HCM

Question 1

hypertrophic cardiomyopathy

Answer 1

autosomal dominant genetic disorder of inappropriate LV and/or RV hypertrophy resulting in left ventricular outflow obstruction, diastolic dysfunction, and myocardial ischemia

Question 2

PE for hypertrophic cardiomyopathy

Answer 2

fourth heart sound (S4)
pulses bisferiens

Question 3

murmur for hypertrophic cardiomyopathy

Answer 3

harsh crescendo-decrescendo systolic murmur that begins after S1 and is heard best at the apex and lower left sternal border

usually no carotid radiation

Question 4

increased hypertrophic cardiomyopathy

Answer 4

decreased venous return (valsalva, standing)
decreased afterload (amyl nitrate)

Question 5

decreased hypertrophic cardiomyopathy

Answer 5

increased venous return (squatting, supine, leg raise)
increased preload (handgrip)

Question 6

tx for HCM

Answer 6

beta blockers first line
CCB (Non-DHP - verapamil/diltiazem)

myomectomy septal reduction therapy if refractory
alcohol septal ablation is alternative

Question 7

cautions for HCM

Answer 7

avoid dehydration, extreme exertion, strenuous exercise, digoxin, vasodilators (dihydropiridine CCB), diuretics, ACEI, nitrates, ARBS