Cardiac hypertrophy can be either physiological (beneficial, adaptive) or pathological (detrimental, maladaptive), with distinct cellular and molecular characteristics.

The heart, being a muscular organ, also undergoes hypertrophy in response to increased workload. Physiological cardiac hypertrophy, often seen in endurance athletes (known as 'athlete's heart'), is a beneficial adaptation. It involves a proportional enlargement of all four chambers of the heart, accompanied by increased vascularization (blood supply) and efficient energy metabolism, leading to enhanced cardiac function and performance. In stark contrast, pathological cardiac hypertrophy, often triggered by chronic hypertension or valvular disease, is a maladaptive response. This form of hypertrophy is characterized by disorganized growth, fibrosis (scarring), reduced capillary density, and altered gene expression, ultimately leading to impaired diastolic and systolic function, heart failure, arrhythmias, and increased risk of sudden death. Differentiating between these two forms is crucial for diagnosis and treatment.