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18 Cards in this Set
- Front
- Back
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What mutation causes hypertrophic cardiomyopathy?
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Gene Mutation in Sarcomere: Disruption of the contractile unit
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Dynamic Outflow Obstruction: what is it?
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obstruction to the outflow of blood from the left ventricle that is variable and dependent on the amount of blood in the ventricle immediately before ventricle systole (contraction).
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What is difference between obstructive and non-obstructive hypertrophic cardiomyopathy? (HCM)?
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Depending on whether the distortion of normal heart obstructive: anatomy causes an obstruction of the outflow of blood from the left ventricle of the heart
non-obstructive : it doesn't |
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The obstructive variant of HCM, hypertrophic obstructive cardiomyopathy (HOCM) has also historically been known as ___ and ____
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asymmetrical septal hypertrophy (ASH) and idiopathic hypertrophic subaortic stenosis (IHSS)
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What causes the dynamic outflow obstruction?
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related to the anterior positioning of the papillary muscle due to the hypertrophy; causing leaflet to get caught in the outflow trac of the heart + abnormally directed jet right at the mitral leaflet due to bulge of the myocardium.
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PE findings of hypertrophic cardiomyopathy
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Harsh crescendo-decrescendo mid- systolic murmur
Clinical maneuvers that affect gradient intensity the murmur Apical impulse Enlarged Double impulse (LAC) S3 , S4 Paradoxical splitting of S2 Bisferiens carotid pulse |
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How does changing preload affect intensity of murmur in LVOT obstruction?
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Increase preload, increase LVOT diameter lessen degree of obstruction
--> murmur lessens Decreasing preload will make the obstruction worse --> worsen murmur |
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How does changing afterload affect intensity of murmur in LVOT obstruction?
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Increase Afterload: decrease emptying, decrease gradient
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How does changing contractility affect intensity of murmur in LVOT obstruction?
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Decrease contractility: increase empyting, louder murmur
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What maneuvers
A) Increase D) Decrease Preload? |
A) leg raise, squat
B) squat to stand, valsalva, amyl nitrate |
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Increasing contractility causes an _____ in the murmur
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Increase
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Treatment for Symptomatic Patients with LVOT
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Give Negative Inotropes
(beta blockers, CCBs, disopyramide) Avoid dehydration Avoid vasodilators No competitive sports (risk of sudden death) Low and moderate exertion activity only. |
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Alcohol Septal Ablation: what is it and what is it used for?
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percutaneous, minimally-invasive treatment performed by an interventional cardiologist to relieve symptoms and improve functional status in severely symptomatic patients with hypertrophic cardiomyopathy.
Alcohol septal ablation is a technique designed to reduce the obstruction to blood being ejected from the heart; the technique creates a small controlled heart attack, killing the area of heart muscle responsible for the obstruction, and eventually causing it to become less thick. |
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Septal Myectomy: what is it and what is it used for?
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Surgery for hypertrophic cardiomyopathy.
The surgery entails removing a portion of the septum that is obstructing the flow of blood from the left ventrical to the aorta. |
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What is the biology/morphology of the mitral valve in mitral valve prolapse?
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Thick, redundant leaflets
Thin, prolonged chordae Dilated annulus |
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PE findings for mitral valve prolapse
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Click and murmur.
Click: Billowing of redundant valve into LA Murmur: Mitral regurgitation |
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What effects timing of click seen in mitral valve prolapse?
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Loading conditions of the LV
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When is MV prolapse/regurgitation treated?
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Symptoms or
Flail leaflet or Pulmonary Hypertension or Deteriorating LV function on echo |
