Hypertrophic Cardiomyopathy - Cardiology - Lecture Slides, Slides of Cardiology

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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
• ↑ with decreased preload, decreased afterload, or increased contractility.
• Venturi effect: anterior mitral valve leaflets & chordae sucked into outflow tract → ↑ 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 ↓ 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 ―a‖ wave
• Rapid upstroke carotid pulse, ―jerky‖ bifid (spike- and-dome pulse)
• Harsh systolic ejection murmur across entire precordium → apex & heart base
• MR: separate murmur: severity of MR related to degree of outflow obstruction

EKG: