Hypertrophic Flashcards
What is the etiology of HCM?
Idiopathic - but may due to dominant autosomal gene with variable penetrance
What is ASH?
Asymmetric septal hypertrophy ( most common)
What’s the ratio for ASH?
> 1.3 :1
What is IHSS ? It’s A.K.A?
Idiopathic hypertrophic sub aortic stenosis
also known as HOCM
IHSS combines what 2 things?
SAM & ASH
HOCM combines what 2 things?
SAM & HCM
Which cardiomyopathy is autosomal dominant?
HCM
HCM is what kind of disarray?
Myocardial fiber
HCM leads to?
Diastolic dysfunction (filling issues)
True or false- LAE occurs with HCM
True
True or false - MR does not occur with H?
False. MR does occur
With HOCM what leaflet does the obstruction hit?
AMVL
Mitral valve _____ and septal ___ may result from leaflets striking the IVS
Thickening ; scarring
True or false- MAC may be present with HCM
True
Diastolic dysfunction occurs with HCM because of the?
Noncompliant LV
What are the 5 symptoms of HCM?
DOE
Angina
syncope
Sudden death
Arrhythmias
What murmur is associated with HCM?
Systolic murmur- crescendo decresendo. Increased with amyl nitrate or valsalva
What is amyl nitrate?
Vasodilator for chest pain
They’re are 4 HCM variation. Name them. Describe them.
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
What is the most common HCM variation?
Sigmoid 40-50%
What is the second most common HCM variation?
Reverse curve 30-40%
AHCM shows what signs on EKG?
Increased QRS and giant negative T waves
AHCM is most common in what country?
Japan
AHCM has what specific sign we use to describe it?
Ace of spades
What is the etiology of AHCM?
Genetic
What does the Doppler of AHCM look like?
Sharp downward peak then flow acceleration in mid LV
Flow acceleration in mid LV describes what type of HCM?
Apical Hypertrophic cardiomyopathy
What will the myocardium of a HCM look like?
Bright appearance from fiber disarray
True or false - with HCM the LV cavity is large
False. LV is small with HCM
Ventricular contraction with HCM may be ___ or _____
Normal Or hyper dynamic
With HOCM what might occur with the aortic valve?
Mid systolic closure is there’s an obstruction
HCM may be symmetric or asymmetric. What is the ratio for asymmetric Hypertrophy?
> 1.3 :1
With HOCM septal contact with the AMVL increases with what 2 things?
Valsalva or amyl nitrate
LVOT obstruction causes the aortic valve to?
Close during mid systole
With HCM what does the mitral inflow look like?
Decreased E wave due to abnormal relaxation and large A wave
On your E/A wave. What is the duration just before the E wave called?
IVRT
On your E/A wave. What is the duration just after the A wave called?
IVCT
True or false - mid ventricular subaortic gradient may be present with HCM?
True
What does the Doppler of HOCM & IHSS look like?
Late peaking systolic jet ; dagger shape
A late peaking Doppler jet goes with?
IHSS & HOCM
What is the drug inderal ?
Beta blocker
The drug indetral ____ SAM with excercise
Reduces
True or false- With HCM the subaortic gradient will increase with provocation
True
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?
- LV infarction
- RV infarction
- A-fib developed
- Post MI VSD
- LV infarction
What are 2 treatments for HCM?
- 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.
Strain measures the ____ within the ____
Deformation ; myocardium
The acoustic signature in tissue that the GLS software tracks is called?
Speckle
What’s a normal GLS?
-16 to -20 %or more
HOCM patients usually have a GLS of?
-8% to -10%
What changes first within the myocardium?
Strain or EF?
Strain is though to change first
____ is the acoustic signature in myocardial tissue which is what strain tracks
Speckle