 |  nbm 6, please hlps, exam 2 days!!!
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| Author | 16 Posts |
hottie99
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hi, i have a guess ont his, but not even sure it looks liek wat it is, i had put bottom choice, or u can se on my selection, but wat is it???? thanks!
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| maoudoody
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but in essential htn only the left side hypertrophied
the pic shows an equal size left and right side thickness
well i took a lot of time thinking
and it appeared out that normally right ventricle thickness is about the third of the left
so may be when the right enlarged it gives this pic where the thickness allover the heart is the same
so will go with primary pulmonary HTN
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| maoudoody
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dilated cardiomyopathy there is enlargment in the heart chambers all are enlarged
other causes will produce asymmetrical enlargment unlike the pic
for example:
1-ASD: left to right shunt i.e enlargment of the right atrium and also it is unlikely to leave a women with asd without surgery till 45 years if someone would say after 45 years the shunt is reversed and the left side started to be strained
2-mitral stenosis: the left ventricle wont be hypertrophied,,,only the right atrium
3-HTN : i said be4 only the left side so asymmetrical hypertrophy
this is just a suggestion not sure but it appears to be reasonable
good luck hottie
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| hottie99
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i see wat ur saying, thanks, i was just curious.. i thought tho it ws just lvh, like the entire venricle, why wouldnt the rite be different, why isnt that just the outter portion b/c that too has a septal involvement,u know? so im not sure, i know it's htn, whether it's essetial or pulm is yet to be seen, but thx anyways! 
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| Tiff
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It looks like concentric hypertrophy which is seen in systemic hypertension. I agree with your answer choice.
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| Tiff
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hottie99 wrote:i see wat ur saying, thanks, i was just curious.. i thought tho it ws just lvh, like the entire venricle, why wouldnt the rite be different, why isnt that just the outter portion b/c that too has a septal involvement,u know? so im not sure, i know it's htn, whether it's essetial or pulm is yet to be seen, but thx anyways!
If it was pulmonary hypertension there wouldn't be hypertrophy. It would be just dilated (of course of the right ventricle). If you couldn't tell which ventricle it was you can just tell determine concentric hypertrophy (systemic hypertension) or dilated ventricle (pulmonary hypertension).
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| maoudoody
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Tiff :
i didnot get what u say
cause pulmonary HTN is an afterload on rt vent so it will obviously hypertrophy??
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| kabootra
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Tiff:
http://www.prep4usmle.com/templates/images_defaul...
raised eyebrow
Isn't pulmonary hhtn afterload problem????
WEll,acc. to me ------dilated----pre-load
constrictive----after-load
systemic htn is correct !! or tht wht i wud do
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| kabootra
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Tiff:
Isn't pulmonary hhtn afterload problem????
WEll,acc. to me ------dilated----pre-load
constrictive----after-load
systemic htn is correct !! or tht wht i wud do
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| calidoc4you
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 i agree
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| hottie99
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ok maybe for primary pulm htn, but let's say in mitral stenosis, there is rvh rite, due to all the increased flow thru the lungs? isnt that pulm htn from the stenotic valves causing the left atrial enlargement, and then backflow to lungs, making right ventricle work harder, so it hypertrophies, or am i wrong on that logic as well... 
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| Tiff
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Ok. To clear up any confusion. A I had to look this up. So, according to Robbins Pathology...
Pulmonary Hypertensive Heart Disease (Cor pulmonale) presents as follows: marked dilation of the right ventricle without hypertrophy. In chronic cor pulmonale, the ventricular wall thickens. It may even approximate the size of the left ventricle. (In the picutre one ventricle is overwhemingly larger than the other. It's not going to be significantly larger than the left ventricle)
Systemic Hypertensive Heart Disease presents as follows: circumferential hypertrophy without dilation of the left ventrice. The thickening of the left ventricular wall increases the ratio of its wall thickness to radius and increases the weight of the heart disproprotionately to the increase in overal cardiac size.
Even though the the right ventricle has the potential to hypertrophy,it would become the same size of the left ventricle. Not larger. And there's a lumen. Especially not significantly larger. In the picture you can see a massive hypertrophied ventricle and the other ventricle is very small in comparison. Concentric hypertrophy in systemic hypertension greatly diminishes the lumen and is usually seen left sided.
Hope this helps.
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| hottie99
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ok cleard up on the pph, but wat about ms, isn't it hypertrophy then or should it be dilated since volum is back logged in the lungs?
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| Tiff
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hottie99 wrote:
ok cleard up on the pph, but wat about ms, isn't it hypertrophy then or should it be dilated since volum is back logged in the lungs?
Mitral stenosis causes hypertrophy of the left atrium.
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| hottie99
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no i dont think that, i knwo there's the left atrial enlargement from the dilation due to the increased volume, that's why their at a risk for afib... and the LAE causes the dysphagia, so there's the back flow to the lungs, and they have pulm htn, and they have rvh, that much i remember from kaplan when i had dr. barone, b.c he said they like to ask about lvh always, but this one has rvh... hmm, ah well, dont sweat it guys, it's ok.. watever happens happens..
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| Tiff
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hottie99 wrote:
no i dont think that, i knwo there's the left atrial enlargement from the dilation due to the increased volume, that's why their at a risk for afib... and the LAE causes the dysphagia, so there's the back flow to the lungs, and they have pulm htn, and they have rvh, that much i remember from kaplan when i had dr. barone, b.c he said they like to ask about lvh always, but this one has rvh... hmm, ah well, dont sweat it guys, it's ok.. watever happens happens..
Yes - you're right. That does happen over time. Left atrium dilates. But after a long time other changes will occur and the congestion in the lungs will lead to RVH. Left ventricle remains normal.
Good luck!
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