Hypertrophic cardiomyopathy: Difference between revisions
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Definitive = Myomectomy | Definitive = Myomectomy | ||
===Decompensated | ===Decompensated=== | ||
*If decompensated presents as hypotensive CHF | *If decompensated presents as hypotensive CHF | ||
**Preserve preload | **Preserve preload | ||
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)