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

Which of the following is NOT a common cause of Eccentric LVH?

1. Coronary artery disease

2. Hyperthyroidism

3. Pulmonary embolism

4. Systemic lupus erythematosus (SLE)

The correct answer is: Coronary artery disease

Eccentric left ventricular hypertrophy (LVH) is primarily related to volume overload conditions where the heart muscle increases in size due to sustained periods of abnormally high blood volume in the left ventricle. The heart adapts to this overload by remodeling, which leads to the eccentric pattern of hypertrophy. Coronary artery disease typically causes concentric LVH due to pressure overload from conditions such as hypertension or aortic stenosis, not volume overload. It leads to thickening of the ventricular walls rather than dilation, which contrasts with the adaptive mechanism seen in eccentric LVH. Hyperthyroidism is known to cause an increase in heart rate, and this high-output state can lead to dilation of the heart chambers, resulting in eccentric LVH. The increased metabolic demand caused by thyroid hormone excess forces the heart to adapt to adequately fill and pump a greater volume of blood. Pulmonary embolism can lead to right-sided heart strain and subsequently increased pressures in the right ventricle, but it may also cause secondary changes to the left side due to altered hemodynamics, potentially contributing to eccentric remodeling. Systemic lupus erythematosus (SLE), an autoimmune disorder, can lead to various cardiac complications, including pericarditis and