Hypertrophic

Question 1

What is the etiology of HCM?

Answer 1

Idiopathic - but may due to dominant autosomal gene with variable penetrance

Question 2

What is ASH?

Answer 2

Asymmetric septal hypertrophy ( most common)

Question 3

What’s the ratio for ASH?

Answer 3

> 1.3 :1

Question 4

What is IHSS ? It’s A.K.A?

Answer 4

Idiopathic hypertrophic sub aortic stenosis
also known as HOCM

Question 5

IHSS combines what 2 things?

Answer 5

SAM & ASH

Question 6

HOCM combines what 2 things?

Answer 6

SAM & HCM

Question 7

Which cardiomyopathy is autosomal dominant?

Answer 7

HCM

Question 8

HCM is what kind of disarray?

Answer 8

Myocardial fiber

Question 9

HCM leads to?

Answer 9

Diastolic dysfunction (filling issues)

Question 10

True or false- LAE occurs with HCM

Answer 10

True

Question 11

True or false - MR does not occur with H?

Answer 11

False. MR does occur

Question 12

With HOCM what leaflet does the obstruction hit?

Answer 12

AMVL

Question 13

Mitral valve _____ and septal ___ may result from leaflets striking the IVS

Answer 13

Thickening ; scarring

Question 14

True or false- MAC may be present with HCM

Answer 14

True

Question 15

Diastolic dysfunction occurs with HCM because of the?

Answer 15

Noncompliant LV

Question 16

What are the 5 symptoms of HCM?

Answer 16

DOE
Angina
syncope
Sudden death
Arrhythmias

Question 17

What murmur is associated with HCM?

Answer 17

Systolic murmur- crescendo decresendo. Increased with amyl nitrate or valsalva

Question 18

What is amyl nitrate?

Answer 18

Vasodilator for chest pain

Question 19

They’re are 4 HCM variation. Name them. Describe them.

Answer 19

Sigmoid - septum is thicker than the rest of septum
Reverse curve - entire septum curves into LV
Apical - ace of spades HCM- apex is thicker than rest of LV
Netural- concentric HCM

Question 20

What is the most common HCM variation?

Answer 20

Sigmoid 40-50%

Question 21

What is the second most common HCM variation?

Answer 21

Reverse curve 30-40%

Question 22

AHCM shows what signs on EKG?

Answer 22

Increased QRS and giant negative T waves

Question 23

AHCM is most common in what country?

Answer 23

Japan

Question 24

AHCM has what specific sign we use to describe it?

Answer 24

Ace of spades

Question 25

What is the etiology of AHCM?

Answer 25

Genetic

Question 26

What does the Doppler of AHCM look like?

Answer 26

Sharp downward peak then flow acceleration in mid LV

Question 27

Flow acceleration in mid LV describes what type of HCM?

Answer 27

Apical Hypertrophic cardiomyopathy

Question 28

What will the myocardium of a HCM look like?

Answer 28

Bright appearance from fiber disarray

Question 29

True or false - with HCM the LV cavity is large

Answer 29

False. LV is small with HCM

Question 30

Ventricular contraction with HCM may be ___ or _____

Answer 30

Normal Or hyper dynamic

Question 31

With HOCM what might occur with the aortic valve?

Answer 31

Mid systolic closure is there’s an obstruction

Question 32

HCM may be symmetric or asymmetric. What is the ratio for asymmetric Hypertrophy?

Answer 32

> 1.3 :1

Question 33

With HOCM septal contact with the AMVL increases with what 2 things?

Answer 33

Valsalva or amyl nitrate

Question 34

LVOT obstruction causes the aortic valve to?

Answer 34

Close during mid systole

Question 35

With HCM what does the mitral inflow look like?

Answer 35

Decreased E wave due to abnormal relaxation and large A wave

Question 36

On your E/A wave. What is the duration just before the E wave called?

Answer 36

IVRT

Question 37

On your E/A wave. What is the duration just after the A wave called?

Answer 37

IVCT

Question 38

True or false - mid ventricular subaortic gradient may be present with HCM?

Answer 38

True

Question 39

What does the Doppler of HOCM & IHSS look like?

Answer 39

Late peaking systolic jet ; dagger shape

Question 40

A late peaking Doppler jet goes with?

Answer 40

IHSS & HOCM

Question 41

What is the drug inderal ?

Answer 41

Beta blocker

Question 42

The drug indetral ____ SAM with excercise

Answer 42

Reduces

Question 43

True or false- With HCM the subaortic gradient will increase with provocation

Answer 43

True

Question 44

A 64 year old female with IHSS and a resting gradient of 150mmhg was admitted to the hospital with chest pain. The next day the resting gradient was 15mmhg. What happened? 1. LV infarction 2. RV infarction 3. A-fib developed 4. Post MI VSD

Answer 44

2. LV infarction

Question 45

What are 2 treatments for HCM?

Answer 45

- surgical septal myectomy ( open heart surgery to remove thick myocardium) - ETOH septal ablation (non-surgical. Catheter put into groin and into aorta and into the vessels that enter the IVS. Alcohol is injected into thick myocardium. The toxicity of the alcohol shrinks and kills the thick areas.

Question 46

Strain measures the ____ within the ____

Answer 46

Deformation ; myocardium

Question 47

The acoustic signature in tissue that the GLS software tracks is called?

Answer 47

Speckle

Question 48

What’s a normal GLS?

Answer 48

-16 to -20 %or more

Question 49

HOCM patients usually have a GLS of?

Answer 49

-8% to -10%

Question 50

What changes first within the myocardium? Strain or EF?

Answer 50

Strain is though to change first

Question 51

____ is the acoustic signature in myocardial tissue which is what strain tracks

Answer 51

Speckle