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In response to an increased workload due to physiological or pathological stimuli, the heart may undergo a process of growth with increased muscle mass, the cardiac hypertrophy, in which the increase in weight is greater than 95% of the normal limit in relation to body weight and sex (1). The estimated prevalence of left ventricular hypertrophy in the population is around 16% (2). Cardiac hypertrophy is a unique mechanism of long term compensation used by the heart to adapt permanently to a greater workload. This may be due to a pressure overload (like in hypertensive patients and in people who practice power sports, such as weight lifting) or to a volume overload (like in endurance sports such as cycling, marathon, swimming or in the case of heart valve insufficiency) (3). Although representing a compensation mechanism, several studies showed that cardiac hypertrophy increases the cardiovascular morbidity and mortality (4,5). In early stage, it can maintain adequate cardiac function, but after a variable period of time may evolve to contractile dysfunction and heart failure (3). In fact, the peculiar and unusual structural, molecular and metabolic features of hypertrophic heart, that in the initial phase allow an increase of cardiac function, over a certain limit decrease the contractile efficiency and cause the evolution of hypertrophy in heart failure (6). The latter represents an important cause of death, presenting an annual mortality rate ranging between 10% and 20% depending on its severity, reaching 30-40% at one year after the onset of symptoms (7). In this paper we report a rare case of extremely high degree of concentric cardiac hypertrophy (cardiomegaly) and a detailed analysis of the pathogenic mechanisms occurring in the determination of deadly event.

Cardiac hypertrophy and heart failure: From the case to review of literature