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Concentric Heart Hypertrophy

This is a puzzling entity for cardiologists!

The reason for that is that they are missing the link to the peripheral vascular system and especially to venous one.

Few, if at all are at the same time angiologists.

Also, ultrasound is the poorest sister of imaging, a kind of Cinderella, too frequently neglected and executed by technicians who have no training in physiology.

They all spend no more than 5-15 minutes at such an examination.

As a radiologist, I would spend usually 1 hour on an abdominal echography, encompassing the heart.

My experience taught me that deep venous thrombosis goes most of the time undiagnosed, if D-Dimers are within normal range.

Lectures in university 50 years ago taught that pulmonary arterial hypertension is frequent in elderly ladies, which our professor related to washing powders and liquids.

By gaining experience, I understood that this entity is linked to small deep venous thromboses of the legs, embolizing continually to the lungs.

The trigger is a deficit in vitamin B12.

The heart is one single organ working as a whole.

First rhythm becomes slightly elevated, but distensibility of pulmonary arteries is extensive.

This is not the case for peripheral arteries, where pressure goes up.

Therapy thus erroneously applied is with anti-hypertensive agents.

Hyperactivity of the right ventricle forces rhythm to go up and as pressure in arteries rises, hypertrophy of the right side is the consequence.

Slight tachycardia follows, about 90/min, which specialists consider again irrelevant.

So, you understand the problem, right and left heart are submitted to the same slightly, but constantly accelerated rhythm.

As every muscle supporting more work, both ventricles experience concentric hypertrophy!

Therapy is simple, if you understand the underlying physiopathology!

A subcutaneous vitamin B12 injection every 3 weeks and aspirin as a platelet anti-aggregant will do the whole job as prevention.

This, of course, after treatment of the thromboembolic entity.

Hence, for a long time opinions between specialists were divergent as to the role of beta-blockers.

Good professionals pretended because of observation that Propranolol is not an anti-hypertensive medicine, but on the other side many felt that it prolongates life-expectancy.

As to diagnosis, probably in near future we will see ultrasound machines, functioning automatically like a scanner, dedicated to the calf of the leg.

Adaptability to different sizes with compression should be warranted.

Here, AI can be  employed as the best tool for delicate findings.

Aim of such a procedure is to obviate the high examiner dependency of results.

I wonder what percentage of arterial hypertension is due in fact to thrombo-embolic events.