A 61-year-old hypertensive male scheduled for elective laparoscopic inguinal hernia repair undergoes preoperative transthoracic echocardiography.
He is asymptomatic, with good effort tolerance (≈6 METs), controlled blood pressure, and no prior cardiac disease.
The echocardiogram reveals:
Moderate concentric LV hypertrophy (LVH)
Grade I diastolic dysfunction
Left ventricular ejection fraction (EF): 63%
Moderate aortic regurgitation (AR)
Grade II mitral regurgitation (MR)
Grade I tricuspid regurgitation (TR)
Normal pulmonary artery pressure (RVSP = 21 + RAP)
No aortic stenosis, trileaflet sclerotic valve
This represents a compensated, pressure–volume–adaptive heart, typical of patients presenting for elective surgery with chronic hypertension and age-related valve sclerosis.
An anesthesiologist must extract three key pieces of information from an echo report:
How strong the heart pumps (systolic function)
How well it fills (diastolic function)
What impedes or leaks the flow (valvular and pressure pathophysiology)
Each parameter on the report contributes to one of these three physiologic domains.
Echocardiography therefore serves as a dynamic hemodynamic map—a noninvasive reflection of preload, afterload, contractility, and compliance.
“A good anesthesiologist reads an echo the way a pilot reads a cockpit—every number tells a part of the flight story.”
Concentric LVH signifies chronic pressure overload—most commonly due to systemic hypertension or aortic outflow resistance.
The hypertrophied myocardium contracts well (normal EF), but becomes stiff during relaxation, leading to diastolic dysfunction.
Clinical Implication for Anesthesia:
LVH increases myocardial oxygen demand and decreases coronary reserve.
These ventricles are “preload-sensitive” and “afterload-intolerant.”
Laplace’s Law: Wall stress (σ) = Pressure (P) × Radius (r) / 2 × Wall thickness (h).
Thickening (↑h) normalizes wall stress but increases stiffness.
Cellular Remodeling: Hypertrophy involves parallel addition of sarcomeres, increasing myocyte diameter but reducing chamber compliance.
Energy Cost: LVH hearts consume more oxygen for the same stroke volume—important when anesthetics depress coronary autoregulation.
“LVH is the price a ventricle pays for surviving high blood pressure.”
It’s strong but less forgiving—don’t let it run dry or overfilled.
References
Ganau A, et al. Patterns of left ventricular hypertrophy and clinical outcomes. J Am Coll Cardiol. 1992;19(7):1550–8.
Marwick TH. Echocardiographic assessment of LVH in the perioperative period. Br J Anaesth. 2021;127(1):69–78.
Grossman W, et al. Cardiac hypertrophy: cellular and molecular...
