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Hypertrophic Cardiomyopathy - Cardiology - Lecture Slides, Slides of Cardiology

Cardiology is branch of Biology. Its all about heart. Why it beat fast at different occasions? What can be caused to stop its working? How to do ECG? When bypass is due? ECG, valvular, ventricular spetal defect, atria, blood pressure are main topics here. This lecture is about: Hypertrophic, Cardiomyopathy, Who, Diagnosis, Stimulus, Abnormality, Variants

Typology: Slides

2011/2012

Uploaded on 10/19/2012

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Hypertrophic Cardiomyopathy
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Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy

Differential Diagnosis:

HCM

  • Can be asymmetric
  • Wall thickness: > 15 mm
  • LA: > 40 mm
  • LVEDD : < 45 mm
  • Diastolic function: always abnormal

Athletic heart

  • Concentric & regresses
  • < 15 mm
  • < 40 mm
  • 45 mm

  • Normal

Stimulus:

  • Unknown
  • Disorder of intracellular calcium metabolism
  • Neural crest disorder
  • Papillary muscle malpositioned and misoriented

Variants of HCM:

Most common location: subaortic , septal, and ant. wall.

  • Asymmetric hypertrophy (septum and ant. wall): 70 %.
  • Basal septal hypertrophy: 15- 20 %.
  • Concentric LVH: 8-10 %.
  • Apical or lateral wall: < 2 % (25 % in Japan/Asia): characteristic giant T-wave inversion laterally & spade- like left ventricular cavity: more benign.

Pathophysiology of HCM

  • Dynamic LV outflow tract obstruction
  • Diastolic dysfunction
  • Myocardial ischemia
  • Mitral regurgitation
  • Arrhythmias
  • Left ventricular outflow tract gradient
  • โ†‘ with decreased preload, decreased afterload, or increased contractility.
  • Venturi effect: anterior mitral valve leaflets & chordae sucked into outflow tract โ†’ โ†‘ obstruction, eccentric jet of MR in mid- late systole.

Arrhythmias:

  • Sustained V-Tach and V-Fib: most likely mechanism of syncope/ sudden death.
  • Dependant on atrial kick: CO โ†“ by 40 % if A. Fib present.

Clinical presentation:

  • Any age
  • Leading cause of sudden death in competitive athletes
  • Triad: DOE, angina, presyncope/syncope.

Physical exam:

  • Apex localized, sustained
  • Palpable S
  • Tripple ripple
  • Prominent โ€•aโ€– wave
  • Rapid upstroke carotid pulse, โ€•jerkyโ€– bifid (spike- and-dome pulse)
  • Harsh systolic ejection murmur across entire precordium โ†’ apex & heart base
  • MR: separate murmur: severity of MR related to degree of outflow obstruction

EKG: