HOCM

Question 1

ECG criteria of HOCM

Answer 1

deep dagger Q wave in chest leads V1-V5
Voltage criteria for LVH
T wave in precordial leads suggestive strain pattern

Question 2

List 5 questions you ask regarding symptoms

Answer 2

exertional syncope 
chest pain 
 palpitation 
Hx  of PND 
Family hx of sudden cardiac death

Question 3

justify 3 Ix would you perform

Answer 3

CXR : exclude pulmonary oedema
Echo : looking for outflow obstruction 
Troponin as a marker of ischemic event 
serial ECG for dynamic changes 
VBG for electrolyte disturbance .

Question 4

If the patient is minor 16 yrM and prior to any IX patient feels fine and wants to discharge against medical advise , what is your Mx ?

Answer 4

1-Given minor , need to assess understanding and involve parents regarding understanding the risk especially sudden cardiac death
2- Avoid strenuous exercise prior to cardiology review ( with early review booked )
3-document the above discussion in medical records