This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
This document contains information about hypertrophic obstructive cardiomyopathy (HOCM). It begins with an overview of HOCM, defining it as a genetic heart condition characterized by asymmetric left ventricular hypertrophy. It then discusses the pathophysiology of HOCM, focusing on left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation due to systolic anterior motion of the mitral valve. The document outlines clinical manifestations such as symptoms, physical exam findings, ECG and echocardiographic features, and complications. It concludes by covering treatment options for HOCM including medications, surgical septal myectomy via transaortic or transapical approaches, and other procedures like alcohol septal
Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease characterized by increased and thickened heart muscle. It is the most common cause of sudden cardiac death in young people. HCM can cause symptoms such as chest pain, heart failure, and palpitations. Treatment involves managing left ventricular outflow tract obstruction through medications, septal reduction procedures, or alcohol septal ablation. Patients at high risk for sudden cardiac death may receive an implantable cardioverter defibrillator for prevention. Risk factors include a family history of sudden death, abnormal blood pressure response to exercise, and extensive thickening of the heart muscle.
A review of Hypertrophic cardiomyopathy. Ideal for Cardiology Fellows and Internal Medicine Residents. Draws figures and information from review articles published on the subject as well as classical teaching books.
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM)Kurian Joseph
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by excessive thickening of the heart muscle. It was initially described in the 1950s and causes significant morbidity and mortality due to heart failure, arrhythmias, and sudden cardiac death. The pathophysiology involves left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation. Treatment involves medications, septal reduction procedures like myectomy or alcohol ablation, and implantable cardioverter-defibrillators in high-risk patients. Prognosis depends on symptom severity and risk factors for sudden cardiac death.
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
Echo Differentiation of Restrictive Cardiomyopathy and Constrictive PericarditisJunhao Koh
1. The document compares and contrasts constrictive cardiomyopathy (CP) and restrictive cardiomyopathy (RCMP), discussing their definitions, etiologies, pathophysiology, and echocardiographic findings.
2. Key differences include CP presenting with thickened pericardium while RCMP presents with stiff myocardium. CP shows ventricular interdependence and respiratory variation on echo, while RCMP shows restrictive physiology from diastolic dysfunction.
3. Optimizing the echo exam is important for evaluating CP, including adjusting the respirometer waveform, Doppler sweep speed, and positions like upright to increase respiratory variation. Hepatic vein and SVC Doppler also help differentiate the conditions.
This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
This document contains information about hypertrophic obstructive cardiomyopathy (HOCM). It begins with an overview of HOCM, defining it as a genetic heart condition characterized by asymmetric left ventricular hypertrophy. It then discusses the pathophysiology of HOCM, focusing on left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation due to systolic anterior motion of the mitral valve. The document outlines clinical manifestations such as symptoms, physical exam findings, ECG and echocardiographic features, and complications. It concludes by covering treatment options for HOCM including medications, surgical septal myectomy via transaortic or transapical approaches, and other procedures like alcohol septal
Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease characterized by increased and thickened heart muscle. It is the most common cause of sudden cardiac death in young people. HCM can cause symptoms such as chest pain, heart failure, and palpitations. Treatment involves managing left ventricular outflow tract obstruction through medications, septal reduction procedures, or alcohol septal ablation. Patients at high risk for sudden cardiac death may receive an implantable cardioverter defibrillator for prevention. Risk factors include a family history of sudden death, abnormal blood pressure response to exercise, and extensive thickening of the heart muscle.
A review of Hypertrophic cardiomyopathy. Ideal for Cardiology Fellows and Internal Medicine Residents. Draws figures and information from review articles published on the subject as well as classical teaching books.
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM)Kurian Joseph
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by excessive thickening of the heart muscle. It was initially described in the 1950s and causes significant morbidity and mortality due to heart failure, arrhythmias, and sudden cardiac death. The pathophysiology involves left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation. Treatment involves medications, septal reduction procedures like myectomy or alcohol ablation, and implantable cardioverter-defibrillators in high-risk patients. Prognosis depends on symptom severity and risk factors for sudden cardiac death.
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
Echo Differentiation of Restrictive Cardiomyopathy and Constrictive PericarditisJunhao Koh
1. The document compares and contrasts constrictive cardiomyopathy (CP) and restrictive cardiomyopathy (RCMP), discussing their definitions, etiologies, pathophysiology, and echocardiographic findings.
2. Key differences include CP presenting with thickened pericardium while RCMP presents with stiff myocardium. CP shows ventricular interdependence and respiratory variation on echo, while RCMP shows restrictive physiology from diastolic dysfunction.
3. Optimizing the echo exam is important for evaluating CP, including adjusting the respirometer waveform, Doppler sweep speed, and positions like upright to increase respiratory variation. Hepatic vein and SVC Doppler also help differentiate the conditions.
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
This document summarizes hypertrophic cardiomyopathy (HCM), an autosomal dominant genetic heart condition characterized by unexplained left ventricular hypertrophy. Key points include that it has a prevalence of 1 in 500 adults and is caused by over 200 mutations in genes involved in heart muscle proteins. Symptoms range from none to heart failure, arrhythmias, and sudden cardiac death. Diagnosis is typically made by echocardiogram showing left ventricular hypertrophy. Treatment involves managing symptoms and reducing risk of complications like sudden cardiac death.
This document discusses ECG patterns in congenital heart disease. It begins by outlining the significance of ECG in diagnosing congenital heart defects. It then provides an overview of normal ECG changes in children and how they evolve over time as hemodynamics change. Next, it describes how ECG can help identify situs and ventricular position. It then discusses the characteristic ECG patterns seen in common acyanotic defects like atrial septal defects and ventricular septal defects. It also covers cyanotic defects like transposition of the great arteries. The document provides detailed information on ECG features, associated conditions, complications and evolution over time for many different congenital heart defects.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
This document provides an overview of echocardiographic evaluation of restrictive cardiomyopathy. Key points include:
- Restrictive cardiomyopathy is characterized by a nondilated left ventricle with abnormal diastolic function and typically normal systolic function.
- Causes include infiltrative diseases like amyloidosis and storage diseases. Echocardiography can help diagnose but it is more difficult than other cardiomyopathies.
- Findings include low diastolic volume, normal ejection fraction, diastolic dysfunction with rapid early mitral inflow. Echocardiography helps differentiate restrictive cardiomyopathy from constrictive pericarditis.
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
Hypertrophic cardiomyopathy is a genetic heart condition characterized by thickened heart muscle and potential outflow tract obstruction. It affects 0.2-0.5% of the population and is caused by mutations in genes encoding sarcomere proteins. Symptoms include chest pain, dizziness, and palpitations. Diagnosis is made via echocardiogram and genetic testing. Treatment focuses on symptom relief through medications or procedures to reduce outflow tract obstruction, as well as preventing sudden cardiac death through ICD implantation in high-risk patients.
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
This document provides an overview of echocardiography in pericardial diseases. It begins with an introduction to pericardial anatomy and pathophysiology. It then discusses various pericardial diseases that can be evaluated by echocardiography, including acute pericarditis, recurrent pericarditis, pericardial effusions, cardiac tamponade, and constrictive pericarditis. For each condition, it describes the echocardiographic findings and techniques used to evaluate the condition. It emphasizes that echocardiography is usually the initial imaging test of choice but that CT or CMR may be needed in some complex cases.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
This document discusses various echocardiographic scoring systems used to assess mitral valve anatomy and predict outcomes of percutaneous balloon mitral valvuloplasty (PBMV). The Wilkins score and Commissural Calcification score are described in detail. The Wilkins score grades leaflet thickening, mobility, calcification and subvalvular involvement on a scale of 4-16. A score ≤8 indicates favorable anatomy for PBMV. The Commissural Calcification score quantifies calcification at each commissure. Other discussed scores include the Cormier score, RT-3DE score, Chen score, Reid score and Nobuyoshi score. Limitations of the scoring systems and ideas for an ideal future scoring
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
This document discusses the echocardiographic evaluation of mitral valve prolapse (MVP). It describes the use of M-mode, 2D, and 3D echocardiography to diagnose MVP and assess mitral regurgitation severity. Measurement of the vena contracta and use of the proximal isovelocity surface area method are emphasized for accurate regurgitant quantification. Surgical indications and repair techniques are also summarized.
A 52-year-old male presented with chest pain. His ECG showed evolving inferior wall myocardial infarction. ST depression is more frequently seen in lead aVL than other leads for inferior MI. A 51-year-old female presented with prior chest pain and is now pain-free. Her ECG shows Wellens' syndrome type I pattern and she should be monitored closely in the ICCU. Fragmented QRS complexes can indicate ischemia or scar tissue and are associated with worse cardiac outcomes.
Hypertrophic cardiomyopathy (HCM) is a disease where the heart muscle becomes abnormally thickened, making it harder for the heart to pump blood. It is usually inherited and symptoms can include chest pain, shortness of breath, fainting, and palpitations. The condition makes individuals prone to arrhythmias and heart failure. While medications and procedures like implantable defibrillators can help treatment, individuals with a family history of sudden cardiac death are at highest risk of complications from HCM.
Valvular heart disease refers to abnormalities of the heart valves that result in obstruction of blood flow or backflow of blood. Echocardiography plays a key role in evaluating valve function and structure non-invasively. Common valvular abnormalities include aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Treatment depends on severity and symptoms, ranging from medical management to surgical repair or replacement of the affected valve.
Valvular heart disease refers to disorders that affect one of the heart's valves, causing stenosis (narrowing) or regurgitation (leakage). The major types are aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, and tricuspid regurgitation. Symptoms depend on the specific valve affected and include shortness of breath, chest pain, fatigue, and heart failure. Diagnosis involves listening for murmurs, ECGs, echocardiograms, and cardiac catheterization. Treatment ranges from medication and lifestyle changes to surgery depending on severity, with valve replacement or repair being done for severe cases.
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
This document summarizes hypertrophic cardiomyopathy (HCM), an autosomal dominant genetic heart condition characterized by unexplained left ventricular hypertrophy. Key points include that it has a prevalence of 1 in 500 adults and is caused by over 200 mutations in genes involved in heart muscle proteins. Symptoms range from none to heart failure, arrhythmias, and sudden cardiac death. Diagnosis is typically made by echocardiogram showing left ventricular hypertrophy. Treatment involves managing symptoms and reducing risk of complications like sudden cardiac death.
This document discusses ECG patterns in congenital heart disease. It begins by outlining the significance of ECG in diagnosing congenital heart defects. It then provides an overview of normal ECG changes in children and how they evolve over time as hemodynamics change. Next, it describes how ECG can help identify situs and ventricular position. It then discusses the characteristic ECG patterns seen in common acyanotic defects like atrial septal defects and ventricular septal defects. It also covers cyanotic defects like transposition of the great arteries. The document provides detailed information on ECG features, associated conditions, complications and evolution over time for many different congenital heart defects.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
This document provides an overview of echocardiographic evaluation of restrictive cardiomyopathy. Key points include:
- Restrictive cardiomyopathy is characterized by a nondilated left ventricle with abnormal diastolic function and typically normal systolic function.
- Causes include infiltrative diseases like amyloidosis and storage diseases. Echocardiography can help diagnose but it is more difficult than other cardiomyopathies.
- Findings include low diastolic volume, normal ejection fraction, diastolic dysfunction with rapid early mitral inflow. Echocardiography helps differentiate restrictive cardiomyopathy from constrictive pericarditis.
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
Hypertrophic cardiomyopathy is a genetic heart condition characterized by thickened heart muscle and potential outflow tract obstruction. It affects 0.2-0.5% of the population and is caused by mutations in genes encoding sarcomere proteins. Symptoms include chest pain, dizziness, and palpitations. Diagnosis is made via echocardiogram and genetic testing. Treatment focuses on symptom relief through medications or procedures to reduce outflow tract obstruction, as well as preventing sudden cardiac death through ICD implantation in high-risk patients.
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
This document provides an overview of echocardiography in pericardial diseases. It begins with an introduction to pericardial anatomy and pathophysiology. It then discusses various pericardial diseases that can be evaluated by echocardiography, including acute pericarditis, recurrent pericarditis, pericardial effusions, cardiac tamponade, and constrictive pericarditis. For each condition, it describes the echocardiographic findings and techniques used to evaluate the condition. It emphasizes that echocardiography is usually the initial imaging test of choice but that CT or CMR may be needed in some complex cases.
This document provides an overview of segmental analysis for congenital heart disease. It discusses the key segments that are analyzed which include thoraco-abdominal situs, pulmonary situs, atrial situs, ventricular situs and looping, connections between segments (venous, atrioventricular, ventriculoarterial), and abnormalities that can occur in each segment. The document emphasizes evaluating each segment in a systematic, sequential manner to identify abnormalities.
This document discusses various echocardiographic scoring systems used to assess mitral valve anatomy and predict outcomes of percutaneous balloon mitral valvuloplasty (PBMV). The Wilkins score and Commissural Calcification score are described in detail. The Wilkins score grades leaflet thickening, mobility, calcification and subvalvular involvement on a scale of 4-16. A score ≤8 indicates favorable anatomy for PBMV. The Commissural Calcification score quantifies calcification at each commissure. Other discussed scores include the Cormier score, RT-3DE score, Chen score, Reid score and Nobuyoshi score. Limitations of the scoring systems and ideas for an ideal future scoring
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
This document discusses the echocardiographic evaluation of mitral valve prolapse (MVP). It describes the use of M-mode, 2D, and 3D echocardiography to diagnose MVP and assess mitral regurgitation severity. Measurement of the vena contracta and use of the proximal isovelocity surface area method are emphasized for accurate regurgitant quantification. Surgical indications and repair techniques are also summarized.
A 52-year-old male presented with chest pain. His ECG showed evolving inferior wall myocardial infarction. ST depression is more frequently seen in lead aVL than other leads for inferior MI. A 51-year-old female presented with prior chest pain and is now pain-free. Her ECG shows Wellens' syndrome type I pattern and she should be monitored closely in the ICCU. Fragmented QRS complexes can indicate ischemia or scar tissue and are associated with worse cardiac outcomes.
Hypertrophic cardiomyopathy (HCM) is a disease where the heart muscle becomes abnormally thickened, making it harder for the heart to pump blood. It is usually inherited and symptoms can include chest pain, shortness of breath, fainting, and palpitations. The condition makes individuals prone to arrhythmias and heart failure. While medications and procedures like implantable defibrillators can help treatment, individuals with a family history of sudden cardiac death are at highest risk of complications from HCM.
Valvular heart disease refers to abnormalities of the heart valves that result in obstruction of blood flow or backflow of blood. Echocardiography plays a key role in evaluating valve function and structure non-invasively. Common valvular abnormalities include aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Treatment depends on severity and symptoms, ranging from medical management to surgical repair or replacement of the affected valve.
Valvular heart disease refers to disorders that affect one of the heart's valves, causing stenosis (narrowing) or regurgitation (leakage). The major types are aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, and tricuspid regurgitation. Symptoms depend on the specific valve affected and include shortness of breath, chest pain, fatigue, and heart failure. Diagnosis involves listening for murmurs, ECGs, echocardiograms, and cardiac catheterization. Treatment ranges from medication and lifestyle changes to surgery depending on severity, with valve replacement or repair being done for severe cases.
The document provides an overview of cardiomyopathies including definitions, classifications, presentations, evaluations, and treatments. It discusses the main types - dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. For dilated cardiomyopathy, it describes the etiologies, clinical features, investigations, and treatments. It notes dilated cardiomyopathy is the most common cardiomyopathic phenotype and often a final common pathway of cardiac injuries. For hypertrophic cardiomyopathy, it discusses the pathophysiology, clinical manifestations, investigations, and treatments including the use of beta-blockers and surgical procedures. For restrictive cardiomyopathy, it lists possible causes and notes the hallmark is abnormal diastolic function with excessive ventricular wall rig
Cardiomyopathy refers to diseases of the heart muscle that are not caused by coronary artery disease, hypertension, or congenital heart defects. The main types are dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is characterized by decreased contractility and ventricular dilation, while hypertrophic cardiomyopathy involves ventricular hypertrophy with impaired diastolic function. Restrictive cardiomyopathy restricts diastolic filling. Management involves medications to reduce symptoms and progression such as ACE inhibitors, beta blockers, diuretics, and device therapy for refractory cases.
This document discusses heart failure, providing definitions, epidemiology, classifications, etiologies, pathophysiology, clinical manifestations, diagnosis, differential diagnosis, and treatment. Heart failure is defined as a clinical syndrome resulting from structural or functional impairment of ventricular filling or ejection of blood. Approximately 2% of developed countries have heart failure, with risk increasing with age. Coronary artery disease is the leading cause. Heart failure can be classified as systolic or diastolic, high-output or low-output, acute or chronic, and right-sided or left-sided. Common causes include coronary artery disease, hypertension, cardiomyopathy, and valvular disease. Treatment involves removing precipitating causes, correcting underlying causes, preventing cardiac
Cardiomyopathies are diseases of the heart muscle that are classified based on etiology and functional characteristics. The main types are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular dysplasia. Symptoms vary depending on the type but often include heart failure symptoms like shortness of breath. Treatment focuses on managing underlying causes, controlling symptoms, preventing worsening of the disease, and reducing complications through medications, lifestyle changes, and procedures.
A 54-year-old male presented to the emergency department with a 4-day history of irregular heart rhythms but no chest pain. He reported a 1-month history of shortness of breath, fatigue, and leg swelling. The document provides detailed information on various types of cardiomyopathies including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. It discusses their etiologies, pathophysiology, clinical manifestations, diagnostic evaluation, and management. The management may include medications, procedures like device implantation, and even heart transplantation in severe cases.
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
This document discusses various types of arrhythmias and heart conditions including their causes, characteristics, and clinical presentations. It covers topics such as:
- Arrhythmias which can be initiated anywhere in the heart's conduction system and may present as tachycardia, bradycardia, or other irregular rhythms.
- Hypertension can lead to hypertensive heart disease over time due to increased pressure on the heart.
- Valvular heart diseases like rheumatic heart disease and degenerative valve diseases can cause stenosis or insufficiency of the heart valves.
- Infective endocarditis is a bacterial infection of the heart valves that forms vegetations and can cause embol
The document discusses the anatomy and physiology of the pericardium and various pericardial diseases. It describes the pericardium's functions in maintaining cardiac structure and output. It then covers acute pericarditis and its symptoms of chest pain, pericardial friction rub, and ECG changes. Pericardial effusion and its causes are discussed along with cardiac tamponade, which results from excessive fluid accumulation compressing the heart. Diagnosis involves echocardiography and treatment involves drainage of excessive fluid in tamponade.
This document discusses various types of valvular heart disease, including stenosis (narrowing of the valves), regurgitation (backward flow of blood through valves), aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency. It describes the causes, pathophysiology, clinical manifestations, diagnosis, and treatment of each condition. Valvular diseases are generally asymptomatic for years initially but can progress to cause heart failure if left untreated. Diagnosis is typically via echocardiogram and treatment involves lifestyle changes, medications, or valve repair/replacement surgery depending on severity.
This document provides an overview of pericardial diseases. It begins with the anatomy and functions of the pericardium. It then discusses various pericardial diseases like acute pericarditis, pericardial effusion, and cardiac tamponade. For acute pericarditis, it describes the key symptoms of chest pain, pericardial friction rub, and ECG changes. It also outlines the diagnostic criteria and treatment approaches for pericardial effusion and cardiac tamponade, including the use of echocardiography, medications, and pericardiocentesis.
Cardiomyopathy is a primary disorder of the heart muscle that weakens the heart's ability to pump blood. There are four main types - dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular dysplasia. Symptoms are generally similar between types and include fatigue, shortness of breath, chest pain, and swelling. Diagnosis involves tests like echocardiograms, MRI, and blood tests. Prognosis and treatment depend on the specific type but may include medications, implanted devices, or transplantation.
Cardiomyopathy refers to diseases of the heart muscle that weaken the heart's ability to pump blood. Dilated cardiomyopathy is characterized by the enlargement and weakening of the heart's main pumping chamber, the left ventricle. The major causes of dilated cardiomyopathy include infections, toxins, inherited conditions, and unknown causes. Symptoms include heart failure and arrhythmias. Diagnosis involves echocardiography and treatments focus on managing symptoms through medications, devices, and transplantation if needed.
Cardiac myopathy is a heart-related disorder. many types are there in cardiomyopathy .4 types of CMP is hypertrophic CMP, dilated CMP, restrictive CMP, stress CMP. causes of this are node related problem,ischemic condion of the heart .symptoms to this is chest pain breathlessness, edema like cardiacfailure will happen at last . manage mesvn t like betablockers , ace inhibitors doamine .dobutamine, and diuretics should be given to the patient .surgical manage meant is septal ablation, and heart transplantation should be given to the patient
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as marked thickening of the left ventricle not caused by other conditions like hypertension. HCM can cause chest pain and shortness of breath due to obstructed blood flow. Diagnosis is made via echocardiogram showing thickened walls. Treatment focuses on symptom management with medications and potentially surgery. Implantable cardioverter-defibrillators are recommended for high-risk patients to prevent sudden cardiac death from arrhythmias. The document reviews genetic causes, clinical presentation, diagnostic tests and surgical/medical management options for HCM in detail over multiple sections.
This document discusses coarctation of the aorta, a congenital heart defect where the aorta is narrowed or constricted. It accounts for 5-8% of congenital heart defects. Coarctation can occur isolated or with other defects like bicuspid aortic valve or ventricular septal defect. Clinical presentation depends on age - infants may present with heart failure while older children and adults often present with hypertension. Imaging like chest x-ray and echocardiogram are used for diagnosis. Treatment involves surgery to repair the coarctation.
Cardiomyopathies are disorders of the heart muscle that cause cardiac dysfunction. The main types are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular dysplasia. Dilated cardiomyopathy is characterized by enlarged ventricles and reduced systolic function, while hypertrophic cardiomyopathy shows thickened heart walls and diastolic dysfunction. Restrictive cardiomyopathy causes impaired ventricular filling due to a stiff ventricle. Arrhythmias include tachycardias like atrial fibrillation and SVT, as well as bradycardias. Treatment focuses on symptom relief through rate or rhythm control methods and reducing thromboembolism risk with anticoagulation.
This document provides information about cardiomyopathy and dilated cardiomyopathy (DCM) specifically. It begins by classifying the main types of cardiomyopathy and then focuses on DCM. It describes DCM as the most common type, usually causing enlargement and spherical shaping of the heart ventricles. Diagnosis involves imaging like echocardiograms and treatment focuses on managing symptoms like with medications, devices, or transplant if needed. The document provides details on the pathophysiology, clinical presentation, diagnosis, and management of DCM.
This document discusses drug-induced thyroid problems. It notes that certain drugs can interfere with thyroid hormone metabolism and cause hypothyroidism or hyperthyroidism. Some common causes of drug-induced thyroid issues mentioned are amiodarone, interferon, lithium, and iodine. The document provides details on how specific drugs like amiodarone, lithium, and iodine can impact thyroid function. It also discusses drug-induced hypothyroidism, hyperthyroidism, and thyroiditis. Guidelines for testing and monitoring patients taking drugs that may affect the thyroid are presented.
An intracerebral hemorrhage occurs when a blood vessel ruptures within the brain tissue, causing blood to accumulate and form a hematoma. The most common causes are hypertension, brain aneurysms, and head trauma. Symptoms include sudden severe headache, vomiting, weakness, and loss of consciousness. Diagnosis is typically made through CT scan or MRI, which show the location and size of the hemorrhage. Treatment aims to control blood pressure, reduce swelling, and in some cases surgically remove the blood clot. Complications can include neurological deficits, seizures, and death, with mortality rates around 50% within one month.
Churg-Strauss syndrome is a disorder marked by blood vessel inflammation. This condition is also known as eosinophilic granulomatosis with polyangiitis (EGPA).
1. Vascular disease of the bowel refers to conditions that affect the blood vessels supplying the intestines, including mesenteric artery disease where plaque builds up in the abdominal arteries.
2. Mesenteric ischemia occurs when there is insufficient blood flow to the intestines, and can be acute or chronic. Acute ischemia presents with sudden severe abdominal pain while chronic ischemia causes gradual pain after eating.
3. Diagnosis involves blood tests, imaging like CT scans, and angiography. Treatment depends on the cause but may include revascularization procedures or bowel resection if tissue has died. Prompt diagnosis and treatment can help avoid poor outcomes.
Broken heart syndrome, also known as Takotsubo cardiomyopathy or stress-induced cardiomyopathy, is a condition where emotional or physical stress causes temporary weakening of the left ventricle. It affects about 1% of those experiencing a myocardial infarction and causes similar symptoms but is not caused by blocked arteries. Diagnosis involves EKG, echocardiogram, cardiac MRI and angiography showing normal arteries and left ventricular dysfunction. Treatment focuses on heart failure medicines and managing symptoms, and most patients fully recover heart function within weeks.
Pneumonia is a common illness that kills millions of people per year, especially children under 5. It can be caused by viruses, bacteria, or fungi. Vaccines are the most effective way to prevent certain types of pneumonia. Treatment involves antibiotics for bacterial pneumonia. Prevention strategies include vaccination, adequate nutrition, environmental measures like clean cooking stoves, and treating underlying illnesses.
This document discusses cardiomyopathy, a disease of the heart muscle. It defines several types of cardiomyopathy including hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular dysplasia. For each type, it describes the effects on the heart muscle and potential causes. It outlines signs and symptoms, risk factors, and diagnostic tests used to identify cardiomyopathy including echocardiograms, stress tests, and cardiac catheterization. Differential diagnoses that must be considered are also listed.
This document discusses assessing the radial pulse. It defines the radial pulse as the pulse felt in the wrist of the radial artery. Measuring the radial pulse provides information about heart rhythm and strength of contraction. The procedure for assessing radial pulse involves washing hands, positioning the wrist, feeling for the pulse with fingers, and counting beats over time. Normal radial pulse rates are between 60-100 beats per minute but can vary based on age, exercise, medications and other factors. Assessing the radial pulse provides valuable information about the cardiovascular system.
This document provides information about lumbar punctures (spinal taps), including:
- Lumbar punctures involve inserting a needle into the spinal canal to collect cerebrospinal fluid (CSF) for diagnostic testing of central nervous system diseases.
- CSF acts as a cushion and protects the brain, and tests of CSF can help diagnose conditions like meningitis, multiple sclerosis, and brain/spinal tumors.
- The procedure involves inserting a needle between vertebrae after numbing the area, collecting CSF, and analyzing samples for signs of infection, inflammation, or cancer. Risks include headaches and back pain, but it is generally safe when performed correctly.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
2. CARDIOMYOPATHY
• Cardiomyopathy is a group of diseases that affect the
heart muscle.
• Types of cardiomyopathy include hypertrophic
cardiomyopathy, dilated cardiomyopathy, restrictive
cardiomyopathy, arrhythmogenic right ventricular
dysplasia, and takotsubo cardiomyopathy (broken heart
syndrome).
3.
4. DEFINITION
• Hypertrophic cardiomyopathy (HCM) is a condition in
which a portion of the heart becomes thickened without
an obvious cause.
• This results in the heart being less able to pump blood
effectively.
7. • Hypertrophic cardiomyopathy also can affect the heart's
mitral valve, causing blood to leak backward through the
valve.
• Sometimes, the thickened heart muscle doesn't block
blood flow out of the left ventricle.
• This is referred to as non-obstructive hypertrophic
cardiomyopathy.
8. • In both obstructive and non-obstructive HCM, the
thickened muscle makes the inside of the left ventricle
smaller, so it holds less blood.
• The walls of the ventricle may stiffen, and as a result, the
ventricle is less able to relax and fill with blood.
• This can raise blood pressure in the ventricles and the
blood vessels of the lungs. Changes also occur to the
cells in the damaged heart muscle, which may disrupt the
heart's electrical signals and lead to arrhythmias.
9.
10. ETIOLOGY
• Familial hypertrophic cardiomyopathy is inherited as an
autosomal dominant trait and is attributed to mutations in
one of a number of genes that encode for the sarcomere
proteins.
• Long-term high blood pressure.
• Heart tissue damage from a heart attack.
• Chronic rapid heart rate.
• Heart valve problems.
• Metabolic disorders, such as obesity, thyroid disease or
diabetes.
11. PATHOPHYSIOLOGY
• In the most common phenotype, the anterior septum and
contiguous anterior free wall below the aortic valve are
markedly hypertrophied and thickened, with little or no
hypertrophy of the left ventricular (LV) posterior wall.
• Sometimes isolated apical hypertrophy occurs; however,
virtually any asymmetric pattern of left ventricular
hypertrophy can be observed, and in a small minority of
patients even symmetric hypertrophy has been noted.
12. • Hypertrophy results in a stiff, noncompliant chamber
(usually the left ventricle) that resists diastolic filling,
elevating end-diastolic pressure and thus increasing
pulmonary venous pressure. As resistance to filling
increases, cardiac output decreases, an effect worsened
by any outflow tract gradient present. Because
tachycardia allows less time for filling, symptoms tend to
appear mainly during exercise or tachyarrhythmias.
13. • Coronary blood flow may be impaired, causing angina
pectoris, syncope, or arrhythmias in the absence of
epicardial coronary artery disease (CAD).
• Flow may be impaired because capillary density relative
to myocyte size is inadequate (capillary/myocyte
imbalance) or lumen diameter of intramyocardial coronary
arteries is narrowed by intimal and medial hyperplasia
and hypertrophy.
14.
15. SIGNS AND SYMPTOMS
• Could be asymptomatic
• Shortness of breath
• Exertional chest pain
• Heart palpitations
• Lightheadness, fainting, weakness/ syncope
• Sudden cardiac death
• Usually the onset is between 20-40 years.
16. RISK FACTORS FOR SUDDEN DEATH
• History of cardiac arrest and ventricular fibrillation
• Ventricular tachycardia
• Family of premature sudden death
• Unexplained syncope
• Abnormal blood pressure
19. • Diagnosis is suspected based on a typical murmur and
symptoms. Suspicion is increased if the patient has a
history of unexplained syncope or a family history of
unexplained sudden death. Unexplained syncope in young
athletes should always raise suspicion. Hypertrophic
cardiomyopathy must be distinguished from aortic stenosis
and coronary artery disease, which cause similar
symptoms.
20.
21. • ECG and 2-dimensional echocardiography and/or MRI (the
best noninvasive confirmatory tests) are done.
• Chest x-ray is often done but is usually normal because
the ventricles are not dilated (although the left atrium may
be enlarged). Patients with syncope or sustained
arrhythmias should be evaluated as inpatients. Exercise
testing and 24-hour ambulatory monitoring may be helpful
for patients considered at high risk, although accurately
identifying such patients is difficult.
22. • The ECG usually shows voltage criteria for LV hypertrophy
(eg, S wave in lead V1 plus R wave in lead V5 or V6 > 35
mm).
• Very deep septal Q waves in leads I, aVL, V5, and V6 are
often present with asymmetric septal hypertrophy;
hypertrophic cardiomyopathy sometimes produces a QRS
complex in V1 and V2, simulating previous septal infarction.
T waves are usually abnormal; the most common finding is
deep symmetric T-wave inversion in leads I, aVL, V5, and
V6.
23. • ST-segment depression in the same leads is common
(particularly in the apical obliterative form). The P wave is
often broad and notched in leads II, III, and aVF, with a
biphasic P wave in leads V1 and V2, indicating left atrial
hypertrophy. Incidence of preexcitation phenomenon of
the Wolff-Parkinson-White syndrome type, which may
cause palpitations, is increased. Bundle branch block is
common.
24. Classic HCM pattern with asymmetrical septal hypertrophy
Voltage criteria for left ventricular hypertrophy.
Deep narrow Q waves < 40 ms wide in the lateral leads I, aVL and V5-6.
This ECG was taken from a 30-year old man who presented with
exertional lightheadedness and palpitations. The ECG was misread by
the cardiology team as showing “left ventricular hypertrophy, lateral
infarct age undetermined”.
The patient was discharged home and subsequently died of a VF arrest
while running to catch a bus. Autopsy showed septal hypertrophy
consistent with HCM.
25. • Cardiac magnetic resonance imaging (CMR), considered
the gold standard for determining the physical properties
of the left ventricular wall, can serve as an alternative
screening tool when an echocardiogram provides
inconclusive results.
26.
27. • Cardiac catheterization is usually done only when
invasive therapy is considered. Usually, no significant
stenosis are present in the coronary arteries, but older
patients may have coexisting CAD.
• Genetic markers do not influence treatment or identify
high-risk individuals. However, genetic testing may be of
benefit in screening family members.
28. PROGNOSIS
Overall, annual mortality is about 1% for adults but is
higher for children. Death is usually sudden, and sudden
death is the most common sequelae; chronic heart failure
occurs less often. A higher risk of sudden cardiac death is
predicted by the presence of the following risk factors:
• Family history of sudden cardiac death due to
hypertrophic cardiomyopathy
• Unexplained recent syncope
29. • Multiple repetitive non-sustained ventricular tachycardia
(on ambulatory ECG)
• Hypotensive or attenuated blood pressure response to
exercise
• Massive left-ventricular hypertrophy (thickness ≥ 30 mm)
• Extensive and diffuse late gadolinium enhancement on
MRI
30. TREATMENT
• Beta-blockers
• Rate-limiting and negative inotropic calcium channel
blockers
• Avoidance of nitrates, diuretics, and angiotensin-
converting enzyme (ACE) inhibitors
• Possibly antiarrhythmics (eg, disopyramide, amiodarone)
• Possibly implantable cardioverter-defibrillator and
sometimes surgery or ablative procedures
31.
32. • Treatment of hypertrophic cardiomyopathy is based on the
phenotype. Patients without obstruction generally have a
stable clinical course without significant symptoms, although
some experience heart failure symptoms due to diastolic
dysfunction.
• Beta-blockers and heart rate-limiting calcium channel
blockers with a lower arterial dilation capacity (usually
verapamil), alone or combined, are the mainstays. By
slowing the heart rate, they prolong the diastolic filling
period, which may increase left ventricular filling in patients
with diastolic dysfunction. Long-term efficacy of such
therapy, however, has not been proven.
33. • Avoid nitrates and other drugs that decrease preload (eg,
diuretics, angiotensin-converting enzyme inhibitors,
angiotensin II receptor blockers) because these decrease
left ventricular size and worsen left ventricular function.
34.
35. If syncope or sudden cardiac arrest has occurred or if ventricular
arrhythmia is confirmed by ECG or 24-hour ambulatory monitoring,
an implantable cardioverter-defibrillator (ICD) should usually be
placed. Controversy exists regarding the need to place a
defibrillator in patients without syncope, sudden cardiac arrest, or
ventricular arrhythmias. It is generally believed that ICD insertion
should be considered in patients with high-risk features, which
include
• A family history of premature sudden cardiac arrest
• Left ventricular wall thickness > 3 cm
• Abnormal blood pressure response on exercise treadmill testing
(fall in systolic pressure of > 10 mm Hg)
• Left ventricular outflow tract obstructive gradient of > 50 mm Hg
• Delayed enhancement on cardiac MRI
36. PREVENTION
• Maintain a healthy, well-balanced diet
• Limit alcohol intake or abstain from drinking altogether
• Quit smoking
• Manage stress