15. HCM (part 2) Flashcards Preview

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Flashcards in 15. HCM (part 2) Deck (12):

What is dilated cardiomyopathy?

  • Cardiac muscle cells are dying as heart cells outgrow O2 supply
  • Remaining cells are under a greater amount of stress and can't handle blood volume, leading to dilated cavity


What are the exercise recommendations for hypertrophic cardiomyopathy patients? Why?

  • Withdrawal from competitive sports and training programs
  • Intense training and competition increase risk of sudden cardiac death or progression of disease in susceptible athletes


What are the recreational sports recommendations for hypertrophic cardiomyopathy patients?


  • Burst exertion (basketball, soccer, tennis)
  • Programs that require systematic, progressive higher levels of conditioning (rowing, cycling, running)
  • Extreme environmental conditions


What are the treatment options for hypertrophic cardiomyopathy?

  • LV mass reduction to reduce LV outflow track obstruction
    • Surgival myectomy
    • Percutaneous alcohol septal ablation
  • Pharmacological
    • Beta blockers, antiarrhythmics, anticoagulants
  • Implantable cardioverter-defribrillator (ICD)


What are the medical recommendations for asymptomatic patients?

Periodic, longitudinal assessment ("watchful waiting")


What would be the prescribed treatment of a patient who is genetically affected, but did not express the phenotype of hypertrophic cardiomyopathy?

Longitudinal follow up ("watchful waiting")


What would be the prescribed treatment of a patient who has no/mild symptoms of hypertrophic cardiomyopathy w/ no risk of sudden death?

  • Withdraw from intense activity
  • Drugs like beta blockers


What would be the prescribed treatment of a patient who is at high risk for sudden death due to hypertrophic cardiomyopathy?

Implantable defibrillator


What is the best way to diagnose an abnormal hypertrophic cardiomyopathy?



What factors/characteristics distinguish hypertrophic cardiomyopathy from an athlete's heart?


  • Unusual pattern of LV hypertrophy
  • Small LV cavity < 45 mm
  • Abnormal LV filling
  • Fam history of HCM

Athlete's heart:

  • Large LV cavity > 55 mm
  • Decreased heart muscle thickness w/ deconditioning (reversible)
  • High VO2max


Describe pre-participation screening for athletes in the USA.

  • AHA recommends CV screenings for college and high school athletes before athletic participation and at 2-4 year intervals
  • Consists of health history and physical exam
  • Routine ECG testing is NOT included in this recommendation


Why wouldn't a routine ECG or exercise testing be recommended as part of a pre-participation screening process?

  • Abnormal ECGs very common for athletes
  • Consequences of false positives:
    • Unnecessary and expensive additional testing
    • Adverse psychological stress
    • Potential misuse of data for employment and insurance decisions
    • Sports eligibility