Lvh causes
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"left ventricular hypertrophy" causes mechanisms
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Here is a comprehensive overview of the causes of Left Ventricular Hypertrophy (LVH), organized by mechanism:
Causes of Left Ventricular Hypertrophy (LVH)
LVH develops when the left ventricle (LV) is subjected to sustained increased mechanical stress - either pressure overload, volume overload, or intrinsic muscle disease. The response depends on the type of stress, producing two distinct structural patterns.
Mechanism 1: Pressure Overload → Concentric LVH
In pressure overload, systolic wall stress increases. Sarcomeres replicate in parallel, increasing wall thickness while cavity size is preserved or reduced. The wall thickness-to-radius ratio increases.
| Cause | Notes |
|---|---|
| Systemic hypertension | Most common cause overall; chronic pressure elevation forces the LV to pump against higher afterload |
| Aortic stenosis | Outflow tract obstruction; classic cause of isolated LVH |
| Hypertrophic obstructive cardiomyopathy (HOCM) | Dynamic outflow obstruction |
| Coarctation of the aorta | Increases systemic afterload proximal to the lesion |
| Subvalvular/supravalvular aortic stenosis | Congenital obstruction mimicking valvular AS |
"The most common reasons for isolated left ventricular hypertrophy are hypertension and aortic stenosis." - Morgan & Mikhail's Clinical Anesthesiology, 7e
Mechanism 2: Volume Overload → Eccentric LVH
In volume overload, diastolic wall stress increases. Sarcomeres replicate in series, elongating myocytes and enlarging the cavity. Wall thickness also increases, but the wall thickness-to-radius ratio stays normal.
| Cause | Notes |
|---|---|
| Aortic regurgitation | Increased LV diastolic volume from backflow |
| Mitral regurgitation | Volume returns to LV during systole |
| Mitral stenosis | Raises left atrial pressure, downstream LV effects |
| High-output states | Anemia, arteriovenous fistula (e.g., dialysis access), pregnancy, hyperthyroidism, Paget's disease |
| Chronic kidney disease / fluid overload | Extracellular volume excess is a well-established cause - Brenner & Rector's The Kidney notes that volume overload "increases left ventricular filling pressure and thereby stretches the ventricular wall" |
| Obesity | Increased circulating blood volume and cardiac output demand |
Mechanism 3: Intrinsic/Genetic Myocardial Disease
| Cause | Notes |
|---|---|
| Hypertrophic Cardiomyopathy (HCM) | "The leading cause of LVH unexplained by other clinical or pathologic causes" (Robbins & Cotran). Autosomal dominant; gain-of-function mutations in sarcomeric proteins (myosin-binding protein C, β-MHC) causing hypercontractility. >400 known mutations in 9 genes |
| Storage/infiltrative diseases | Fabry disease (α-galactosidase A deficiency), glycogen storage diseases, amyloidosis - all cause pseudo-hypertrophy from protein/lipid deposition |
| Mitochondrial cardiomyopathy | Rare; causes myopathic LVH in children |
Mechanism 4: Physiological (Non-pathological)
| Cause | Notes |
|---|---|
| Athletic heart syndrome | Regular intense exercise (endurance or resistance) causes adaptive, reversible LVH; usually eccentric with preserved systolic function and no fibrosis |
Summary: Concentric vs. Eccentric LVH
| Feature | Concentric LVH | Eccentric LVH |
|---|---|---|
| Stimulus | Pressure overload | Volume overload |
| Sarcomere replication | Parallel | In series |
| Wall thickness | Increased | Increased |
| Cavity size | Normal or reduced | Enlarged |
| Wall thickness:radius ratio | Increased | Normal |
| Common causes | HTN, aortic stenosis | AR, MR, high-output states |
Key sources:
- Morgan & Mikhail's Clinical Anesthesiology, 7e - Ventricular Hypertrophy section
- Robbins & Cotran Pathologic Basis of Disease - Hypertrophic Cardiomyopathy
- Brenner & Rector's The Kidney - Altered Cardiac Geometry in CKD
- Comprehensive Clinical Nephrology, 7e - Heart Failure in CKD
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