HCM Flashcards
LV thickness of —- indicates HCM
15 mm
With family history 13 is enough
IVS/PW ratio in HCM
1.3
If hypertensive 1.5
MR Jet in HCM
Inferolateral mid to late systolic
Central or Antr jet indicates primary MV d/s
When to do Exercise stress Echo in HCM
If LVOTO less than 50 mm Hg
Pharmacological stress not recommended
Risk of sudden death in HCM high if wall thickness is
MORE than 3 CM
SAM in HCM indicates a gradient of
30mmHg at least
How to calculate HCM gradient from the M mode of AML
x/y *25 +25; X is duration of SAM ; y is time to SAM
How to differentiate HCM from athletes heart
LV>55 mm; HCM -Small LV
When to consider septal ablation in HCM
If gradient at rest or exercise more than 50
HCM incidence
1in500
Septal Q in HCM is seen in
V5,6 aVL,I,2,3,aVF
Shape of LV in Apical HCM
Spade
Midsystolic notching of Aortic Valve is seen in
HOCM
Spike and Dome pattern is seen in HCM in
ARTERIAL WAVEFORM
Effect of Valsalva in HOCM murmur
INCREASES intensity and duration
Best position for HCM murmur
Standing; better than lying or sitting
In squatting LV becomes
BIG
Brockenborough Braunwauld sign is
Post extrasystolic drop in PULSE PRESSURE
So weak pulse after a VPC
Systolic BP falls . Diastolic doesn’t change much
If ECG is s/o HCM and Echo is normal what to do
MRI
Association of WPW and HCM
33% had WPW in one study
Q in HCM is —-shaped
Dagger; just means narrow unlike W of MI
Indications for invasive septal reduction therapy in HOCM
Gradient (rest or provocable) 50 or more
AND Refractory Symptoms
CW profile in HCM
Dagger shaped. Due to the late systolic peak
In contrast fixed obstruction has a smoother contour and earlier peak
Predictors of higher risk of SCD in HCM in Holter
NSVT-prolonged or repetitive episodes
But primary prevention of SCD in HCM is not well defined
Others include Thickness >30mm, Hypotensive BP response in TMT, Syncope, Family h/o SCD
3 types of Amyloidosis that affects heart
- AL Amyloidosis - Plasma cell dyscrasias- cardiac involvement seen in 50% of AL Amyloidosis
- AA Amyloidosis- In chronic inflammation- card involved only in 5%
- TTR Amyloidosis ( Transthyretin)- Wild Type causes Senile systemic Amyloidosis- causes infiltrative CMP looks like HCM
