Hypertrophic cardiomyopathy: Difference between revisions
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==Background== | ==Background== | ||
Genetically-linked (AD) hypertrophy of cardiac muscle - can but does not always cause outflow obstruction | *Genetically-linked (AD) hypertrophy of cardiac muscle - can but does not always cause outflow obstruction | ||
*"HOCM" | |||
*Abnormal LV diastolic function due to decr compliance | |||
==Diagnosis== | ==Diagnosis== | ||
*Sx: Syncope or sudden death most common | |||
**Also exertional dyspnea, chest pain, syncope, dizzyness, palpitations, or [[CHF]] | |||
*Systolic murmur that increases w/ valsalva | |||
*EKG | |||
**Nonspecific/normal. | |||
**Or, high voltage/LVH, deep narrow Q waves in 1, avL, V5, V6 = "daggers of death" | |||
==Work-Up== | ==Work-Up== | ||
#EKG | #[[EKG]] | ||
#CXR | #CXR | ||
#ECHO | #ECHO | ||
==Differential Diagnosis== | |||
{{Template:Cardiomyopathy DDX}} | |||
==Treatment== | ==Treatment== | ||
Myomectomy | Definitive = Myomectomy | ||
===Decompensated!=== | ===Decompensated!=== | ||
*If decompensated presents as hypotensive CHF | *If decompensated presents as hypotensive CHF | ||
**Preserve preload | **Preserve preload | ||
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==Source== | ==Source== | ||
Tintinalli | *Tintinalli | ||
*Adapted from ....Rosen, Mattu (lecture) | |||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 04:54, 21 March 2014
Background
- Genetically-linked (AD) hypertrophy of cardiac muscle - can but does not always cause outflow obstruction
- "HOCM"
- Abnormal LV diastolic function due to decr compliance
Diagnosis
- Sx: Syncope or sudden death most common
- Also exertional dyspnea, chest pain, syncope, dizzyness, palpitations, or CHF
- Systolic murmur that increases w/ valsalva
- EKG
- Nonspecific/normal.
- Or, high voltage/LVH, deep narrow Q waves in 1, avL, V5, V6 = "daggers of death"
Work-Up
- EKG
- CXR
- ECHO
Differential Diagnosis
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
Treatment
Definitive = Myomectomy
Decompensated!
- If decompensated presents as hypotensive CHF
- Preserve preload
- Careful hydration
- Avoid high airway pressure if intubate
- Limit tachycardia
- Beta blockers
- Avoid vasodilators (no nitrates)
- Maintain sinus rythm (i.e. cardiovert A. fib)
- Increase afterload (hypotensive only)
- Phenylephrine
- Preserve preload
See Also
Source
- Tintinalli
- Adapted from ....Rosen, Mattu (lecture)