Hypertrophic Cardiomyopathy

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Hypertrophic Cardiomyopathy

  1. 1. Hypertrophic cardiomyopathy with mid-cavity obstruction and apical aneurysm
  2. 2. <ul><li>56 yo AAM with PMH of HTN who presented to Washington Hospital Center after an abnormal stress test. </li></ul>
  3. 3. History of Present Illness <ul><li>Patient’s medical history begins in 1999 when he presented to Southern Maryland with nausea and vomiting. </li></ul><ul><ul><li>Patient underwent a full cardiac workup including an echocardiogram that was significant for LVH and a cardiac catheterization that was reportedly normal. </li></ul></ul><ul><ul><li>He was discharged with a diagnosis of vertigo. </li></ul></ul>
  4. 4. History of Present Illness <ul><li>For the next eleven years the patient was followed by a private cardiologist. </li></ul><ul><ul><li>He reports that he underwent yearly echocardiograms during this time period. </li></ul></ul><ul><ul><li>Upon questioning, the patient denies chest pain, but does report feeling occasionally lightheaded. </li></ul></ul><ul><li>This year his private cardiologist passed away and a new cardiologist that took over his care. </li></ul><ul><ul><li>On an initial visit his ekg was found to be abnormal. This prompted a stress test. </li></ul></ul>
  5. 5. History of Present Illness <ul><li>During the exercise stress test the patient developed VT. On the stress test, the patient was able to exercise for 8 min and reached a max HR 142 bpm. Nuclear images found a fixed apical wall defect w/ small inferior wall ischemia. Patient was found to have a dyskinetic apex consistent with aneurysm. </li></ul>
  6. 6. History of Present Illness <ul><li>Patient had echo was found to have LVEF 68% with an apical aneurysm. </li></ul>
  7. 7. History <ul><li>PMH: as above </li></ul><ul><li>Medications: Verapamil 240 mg daily, Atenolol 100 mg daily, ASA 81, Nexium </li></ul><ul><li>Family History: Brother CAD, Mother CAD with defibrillator </li></ul><ul><li>Social History: +smoker (quit 3 weeks prior to current admission), social drinker, works as chemical engineer </li></ul>
  8. 8. Admission Exam and Labs <ul><li>Physical Exam </li></ul><ul><li>Gen: pleasant, NAD </li></ul><ul><li>36.9 118/77 56 18 98% RA </li></ul><ul><li>HEENT: MMM </li></ul><ul><li>Neck: -JVD </li></ul><ul><li>Chest: RRR –m, -g </li></ul><ul><li>Lungs: CTAB </li></ul><ul><li>Abd: soft </li></ul><ul><li>Ext: edema </li></ul><ul><li>Labs: </li></ul><ul><li>104 15 </li></ul><ul><li>3.6 24 1.6 </li></ul>109 6.6 13.2 39.2 220

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