HOCM Flashcards
1
Q
Sports clearance
A
- If have HOCM by dx and clinical expression of phenotype (ie symptoms)
- Genotype + with no symptoms + no fhx SCD, no LVH on imaging OK for sports
2
Q
Dx of HOCM
A
Peak gradient >30mm significant
if resting gradient <50 - need provocative measures
1) Stress echo
2) Valsalva
3) Amyl nitrate
4) Hand grip
**equivocal cases - cath with isoproteronol can elicit gradient
3
Q
Brockenbrauk sign
A
HOCM
Post systolic beat - DECREASE pulse pressure, increased gradient (LV and aortic curve farther apart, aortic wave higher therefore PP increased and gradient increases
AS - post systolic beat - INCREASED pulse pressure
4
Q
Hypotension tx
A
Use only alpha antagonist - no ionotropes
Phenylephrine - alpha only
Others
Dob, Isoproternol, Epinephrine, dopamine all have B1 agonism - inc contractiliy worsen outflow tract gradient and cause more hypotension
