USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

Which condition is commonly associated with Eccentric LVH?

1. Congenital heart defects

2. Hypertrophic cardiomyopathy

3. Left ventricular hypertrophy (LVH)

4. Myocarditis

The correct answer is: Congenital heart defects

Eccentric left ventricular hypertrophy (LVH) is characterized by an increase in myocardial wall stress often due to volume overload, which can lead to the hypertrophy of the left ventricle. This remodeling occurs in conditions where the heart is subjected to increased blood volume, such as in valvular diseases (like aortic regurgitation), chronic hypertension leading to a high-output state, or myocardial ischemia where the heart adapts to maintain output. Congenital heart defects, especially those involving shunts such as ventricular septal defect (VSD) or atrioventricular septal defects, lead to increased blood volume returning to the left ventricle. This increased volume often results in eccentric hypertrophy as the ventricle can expand to accommodate this additional volume. The heart remodels by dilating and thickening the ventricular walls to handle the increased preload efficiently. In contrast, hypertrophic cardiomyopathy generally leads to concentric LVH due to pressure overload and does not typically present with an eccentric pattern. Myocarditis may lead to various forms of left ventricular changes, but it is less specifically associated with a consistent pattern like eccentric LVH. Recognizing the characteristic patterns of LVH associated with different conditions is key for understanding