Miscellaneous

Question 1

Dyslipidaemia

Answer 1

Secondary causes
- Hypothyroidism, Nephrotic Syndrome, CKD, Cholestasis, T2DM, Obesity, Excessive alcohol consumption, CKD, drugs (Thiazides, beta blockers, oral oestrogens, atypical anti-psychotics, antiretrovirals)

Question 2

Hypertrophic Obstructive Cardiomyopathy

Answer 2

Relatively common, inherited cardiac disease. 1 in 500 people. HCM-induced left ventricular hypertrophy
- 1% annual mortality rate. Most common cause of sudden cardiac death in young athletes.

Clinical Picture
- Mostly asymptomatic
- Most common symptom - Exertional dyspnoea
- Crescendo-decrescendo systolic murmur heard most over apex.

Ix
- ECG
- Echo- LVH> 11mm, presence of mitral regurgitation
- Treadmill Stress Echo - Exertional dyspnoea / presyncopy. Significant BP drop. Arrhythmias.
- 24 hour holter - Identify subclinical arrhythmias.
- Cardiac MRI - Gold standard for volumetric ventricular assessment.

Management
- Cease competitive sport to reduce chance of sudden cardiac death.
- Low or moderate intensity exercise can be allowed on an individual basis.
- Betablocker (E.g. Metoprolol) in symptomatic patient.
- Septal reduction therapy via septal myectomy. Consider when medical therapy ineffective and when patient has disabling symptoms.
- Implantable Cardioverter-defibrillator.
- Cascade testing for relatives. Pathogenic mutation can be found in 65% of cases.