Clinical VignetteQuestion 1 of 23
Thick & Strong
A 68-year-old man comes to the office because of a 6-month history of progressive shortness of breath when climbing stairs and occasional chest tightness with exertion that resolves with rest. He denies orthopnea or paroxysmal nocturnal dyspnea. He has a history of hypertension treated with amlodipine. His temperature is 37.0°C (98.6°F), pulse is 76/min, respirations are 14/min, and blood pressure is 135/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Cardiac examination shows a harsh, crescendo-decrescendo systolic murmur best heard at the right upper sternal border that radiates to the carotids. The carotid upstrokes are delayed bilaterally. Point of maximal impulse is nondisplaced. Lungs are clear to auscultation. There is no peripheral edema. Transthoracic echocardiography shows a thickened, calcified aortic valve with reduced opening. The aortic valve area is 0.8 cm² and the mean transvalvular gradient is 45 mm Hg. Left ventricular wall thickness is 1.4 cm with an end-diastolic chamber dimension of 5.0 cm. Left ventricular ejection fraction is 65% and left ventricular end-diastolic pressure is 12 mm Hg.
Which of the following processes best explains the observed left ventricular wall changes in this patient?