LV

Question 1

LVH patterns

Answer 1

Concentric - hypertension, restriction.
Asymmetrical - hypertrophy.

Question 2

LVH measures – 3

Answer 2

• End diastolic wall thickness of basal posterior wall.
  – maximal end diastolic septal thickness.
  – Most common is thick septum with normal posterior wall 

Question 3

HOCM

Answer 3

• Sub aortic obstruction = SAM/mitral leaflet + hypertrophied septum.
  – Doppler velocity curve peaks in late systole, “dagger shaped“ vs mid-systole as seen with valvular obstruction

Question 4

HOCM testing

Answer 4

• IF resting outflow obstruction NOT present (peak gradient <30 mmHg) then exercise testing may detect latent obstruction.
  – defined as increase in subaortic maximum gradient to at least 50 mmHg with exercise.

Question 5

HOCM Doppler

Answer 5

• PW = level of obstruction.
  – CW = maximum velocity.

Question 6

HOCM MR

Answer 6

• from SAM/mitral leaflet inadequate coaptation 
  – typical posterior, directed, regurgitation jet 

Question 7

Septal knuckle/bulge 4

Answer 7

– Can be seen with aging
– dilation/tortuosity of ascending aorta.
- increased angle between basal septum and aortic root.
– bulging of the septum into the LV outflow tract.

Question 8

What does hypertension due to the LV?

Answer 8

• concentric, LV hypertrophy, including basal posterior wall thickening.
• reversible with control of hypertension.

Question 9

Compare dynamic outflow obstruction between hypertensive heart disease and hypertrophy

Answer 9

– Dynamic outflow obstruction/hypertension = mid-ventricular and SAM at mitral chordal region.
– dynamic outflow obstruction/hypertrophy = subaortic and SAM at leaflet level.