AHA HCM 2020 Flashcards
what is 30 day mortality for septal reduction and myomectomy?
1%
What is major adverse effect rate for Myomectomy and ETOH reduction?
10%
Rate of PPM for CHB for Myomectomy and ETOH reduction?
5% myomectomy
10% ETOH
Name 4 phenocopies of HCM?
- Infiltrative (Amyloid)
- Fabry’s disease
- Glycogen Storage disorders
- Freidrich Ataxia
How to screen FDRs for HCM and how often?
Adults:
-At time of diagnosis in proband and then every 3-5 years.
Children and Adolescents:
- 1-2y: If Genotype + or early disease in proband
- 2-3y: All others
How often to repeat echo in HCM?
Every 1-2 years
Who to perform stress echo in?
if resting and echo with provocative manouvre echo is still less than LVOT < 50mmhg
What is recommended for imaging during ETOH ablation?
-TEE with US enhancing contrast injection of the candidate’s septal perforators
4 reasons for CMR in HCM?
- If echo inconclusive for diagnosis
- Alternative causes (Fabrys, Amyloid, Athletes heart)
- Scar burden if no other reason for ICD
- To plan for selection of SRT
How extensive should family history be on initial assessment?
3 generations
Class 1 indication for HCM?
SCD/VT/VF
5 Class 2a recommendations for ICD?
- FH SCD
- Massive LVH (> 30)
- Unexplained Syncope
- Apical Aneurysm
- EF < 50%
2 Class 2b for ICD?
NSVT
LGE on CMR
Indications for septal reduction therapy (3 things)
Severely symptomatic despite OMT at experienced centers
When is myomectomy preferred over ETOH ablation?
Associated disease needing surgery
How long to have SCAF to anticoagulation?
> 24 hours duration
3 indications for Cath in HCM?
- Prior to SRT
- Symptoms of angina/evidence of ischemia
- To quantify LVOT gradient when uncertainty in degree of obstruction
What to do if genotype positive identified in HCM case? What if not identified?
+ Test FDRs for that gene
- Clinical surveillance in FDRs (1-2 years in children, 3-5 years in adults)
After beta blockers/CCB’s, what are 4 AADs that can be used in HCM?
- Amiodarone
- Sotalol
- Dofetilide
- Mexiletene
When to initiate GDMT for HCM with LV dysfunction?
-LVEF < 50% (Also DC Disopyramide, CCB and consider ICD (2a))
When to order CPET in patients with HCM?
NYHA III/IV or refractory arrhythmias -> transplant considerations
Name 4 meds that can be used for rhythm control of AF in HoCM
- Disopyarmide (First line)
- Amiodarone (Reasonable)
- Sotalol (Reasonable)
- Dofetilide (Reasonable)
What are three AADs that can be used for Ventricular Arrhythmias?
Amiodarone
Sotalol
Mexiletene
What are three things that weight loss in HoCM can result in improvement?
- AF
- LVOTO
- HF symptoms
At what LVEF in HCM would you consider CRT when they have an ICD indication already?
LBBB and LVEF < 50%
Name 4 scenarios where you could offer SRT in patients with mild (NYHA II symptoms) ?
Severe and Progressive Pulmonary hypertension thought to be due to LVOT-O or MR
LAE and 1 or more episode of AF
Poor functional capacity attributable to LVOT-O on functional testing
Children and young adults with LVOT-O > 100mmhg
When is it class 1 indication for Myectomy > ETOH ablation ? Vise Versa?
- Myectomy: When other needs for OHS
- ETOH: When unacceptable candidate for Myectomy
Name 4 things to do for HCM patient with LVEF < 50%
- Start on GDMT
- Discontinue Negative Inotropes (Non DHP CCB, Disopyramide)
- Evaluate for ICD (Class 2a) (or CRT if concomitant symptoms and LBBB)
- Evaluate for other causes of LV dysfunction
When should echo be done in pregnant patients with HoCM?
2nd/3rd trimester when hemodynamic load is highest, or if symptoms change
