HOCM

Hypertrophic Obstructive Cardiomyopathy

 

Causes:

  • > 60% of the cases are hereditary -> autosomal dominant (chr 14)

 

Pathophysiology:

  • Hallmark: thickening of the interventricular septum
  • Hypertrophy -> ↓ LV compliance -> diastolic dysfunction
  • Obstruction is reduced\increased via several factors (see pic)

 

Presentation:

  • Dyspnea, angina, palpitations, exertional pre-\syncope, sudden death (esp in young athletes)!
  • Neck: large jugular A waves, bifid carotid pulse
  • Heart: palpable S4, systolic murmur + thrill, mitral regurg murmur

 

Diagnosis:

  • ECG: LVH, LAE, pseudo Q waves (V1-3) -> mimics infarction, ventricular arrhythmia
  • Echo is the mainstay of dx

HOCM 1

 

Treatment:

  • B-blockers, CBB (diltiazem, verapamil)
  • Disopyramide (class 1A antiarrhythmic)
  • If syncope -> implantable defibrillator
  • Surgery -> septoplasty

HOCM 3HOCM 2

 


Download the PDF version: here


 References:

  • Kaplan step 2 lecture notes
  • Toronto notes
  • Lifeinthefastline.com

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