HOCM Flashcards
List predisposing factors for the development of LVOTO.
LVOTO (Left Ventricular Outflow Tract Obstruction
Asymmetric septal wall hypertrophy or motion, Cardiomyopathies (CM) - mitral valve anomalies or surgery, aortic stenosis and aortic valve replacement, apical ballooning (Takotsubo), RV pressure overload.
In patients with predisposing factors,
LVOTO mav develop during tachydysrythmias, preload and afterload reduction (especially in low volume or vasodilatory states), myocardial ischemia, high contractility.
Differentiate dilated and hypertrophic cardiomyopathy. How does your management of each differ?
CM: hypertrophied septum can cause dynamic left ventricular outflow tract obstruction (LVOTO)
during systole.
May also develop dynamic anterior motion of the mitral valve leaflet towards septum (SAM - systolic anterior motion) causing further obstruction. This causes a pressure overload of LV and diastolic dysfunction
Expect to see..
low normal HR, adequate volume loading, high normal SVR, low ventricular contractility,
Tx-
Be cautious with our inotropes, beta-blockers, calcium channel blockers, aggressive management of arrhythmias (may require pacing), direct vasopressors (i.e phenylephrine)
