HOCM

Question 1

Sports clearance

Answer 1

1. If have HOCM by dx and clinical expression of phenotype (ie symptoms)
2. Genotype + with no symptoms + no fhx SCD, no LVH on imaging OK for sports

Question 2

Dx of HOCM

Answer 2

Peak gradient >30mm significant
if resting gradient <50 - need provocative measures
1) Stress echo
2) Valsalva
3) Amyl nitrate
4) Hand grip
**equivocal cases - cath with isoproteronol can elicit gradient

Question 3

Brockenbrauk sign

Answer 3

HOCM
Post systolic beat - DECREASE pulse pressure, increased gradient (LV and aortic curve farther apart, aortic wave higher therefore PP increased and gradient increases

AS - post systolic beat - INCREASED pulse pressure

Question 4

Hypotension tx

Answer 4

Use only alpha antagonist - no ionotropes
Phenylephrine - alpha only
Others
Dob, Isoproternol, Epinephrine, dopamine all have B1 agonism - inc contractiliy worsen outflow tract gradient and cause more hypotension