A 52-year-old man with long-standing hypertension presents with dyspnea on exertion. Echocardiography shows left ventricular wall thickening with preserved ejection fraction. Which is the most common cause of left ventricular hypertrophy in India?

Question

Accepted Answer

B. Chronic hypertension. ## Most Common Cause of Left Ventricular Hypertrophy

**Key Point:** Chronic systemic hypertension is the most common cause of left ventricular hypertrophy (LVH) worldwide and in India, accounting for >90% of cases in the general population.

### Pathophysiology of Hypertension-Induced LVH

1. **Increased afterload** from sustained elevation of systemic blood pressure
2. **Myocyte hypertrophy** — individual cardiac myocytes enlarge in response to mechanical stress
3. **Concentric pattern** — wall thickens symmetrically; cavity size remains normal or decreases
4. **Diastolic dysfunction** develops early; systolic function preserved initially

### Differential Causes of LVH

| Cause | Prevalence | Pattern | Key Feature |
|-------|-----------|---------|-------------|
| **Chronic hypertension** | Most common (>90%) | Concentric | Symmetric wall thickening |
| Aortic stenosis | Rare in India now | Concentric | Valvular obstruction on echo |
| HCM | <1% population | Eccentric/asymmetric | Genetic, SAM, obstruction |
| Athletic heart | Physiologic | Eccentric | Athlete, reversible |

**High-Yield:** In any Indian patient with LVH, hypertension is the default diagnosis until proven otherwise. The prevalence of hypertension in urban India is 25–30%, making it the leading cause of cardiac remodeling.

**Clinical Pearl:** LVH from hypertension is initially *reversible* if blood pressure is controlled early; prolonged hypertension leads to fibrosis and irreversible diastolic dysfunction.

### Why Hypertension Dominates

- **Epidemiology:** ~250 million hypertensive individuals in India; aortic stenosis is now rare due to rheumatic heart disease decline
- **Mechanism:** Sustained pressure overload triggers sustained myocyte growth
- **Time course:** Develops over years of uncontrolled BP

[cite:Robbins 10e Ch 12]

Answer

A. Aortic stenosis

Answer

C. Athletic heart syndrome

Answer

D. Hypertrophic cardiomyopathy

A 52-year-old man with long-standing hypertension presents with dyspnea on exertion. Echocardiography shows left ventricular wall thickening with preserved ejection fraction. Which is the most common cause of left ventricular hypertrophy in India?

Explanation

Most Common Cause of Left Ventricular Hypertrophy

Pathophysiology of Hypertension-Induced LVH

Differential Causes of LVH

Why Hypertension Dominates

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Cause	Prevalence	Pattern	Key Feature
Chronic hypertension	Most common (>90%)	Concentric	Symmetric wall thickening
Aortic stenosis	Rare in India now	Concentric	Valvular obstruction on echo
HCM	<1% population	Eccentric/asymmetric	Genetic, SAM, obstruction
Athletic heart	Physiologic	Eccentric	Athlete, reversible