Ventricular tachyarrhythmias, myocardial ischemia and sudden cardiac death in patients with hypertensive heart disease

Abstract

SummaryHypertensive heart disease is increasingly considered to be a strong and independent risk factor for sudden cardiac death. Ventricular tachyarrhythmias in these patients are common and mainly the result of electrophysiological abnormalities and increased electrical vulnerability of the hypertrophic myocardium. However, arrhythmia occurrence is often facilitated and aggravated by the interaction of hypertensive heart disease with electrolyte disturbances, with the sympathoadrenergic system and, by this, with transient blood pressure crisis, but especially the occurrence of transient episodes of myocardial ischemia seem to carry a particularly high risk of fatal proarrhythmia. Myocardial ischemia in the setting of hypertensive heart disease may result from stenotic lesions in large and/or small coronary artery vessels, and in the absence of both, myocardial hypertrophy itself often causes insufficient cellular oxygen supply and consumption. Recent studies have shown that acute and transient myocardial ischemia are common in many hypertensives, often fail to be symptomatic, and that the dynamic interaction of left ventricular hypertrophy, transient myocardial ischemia, and ventricular tachyarrhythmias provide a crucial link for the high incidence of sudden cardiac death in patients with hypertensive heart disease.