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Cardiology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Hypertrophic obstructive cardiomyopathy (thickened heart muscle) Cause: inherited (seek family history of sudden death). Clinical features: similar to aortic stenosis. Hypertrophic septum on echo. Management: β-blockers (if chest pain, SOB), amiodarone (for arrhythmias), consider myectomy and PPM.
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Severe valvulopathies, such as critical aortic stenosis or mitral stenosis, can be treated with surgery. Medical management and possibly cardiac pacing may be indicated for patients with hypertrophic obstructive cardiomyopathy.
Drugs, accidents and poisoning
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
15.12. Beta-blocking agents such as propranolol are contraindicated in the presence oftetralogy of Fallot.hypertrophic obstructive cardiomyopathy.digoxin overdose.asthma.cyanotic congenital heart disease.
Long-term outcome of conservative and invasive treatment in patients with hypertrophic obstructive cardiomyopathy
Published in Acta Cardiologica, 2019
Sarah Hoedemakers, Bert Vandenberk, Max Liebregts, Tijs Bringmans, Pieter Vriesendorp, Rik Willems, Johan Van Cleemput
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder. It is estimated to affect about 1 in 500 adults (0.2%) [1]. HCM may lead to sudden cardiac death (SCD), heart failure and stroke, the former occurring more in adolescents and young adults [2–5]. With more effective risk stratification and the implantation of cardioverter-defibrillators (ICDs) annual mortality is now estimated at less than 1% [6]. HCM is most frequently caused by pathogenic mutations in sarcomere protein genes, leading to hypertrophy of the myocardial cells and an increased left ventricular wall thickness (LVWT). Hypertrophic obstructive cardiomyopathy (HOCM) is a form of HCM in which the hypertrophy causes obstruction of the left ventricular outflow tract (LVOT). The obstruction is typically caused by an asymmetrical septal hypertrophic pattern of the interventricular septum and systolic anterior movement (SAM) of the mitral valve. It is present in approximately one-third of HCM patients at rest. In one-third, the obstruction is dynamic and only occurs during exercise or after provocative manoeuvres. LVOT obstruction can be asymptomatic or cause symptoms of dizziness, fainting, angina, dyspnoea and is an independent predictor of adverse outcomes, cardiac arrhythmias and SCD [7].
Valvular Resistance and Bleeding Events Among Patients Undergoing Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2019
Masahiko Asami, Thomas Pilgrim, Stefan Stortecky, Fabien Praz, Jonas Lanz, Dik Heg, Eva Roost, Stephan Windecker, Lukas Hunziker
Almost one in three patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) experiences a bleeding event within 5 years from intervention, half of which are unrelated to the access site.1 Bleeding complications among patients undergoing TAVR importantly increase the risk of mortality and have been associated with advanced age, female sex, lower body mass index, anemia, diabetes, and renal failure.2,3 Acquired type 2A von Willebrand syndrome may provide a mechanistic explanation for an increased bleeding tendency in patients with AS.4–6 The underlying mechanism of this unique disease is believed to be the mechanical disruption of large von Willebrand factor multimers associated with high fluid shear stress as they pass through the narrow aortic valve.7,8 This phenomenon has been described in other high shear stress conditions, such as hypertrophic obstructive cardiomyopathy9,10 and supra-valvular AS.11 Thus, a pathological state with a high fluid shear stress may be the cause of this bleeding tendency. However, it remains difficult to identify patients at increased risk of bleeding in this setting. Aortic valvular resistance (VR), which can be calculated from a routine right heart catheterization (RHC) measurement, was shown to be exponentially inversely associated with aortic valve area (AVA).12 Thus, higher VR is a potential marker of high shear stress and may be an indicator for bleeding risk.
Pharmacological and non-pharmacological treatment of obstructive hypertrophic cardiomyopathy
Published in Expert Review of Cardiovascular Therapy, 2018
Luis F. Hidalgo, Srihari S. Naidu, Wilbert S. Aronow
The treatment of hypertrophic obstructive cardiomyopathy currently includes pharmacological and non-pharmacological measures, as well as lifestyle maneuvers, with the main goal of improving morbidity and potentially decreasing mortality [1]. Hypertrophic cardiomyopathy has a prevalence of 1 in 500 individuals worldwide; however, the population at risk seems to be larger by some estimates [2]. Indeed, epidemiologic studies now find that around 1 in 200 individuals may be carriers of pathogenic genes related to hypertrophic cardiomyopathy [3]. The high prevalence and the population at risk advocate for a better understanding of what can be achieved with current treatment by general cardiologists and not simply by experts in the field, who remain confined to large tertiary referral centers.