Left Ventricular Outflow Obstruction
Systolic dysfunction - An abnormal blood pressure response to exercise is seen in 25% of patients with hypertrophic cardiomyopathy. This abnormal blood pressure response is defined by a failure of systolic blood pressure to rise more than 20mmHg or a fall in systolic blood pressure.
Apical hypertrophic cardiomyopathy may show symmetrical T-wave inversions across the precordium.
A normal sinus rhythm is mostly present but supra-ventricular tachycardia, premature ventricular contractions and non-sustained ventricular tachycardia has been demonstrated from 24-hour ambulatory monitoring.
Atrial fibrillation may occur in 25 to 30% of the older population and carries significant risks.
Early activation of the ventricles (Preexcitation) has been linked to hypertrophic cardiomyopathy, the Deterioration and sudden death may arise from the rapid ventricular response with atrial fibrillation.
25% of patients show abnormal Q-waves reflecting prior myocardial infarction, usually due to the disturbance of activation of ventricular septum, Asymmetrical septal hypertrophy and produces:
70% to 80% of patients will have left ventricular hypertrophy (LVH) present.
5% of patients with hypertrophic cardiomyopathy will have a normal ECG presentation.
Many patients are asymptomatic
Clinical Symptoms include
Sudden death common in young adults, occurring mostly in patients with no or mild symptoms usually occurs during or just after intense physical activity.
End stage dilated phase, patients show progressive symptoms of congestive heart failure and a severe intolerance of exercise. In general the ‘End stage dilated phase, is when the patients left ventricular cavity enlarges leading to the disappearance of the outflow tract gradient and the ventricle resembles that of a dilated cardiomyopathy.
Arterial and carotid pulsation
ECG Presentation (See ECG Presentation)
Cardiac Magnetic resonance imaging
Pharmacology of symptomatic obstructive hypertrophic cardiomyopathy
Sudden Cardiac Arrest- Chain of survival
Resuscitation- Queensland Ambulance Service.
Surgical Septal Myectomy
Pacemaker Capable devices.
Sudden Cardiac Death Risk Factors
Isometric exercise like weight lifting or anaerobic strenuous exercises that increase afterload.
End-stage hypertrophic cardiomyopathy
Dehydration from taking diuretics, consumption of alcohol, taking hot baths or showers, vomiting and diarrhoea.