eccentric hypertrophy question

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tomtom1287

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hey guys,

does ejection fraction increase with eccentric hypertrophy due to volume overload or does it remain the same ?
why decreased contractility and systolic failure eventually occurs in eccentric hypertrophy ?

and why does ejection fraction remain same in acute aortic regurgitation?

thank you
 
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Eccentric hypertrophy occurs due to systolic heart failure, so ejection fraction decreases. Decreased contractility occurs because the volume overload stretches out the myocyte, and this stretching eventually surpasses the ability of the Frank-Starling relationship to increase contractility. Once you've gone beyond that point on the Frank-Starling curve, contractility actually decreases, as actin/myosin interaction sites no longer efficiently overlap due to excess volume-induced stretch.

As for aortic regurg, ejection fraction is initially basically the same because, while you have a greater end-diastolic volume than normal due to the regurgitation, you also have a greater stroke volume because of the aforementioned Frank-Starling relationship. For example, let's say initially you have the textbook normal values of 120 mL EDV and 50 mL ESV for a stroke volume of 70 mL and ejection fraction of 70/120 = 58%. Now let's say you have regurgitant backflow of 20 mL; this extra 20 mL gets pumped out each stroke but also goes back into the ventricle each diastolic cycle. So now you have 140 mL EDV and 50 mL ESV for a stroke volume of 90 mL and ejection fraction of 90/140 = 64%. The ejection fraction has increased, but the important note is that the EF is still normal; problems arise whenever the EF decreases, not increases. Slight increases in EF are a compensatory response to the increased EDV, but decreasing to abnormally low EF indicates that the aortic regurgitation has resulted in volume overload and systolic failure.
 
Eccentric hypertrophy occurs due to systolic heart failure, so ejection fraction decreases. Decreased contractility occurs because the volume overload stretches out the myocyte, and this stretching eventually surpasses the ability of the Frank-Starling relationship to increase contractility. Once you've gone beyond that point on the Frank-Starling curve, contractility actually decreases, as actin/myosin interaction sites no longer efficiently overlap due to excess volume-induced stretch.

As for aortic regurg, ejection fraction is initially basically the same because, while you have a greater end-diastolic volume than normal due to the regurgitation, you also have a greater stroke volume because of the aforementioned Frank-Starling relationship. For example, let's say initially you have the textbook normal values of 120 mL EDV and 50 mL ESV for a stroke volume of 70 mL and ejection fraction of 70/120 = 58%. Now let's say you have regurgitant backflow of 20 mL; this extra 20 mL gets pumped out each stroke but also goes back into the ventricle each diastolic cycle. So now you have 140 mL EDV and 50 mL ESV for a stroke volume of 90 mL and ejection fraction of 90/140 = 64%. The ejection fraction has increased, but the important note is that the EF is still normal; problems arise whenever the EF decreases, not increases. Slight increases in EF are a compensatory response to the increased EDV, but decreasing to abnormally low EF indicates that the aortic regurgitation has resulted in volume overload and systolic failure.

Thank You. You said eccentric hypertrophy occurs due to systolic failure. Please do correct me if am wrong but i though eccentric hypertrophy occurs in any condition of volume overload as in aerobic exercise, aortic regurgitation, pregnancy etc. as a compensatory mechanism to reduce wall stress and prevent systolic failure. So eccentric hypertrophy, i thought functions to increase contractility, and increase ejection fraction but eventually somehow results in systolic failure overime
 
Thank You. You said eccentric hypertrophy occurs due to systolic failure. Please do correct me if am wrong but i though eccentric hypertrophy occurs in any condition of volume overload as in aerobic exercise, aortic regurgitation, pregnancy etc. as a compensatory mechanism to reduce wall stress and prevent systolic failure. So eccentric hypertrophy, i thought functions to increase contractility, and increase ejection fraction but eventually somehow results in systolic failure overime

Yeah my bad, I misphrased my first sentence a little bit. Eccentric hypertrophy initially does serve as a compensatory mechanism; the whole stretching the myocytes to increase actin/myosin overlap and thus increase contractility thing, once again. Over time, too much further myocyte stretching eventually overcomes the ability of the Frank-Starling relationship. Basically it keeps compensating and compensating (assuming the volume overload persists over a long term; this is not the case in aerobic exercise, pregnancy obviously), until eventually further compensation actually leads to negative effects.
 
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