Can hypertension cause dilated cardiomyopathy?

Question

Hello doctor,

I am a 30-year-old obese female with no known medical history presented to the emergency room with a 2-month history of shortness of breath and pedal edema. Upon arrival, I was found to be in hypertensive emergency, with blood pressures of 190/110 mmHg. I was given Lasix in the ER, and my blood pressure responded well. A CT angiogram of the chest and a chest X-ray revealed mild pericardial and bilateral pleural effusions. My BNP was elevated at 1000 pg/mL. An echocardiogram showed an LVEF of 20 to 25 percent with severe concentric left ventricular hypertrophy (LVH) and dilated cardiomyopathy.

Given my age, they performed an extensive workup for hypertension and heart failure, including tests for lupus, rheumatoid arthritis, viral antibodies (including echovirus and adenovirus), bilateral renal artery stenosis, fibromuscular dysplasia, and pheochromocytoma. All results were negative. It seems I may have had severe diastolic dysfunction due to underlying untreated and undiagnosed hypertension.

However, my question is regarding the systolic heart failure with dilated cardiomyopathy. What explains this in my case? Can hypertension alone cause dilated cardiomyopathy? If so, would the echocardiogram show both a dilated left ventricle and severe concentric LVH? Or is it possible that I had a viral infection that led to dilated cardiomyopathy and heart failure? I realize this is a medical question and I am not providing all the details, but I would appreciate any explanation you can offer.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

You have hypertension, which may cause concentric left ventricular hypertrophy (LVH). Your ejection fraction (EF) is 20 to 25 percent, and you have both pericardial and bilateral pleural effusions. It is important to evaluate the causes of these effusions, both cardiac and pleural, and to exclude tuberculosis and underlying hypoproteinemia. You may consider performing a TB PCR (tuberculous PCR) and liver function tests (LFTs). With control of your hypertension and treatment of the effusions, both cardiac and pleural, your ejection fraction should improve. Dilated cardiomyopathy is less likely.

I hope this helps you.

Thank you.