Hyperthophic Obstructive Cardiomyopathy

Question 1

What are the causes for HOCM?

Answer 1

o Familial
o Friederich’s Ataxia
o Idiopathic

Question 2

Why is there a prominent a-wave?

Answer 2

o Due to forceful atrial contraction against a non-compliant right ventricle

Question 3

What is HOCM

Answer 3

o Hypertrophic Cardiomyopathy
o Genetic cardiac disorder caused by missense mutation in the genes that encode proteins of the cardiac sarcomere; autosomal dominant
o Resulting in hypertrophy of the ventricular septum with LV outflow tract obstruction
o 1 in 500, male:female 1:1
o Variable penetrance
o Variable expression

Question 4

Indicators of poor outcome in HOCM?

Answer 4

o Family history of sudden death
o History of syncope, cardiac arrest
o Poor BP response to exercise
o Holter monitoring with ventricual arrythmias detected, esp spontaneous VT
o Echo findings

Question 5

Desc ribe the HOCM murmor

Answer 5

The systolic murmur of LVOT narrowing is characteristically crescendo-decrescendo and starts a little after the onset of S1. It is best heard at the left lower sternal border and radiates to the base, but unlike systolic murmur of valvular aortic stenosis, it does not radiate to the carotids.

Intensity increased with valsalva

The associated murmur of mitral regurgitation is prominent in the apical region and shows the same directional changes in response to the interventions noted above.