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
Treatment:
- B-blockers, CBB (diltiazem, verapamil)
- Disopyramide (class 1A antiarrhythmic)
- If syncope -> implantable defibrillator
- Surgery -> septoplasty
Download the PDF version: here
References:
- Kaplan step 2 lecture notes
- Toronto notes
- Lifeinthefastline.com
