms are sufficient to maintain cardiac output Decompensated compensatory mechanisms no longer provide adequate cardiac output, CHF develops
Decompensated hypertrophy no longer provides adequate cardiac output due to decreased myocardial contractility, resulting in LV dilation and gradual onset of CHF
LV
LV
*In some patients, marked LV wall stiffness leads to CHF with little ventricular dilation
Key Points
Morphologic compensatory changes hypertrophy and dilation and the term remodeling Compensated heart disease Pathologic features of compensated / decompensated hypertensive heart disease