Cardiovascular- Cardiomyopathy, Myocarditis, Pericardial disease

Question 1

Mechanism of beta blocker treatment for HCM

Answer 1

BB reduce HR -> increase LV diastolic filling and LVEDV.

Decrease pressure gradient between LVOT and aorta reducing dynamic obstruction.

Question 2

Motions that worsen LVOT obstruction in HCM

Answer 2

Decreasing preload: standing, valsava stain phase

Question 3

Motions that improve LVOT obstruction in HCM

Answer 3

Increasing preload: squatting, Hand grip, supine leg lift

Question 4

Dobutamine effect in LVOT obstruction in HCM

Answer 4

Beta 1 agonist that decreases LV volume and pressure gradient between LVOT and aorta. Worsens LVOT obstruction in HCM

Question 5

Furosemide and nitropursside effect in LVOT obstruction in HCM

Answer 5

Decrease precast and LV volume. Women LVOT obstruction in HCM

Question 6

ECG in HCM

Answer 6

Left axis deviation

Abnormalities of depolarization (Q wave) or repolarization ( inverted T waves)

Question 7

Diagnosis of HCM

Answer 7

BIT: EKG

Confirmation: Echo (septal LV hypertrophy, LVOT obstruction, LA dilation)

Question 8

Management of HCM

Answer 8

Beta Blocker. 
nondihydropyridine CCB 
Avoid dehydration & vasodilators 
ICD for increased risk SCD
Septal ablation

Question 9

Mechanism of syncope in HCM

Answer 9

Reduced cardiac output due to LVOT obstruction.

Ischemia- induced ventricular tachycardia

Question 10

Mechanism of sudden cardiac death (SCD) in HCM

Answer 10

HCM has ↑O2 demand (more muscle mass) and ↓O2 supply (myocardial disarray with microvascular dysfunction). Mismatch can trigger arrhythmia.
Arrhythmia that doesn’t terminate (e.g. syncope) causes SCD