Hypertension + HOCM

Question 1

What is the most common secondary cause of hypertension?

Answer 1

Renal disease e.g. renal artery stenosis

Question 2

What are 2 other secondary causes of hypertension?

Answer 2

1) Endocrine disease e.g. thyroid dysfunction

2) Aortic coarctation

Question 3

How do you diagnose hypertension?

Answer 3

High BP on two occasions - BP + ABPM/HBPM

Question 4

What are the side effects of ACE inhibitors?

Answer 4

1) Dry cough
2) Angioedema
3) Hyperkalaemia

Question 5

When are ACE inhibitors contraindicated?

Answer 5

1) Renovascular disease
2) Aortic stenosis
3) Pregnancy & breastfeeding

Question 6

When can ACE inhibitors increase the risk of hypotension?

Answer 6

If patient is on high-dose diuretic therapy e.g. > 80mg furosemide a day

Question 7

What is the side effect of calcium channel blockers?

Answer 7

Peripheral oedema e.g. ankle

Question 8

What are the side effects of diuretics?

Answer 8

1) Excessive urine output
2) Hyponatraemia
3) Hypokalaemia
4) Hypercalcaemia

Question 9

What are side effects of ARBs?

Answer 9

Hypotension and hyperkalaemia

Question 10

What does HOCM stand for?

Answer 10

Hypertrophic obstructive cardiomyopathy

Question 11

What is HOCM?

Answer 11

LV outflow tract obstruction from asymmetric septal hypertrophy (LVH)

Question 12

What is HOCM the leading cause of?

Answer 12

Sudden cardiac death in the young

Question 13

What causes HOCM?

Answer 13

• Genetic - autosomal dominant
• 50% are sporadic - 70% of these have mutations in genes
• Ask about FH of sudden death

Question 14

When does HOCM present?

Answer 14

Any age

Question 15

What are the symptoms of HOCM?

Answer 15

• Sudden death (VF)
• Palpitations (arrhythmias - AF/VT)
• Angina
• Dyspnoea
• Syncope
• Congestive cardiac failure symptoms

Question 16

What are the signs of HOCM?

Answer 16

• Jerky pulse
• Ejection systolic murmur
• a wave in JVP
• Double-apex beat
• Systolic (apical) thrill at lower left sternal edge

Question 17

What does HOCM (LVH) lead to due to LV outflow tract obstruction?

Answer 17

• HF
• Arrhythmias (AF/VT)
• Ischaemia (ACS)

Question 18

What would you see on an ECG of someone with HOCM?

Answer 18

• LVH
• T wave inversion
• Deep Q waves

Question 19

How do you diagnose HOCM?

Answer 19

Echo

Question 20

What would you see on echo in HOCM?

Answer 20

Asymmetrical septal hypertrophy (LVH)

Question 21

What other investigations can you do in someone with HOCM?

Answer 21

• MRI
• Cardiac catheterisation
• Electrophysiological (WPW)
• Exercise test ± Holter monitor

Question 22

How do you manage HOCM symptomatically?

Answer 22

• Beta blocker/CCB (verapamil) to reduce ventricular contractility (ACS)
• Amiodarone for arrhythmias (AF, VT)
• Anticoagulation (for paroxysmal AF or systemic emboli)
• Consider ICD

Question 23

How do you treat HOCM with severe symptoms?

Answer 23

Septal myomectomy

Question 24

What are poor prognostic factors for HOCM?

Answer 24

• Age < 14 years or syncope at presentation

- FH of HOCM/sudden death