Right Ventricular Hypertrophy - Erler Zimmer

Right Ventricular Hypertrophy - Erler Zimmer

Clinical History

This 56-year-old female, suffering from emphysema, reported a 2-year history of increasing shortness of breath on exertion accompanied by recurrent bouts of bronchitis. During examination, she exhibited a blood pressure of 160/90 mm Hg, a pulse rate of 96 beats/min, and 6 cm of jugular venous congestion. The apex beat was impalpable, bilateral crepitations were audible, and there was peripheral pitting edema. Special investigations revealed an ECG indicating a right heart strain pattern, and arterial blood examination showed respiratory acidosis. Despite treatment efforts, there was a gradual deterioration in her condition, culminating in death.

Pathology

The specimen displays the external surface of the heart viewed from the anterior aspect. The right ventricle appears significantly enlarged and hypertrophied. Otherwise, all other aspects of the heart seem normal. This exemplifies right ventricular hypertrophy (RVH) in a patient with emphysema.

Further Information

RVH typically arises due to chronic lung disease or structural defects in the heart. Pulmonary hypertension (PH) is one of the primary causes, leading to elevated pulmonary artery pressure. As the right ventricle attempts to compensate for this increased pressure, it undergoes changes in shape and size, resulting in hypertrophy and increased wall thickness. The global incidence of PH is 4 per 1 million people, with RVH occurring in approximately 30% of these cases. Common causes of PH include chronic obstructive pulmonary disease (COPD), pulmonary embolism, and other restrictive lung diseases. RVH can also result from structural defects in the heart, such as tricuspid insufficiency, allowing backward blood flow into the ventricle. Other structural defects associated with RVH include tetralogy of Fallot, ventricular septal defects, pulmonary valve stenosis, and atrial septal defects. Additionally, RVH is linked to abdominal obesity and high systolic blood pressure.