Hypertrophic Obstructive Cardiomyopathy

Question 1

What is hypertrophic obstructive cardiomyopathy?

Answer 1

a condition where the left ventricle becomes hypertrophic, with thickening of the muscle.

• This tends to asymmetrically affect the septum of the heart, blocking the flow of blood out of the left ventricle. This is referred to as left ventricular outflow tract (LVOT) obstruction.

Question 2

What does hypertrophic obstructive cardiomyopathy increase a persons risk of? (4)

Answer 2

HF
MI
Arrhythmias
Sudden cardiac death

Question 3

What type of genetic mutation is found in hypertrophic obstructive cardiomyopathy?

Answer 3

Autosomal dominant
Defect in genes for sarcomere proteins

Question 4

What is the presentation of hypertrophic obstructive cardiomyopathy?

Answer 4

Most patients are asymptomatic.
Patients can present with non-specific symptoms. These may come on during exertion:
• Shortness of breath
• Fatigue
• Dizziness
• Syncope
• Chest pain
• Palpitations

Severe cases may present with symptoms of heart failure (e.g., cough, shortness of breath, orthopnoea, paroxysmal nocturnal dyspnoea and oedema).

Question 5

What examination findings are seen in hypertrophic obstructive cardiomyopathy? (3)

Answer 5

• Ejection systolic murmur at the lower left sternal border (louder with the valsalva manoeuvre)
• Fourth heart sound
• Thrill at the lower left sternal border

Question 6

What are the management options for hypertrophic obstructive cardiomyopathy? (5)

Answer 6

• Beta blockers
• Surgical myectomy (removing part of the heart muscle to relieve the obstruction)
• Alcohol septal ablation (a catheter-based, minimally invasive procedure to shrink the obstructive tissue)
• Implantable cardioverter defibrillator (for those at risk of sudden cardiac death or ventricular arrhythmias)
• Heart transplant

Question 7

What 3 things are patients with hypertrophic obstructive cardiomyopathy told to avoid?

Answer 7

Exercise
Heavy lifting
Dehydration

Question 8

Which 2 drug types should be avoided in hypertrophic obstructive cardiomyopathy?
Why?

Answer 8

ACEi and nitrates
Can worsen LVOT obstruction

Question 9

What are the complications of hypertrophic obstructive cardiomyopathy? (4)

Answer 9

• Arrhythmias (e.g., atrial fibrillation)
• Mitral regurgitation
• Heart failure
• Sudden cardiac death