Cardiology Series: Case 11

ANSWERS WILL BE POSTED TOMORROW 15/2/17 by 17:00

A 72 year old female with increasing shortness of breath upon exertion over the last year. At night, she often wakes up gasping for air. In hospital, she was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM)

Image result for hypertrophic obstructive cardiomyopathy echo

Source:https://www.youtube.com/watch?v=NPHfi3wBjVM

1. Define HOCM.

2. What would you look for in the physical examination ?

3. What investigations are used to diagnose HOCM ?

4. How would you manage this lady ? 

5. What complications could arise in HOCM ?

Source: http://www.slideshare.net/kurian3/hypertrophic-obstructive-cardiomyopathy-hocm


ANSWERS

1. HOCM is an autosomal dominant genetic disorder that results in abnormal thickening of the myocardium, most commonly the interventricular septum. This causes left ventricular outflow obstruction and can lead to clinical heart failure amongst other complications.

2. Physical Examination

  • Carotid Pulse: Bifid short upstroke and prolonged systolic ejection
  • Jugular Venous Pulse: Prominent ‘a’ wave depicts reduced ventricular compliance
  • Heart Sounds– S4 is usually presents due to the present of hypertrophy
  • Murmur- medium pitched ejection systolic murmur heard over the left lateral sternal edge without radiation.

3. Investigations

  • Electrocardiogram
  • Echocardiogram (Transesophageal)
  • Coronary Angiography
  • Cardiac Magnetic Resonance Imaging

4. Management Options

Image result for treatment of hocm

Medical Therapy

  • Beta Blockers
  • Verapamil
  • Disopyramide

Surgical Therapy

  • Septal Myectomy
  • Alcohol Septal Ablation

Dual Chamber Pacing

5. HOCM can lead to clinical heart failure, life-threatening arrhythmias, mitral regurgitation and sudden cardiac death.

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