Hypertrophic Cardiomyopathy

Question 1

What is hypertrophic cardiomyopathy?

Answer 1

Hypertrophic, hyperdynamic nondilated LV that is usually associated with left ventricular outflow tract obstruction

Question 2

What are the causes of HCM?

Answer 2

LVOT obstruction (HOCM - ASH & SAM), non obstructive HCM, Affects primarily diastolic fx, genetics

Question 3

Clinical symptoms of HCM?

Answer 3

Asymptomatic, Dyspnea, Angina, Arrhythmias, exercise intolerance, syncope, high risk of sudden death during exercise

Question 4

What types of hypertrophic cm are there?

Answer 4

Obstructive (HOCM)- asymmetric apical hypertrophy and no obstructive (HCM) - mid cavity obstruction from elderly HtN

Question 5

HOCM hallmark findings

Answer 5

ASH-asymmetric septal hypertrophy
SAM-systolic anterior motion of MV apparatus
Both ASH and SAM if obstructive
LV size small to normal
Abnormal diastolic function

Question 6

ASH

Answer 6

Compare IVS wall to LVPW ratio 1.3. - 1 or greater is diagnostic

Question 7

SAM

Answer 7

Motion of MV leaflet or chordate toward IVS that may obstruct lvot
Mostly AMVL
Mechanism of SAM = Venturi affect = suction = LV geometry changes and pap muscle

Question 8

Pulsus bisferiens

Answer 8

Mid systolic closure of aortic valve during m-mode in HCM