This document summarizes a case study of a 40-year-old man presenting with syncope and angina. On examination, he had a bisferiens pulse and a harsh mid-systolic murmur. An echocardiogram revealed hypertrophic cardiomyopathy with a resting left ventricular outflow tract gradient of 27 mmHg. He was diagnosed with hypertrophic obstructive cardiomyopathy and started on atenolol and verapamil to alleviate his symptoms and prevent complications like sudden cardiac death.

1. SATURDAY CLINICAL MEETING DEPARTMENT OF CARDIOLOGY 12 TH FEB 2005

4. WHAT IS SYNCOPE ?

6. Discord in the Evaluation of Syncope Neurologist Cardiologist

9. HOW TO DISTINGUISH SEIZURES FROM SYNCOPE ?

10. - + POST-ICTAL HEADACHE - + POST-ICTAL AMNESIA - + POST-ICTAL CONFUSION - + TONGUE-BITE - + CYANOSIS - + AURA SYNCOPE SEIZURE

11. WHAT ARE THE CAUSES OF CHEST PAIN WITH SYNCOPE ?

12. LOSS OF BLOOD UPPER GE BLEED HYPOVOLEMIA DUE TO CHEMICAL PERITOITIS, SEVERE PAIN ACUTE PANCREATITIS CARDIORESPIRATORY EMBARRASSMENT PLEURAL HEMORRHAGE CARDIORESPIRATORY EMBARRASSMENT TENSION PNEUMOTHORAX CARDIAC COMPRESSION PERICARDIAL TAMPONADE OBSTRUCTION TO CIRCULATION ACUTE PULMONARY EMBOLISM LARGE AREA OF MYOCARDIUM AT RISK, ARRHYTHMIAS ANGINA PECTORIS ARRHYTHMIAS(VT/VF) VASOSPASTIC ANGINA LARGE AREA OF MYOCARDIUM AT RISK, ARRHYTHMIAS ACUTE MYOCARDIAL INFARCTION MECHANISM CONDITION

15. WHAT IS THE MECHANISM OF ANGINA IN HOCM ?

16. ARRHYTHMIAS INCREASED CORONARY VASCULAR RESISTANCE LEFT VENTRICULAR OUTFLOW OBSTRUCTION MYOCARDIAL BRIDGES MYOCYTE DISARRAY ABNORMAL VASCULAR RESPONSES DIASTOLIC DYSFUNCTION SMALL VESSEL DISEASE MYOCARDIAL HYPERTROPHY REDUCED MYOCARDIAL PERFUSION INCREASED MYOCARDIAL OXYGEN DEMAND

21. WHAT IS MEANT BY BISFERIENS PULSE ?

23. WHAT ARE THE CAUSES OF BISFERIENS PULSE?

26. WHAT ARE THE CHANGES SEEN IN JVP IN A CASE OF HOCM ? WHY ?

29. WHAT ARE THE CAUSES OF DOUBLE AND TRIPLE APICAL IMPULSE ?

32. WHAT ARE THE CAUSES OF PARADOXICAL SPLIT S2 ?

33. LBBB RV PACING RV ECTOPY DELAYED ELECTRICAL ACTIVATION OF LV EARLY ELECTRICAL ACTIVATION OF RV AS IN TYPE B WPW SYNDROME. IN WPW SYNDROME, REVERSED SPLIT OCCURS ONLY WHEN THERE IS SIGNIFICANT PRE-EXCITATION SEVERE TRICUSPID REGURGITATION EARLY PULMONIC CLOSURE ANEURYSM OF ASCENDING AORTA POST-STENOTIC DILATION IN AS INCREASE OF HANGOUT INTERVAL ON THE AORTIC SIDE SEVERE AS SEVERE SYSTEMIC HYPERTENSION ACUTE MYOCARDIAL INFARCTION DURING AN EPISODE OF ANGINA CARDIOMYOPATHY SEVERE AR LARGE PATENT DUCTUS ARTERIOSIS PROLONGED LV MECHANICAL SYSTOLE CAUSES MECHANISM

34. WHAT TYPE OF MURMURS CAN BE HEARD IN HOCM ?

37. INVESTIGATION WNL LIVER PROFILE WNL RENAL PROFILE WNL HEMOGRAM

38. INVESTIGATION NORMAL SINUS RHYTHM AXIS : (– 30°) LEFT ATRIAL ENLARGEMENT POOR PROGRESSION OF R WAVE LVH PRESENT LARGE NEGATIVE PRECORDIAL T WAVES ECG

40. WHAT ARE THE ECG CHANGES FOUND IN HOCM ?

42. DIMENSIONS LA – 40mm IVS(D) – 27mm LVPW(D) – 10mm IVS(S) - 30mm LVPW(S) – 19mm LVEF – 77% ASH + GROUND GLASS APPEARANCE OF SEPTUM LVOT Δ RESTING 27 mmHg POST-SORBITRATE 60 mmHg ECHO

46. OCCASIONAL SVCS VPCS OF RBBB, LBBB MORPHOLOGY ONE COUPLET ONE RUN OF 3 BEATS NO SINUS PAUSE ASYMPTOMATIC DURING RECORD HOLTER

48. WHO ARE THE PATIENTS AT HIGH RISK FOR SCD ?

50. COURSE OF EVENTS

54. IMPORTANT POINTS TO REMEMBER ABOUT HOCM

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