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Hypertrophic Cardiomyopathy Flashcards

1
Q

who should get screen for HCM?

A

ALL first-degree relatives w/ echocardiography

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2
Q

when should screening begin for HCM?

A

12 yoa

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3
Q

HCM description

A
  • uncommon
  • primary cardiac disease
  • diffuse or focal myocardial hypertrophy
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4
Q

how is HCM inherited?

A

autosomal DOMINANT, 50% penetration

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5
Q

how do HCM pts present?

A
  • syncope (often arrhythmogenic)
  • chest pain
  • sudden cardiac death
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6
Q

syncope in HCM pts may present in which 2 ways?

A
  • exertional syncope

- syncope a/w volume depletion

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7
Q

DON’T BE TRICKED

  • ALL pts w/ HCM should receive
A

genetic counseling

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8
Q

distinguishing HCM from AS:

HCM

  • carotid pulse
A

rises briskly, then declines, followed by second rise (pulsus bisferiens)

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9
Q

distinguishing HCM from AS:

HCM

  • ejection sound
A

none

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10
Q

distinguishing HCM from AS:

HCM

  • aortic regurgitation
A

none

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11
Q

distinguishing HCM from AS:

HCM

  • Valsalva maneuver
A

increased murmur intensity

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12
Q

distinguishing HCM from AS:

HCM

  • squatting to standing position
A

increased murmur intensity

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13
Q

distinguishing HCM from AS:

HCM

  • standing to squatting position
A

decreased murmur intensity

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14
Q

distinguishing HCM from AS:

HCM

  • carotid radiation
A

none

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15
Q

distinguishing HCM from AS:

HCM

  • apex beat
A

“triple ripple”

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16
Q

distinguishing HCM from AS:

AS

  • carotid pulse
A

rises slowly and has low volume (pulsus parvus et tardus)

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17
Q

distinguishing HCM from AS:

AS

  • ejection sound
A

present

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18
Q

distinguishing HCM from AS:

AS

  • aortic regurgitation
A

may be present

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19
Q

distinguishing HCM from AS:

AS

  • Valsalva maneuver
A

decreased murmur intensity

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20
Q

distinguishing HCM from AS:

AS

  • squatting to standing position
A

decreased murmur intensity

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21
Q

distinguishing HCM from AS:

AS

  • standing to squatting position
A

increased murmur intensity

22
Q

distinguishing HCM from AS:

AS

  • carotid radiation
A

usually present

23
Q

distinguishing HCM from AS:

AS

  • apex beat
A

sustained single

24
Q

ECG findings for HCM

A
  • LVH
  • LAE
  • deeply inverted, symmetric T waves in leads V3-V6 (apical hypertrophic form)
25
diagnostic technique of choice for HCM
echocardiogram
26
pts w/ HCM should avoid
strenuous exercise
27
first-line tx for HCM w/ EF of 50% or more, dyspnea, and/or CP
BBs
28
can CCBs (verapamil) be substituted for BBs for HCM tx?
yes
29
third-line agent that can be added if sxs and significant outflow gradient persist
disopyramide
30
HCM tx used ONLY if systolic dysfunction is present
ACEIs
31
tx for HCM and AF
WARFARIN for ALL pts w/ HCM and AF regardless of CHADS2 score
32
when is surgery or septal ablation for HCM indicated?
- outflow tract gradient > 50 mmHg | - persistent sxs despite max meds
33
sudden death risk factors in HCM
- previous cardiac arrest - spontaneous sustained VT - family h/o sudden death (first-degree relative) - unexplained syncope - LV wall thickness 30 mm or more - blunted increase or decrease in SBP w/ exercise - spontaneous NSVT - HF that progresses to DCM and LVEF 30% or less
34
when are HCM pts high risk for sudden death?
1 or more major risk factors
35
HCM pts who are high-risk for sudden death are candidates for
ICD
36
DON'T BE TRICKED - are ECGs useful in predicting sudden cardiac death?
NO
37
DON'T BE TRICKED - which meds should NOT be prescribed and why?
- digoxin - vasodilators - diuretics - they increase LV outflow obstruction
38
what condition can be difficult to differentiate from HCM?
athlete's heart (syndrome of myocardial hypertrophy)
39
clinical features distinguishing HCM from athlete's heart: HCM - family history
positive
40
clinical features distinguishing HCM from athlete's heart: HCM - ECG
- pathologic Q waves - TWIs - conduction defects
41
clinical features distinguishing HCM from athlete's heart: HCM - doppler echocardiography
diastolic filling abnormalities
42
clinical features distinguishing HCM from athlete's heart: HCM - extent of hypertrophy
> 15 mm
43
clinical features distinguishing HCM from athlete's heart: HCM - pattern of hypertrophy
- asymmetric - concentric - eccentric
44
clinical features distinguishing HCM from athlete's heart: HCM - LV end-diastolic dimension
< 45 mm
45
clinical features distinguishing HCM from athlete's heart: HCM - genetic testing
positive
46
clinical features distinguishing HCM from athlete's heart: athlete's heart - family history
negative
47
clinical features distinguishing HCM from athlete's heart: athlete's heart - ECG
normal
48
clinical features distinguishing HCM from athlete's heart: athlete's heart - doppler echocardiography
normal diastolic filling
49
clinical features distinguishing HCM from athlete's heart: athlete's heart - extent of hypertrophy
12 mm or less
50
clinical features distinguishing HCM from athlete's heart: athlete's heart - pattern of hypertrophy
concentric
51
LV end-diastolic dimension
> 55 mm
52
clinical features distinguishing HCM from athlete's heart: athlete's heart - genetic testing
negative

Board Basics Review (24 decks)

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