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Concentric Left Ventricular Hypertrophy
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Concentric Left Ventricular Hypertrophy

  Dear Doctor,
  I hope that you can help to answer the questions that I now submit.  I shal be succinct in my approach.  Thank you.
  Firstly, just let me provide you with an overview thus far of the relationship that my family have with HCM:  the condition was first detected three and half years ago, when my sister died suddenly at the age of 30 of HCM.  All members of my family were subsequently screened (ECHO and ECG) and it was discovered that my father has a mild form, thankfully not requiring the administration of the listed drugs.  I have two other sisters and one brother.  I am the oldest at 35 and my brother at 26. It is my brother that I am most concerned about.  For the past three and half years, we as a family have insisted on proper screening and thus far we have all been formally screened on three occasions.  This time, it was revealed that my brother shows mild concentric left ventricular hypertrophy.  The cardiologist here in Dublin has recognised the above, I quote from his letter "This would come under the heading then of possible HOCM.  It is frustrating that I cannot be more definite that that.  I suggest an Echo in six months.' unquote.  
  Is it sensible to wait six months for another Echo?  Should not an ECG be involved also?
  That his heart shows mild concentric left ventricular hypertrophy, is this not HCM?
  What are the chances of the muscle tissue now evenly distributed throughout the ventricle (concentic lv hypertrophy) becoming thicker and thus more obstructive to the blood flow from the heart?  
  If diagnosed as HCM would he require drug therapy?  
  Are arrhythmias a concern in this instance?
  What is the difference between HCM and HOCM?  The cardiologist writes 'HOCM' .
  Could it change from 'mild concentric left ventricular hypertrophy' to another form, a more severe form, determining another situation?
  Can a patient with the above diagnosis, be a victim of sudden death?  His age is a factor, is'nt it?
  Perhaps, I have too many questions, if you cannot answer all I would be ever so grateful for as many as you can.  Thank you for your help in advance.  On behalf of my family, thank you.
  Karen Murphy
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Dear Karen,
Firstly, I am very sorry for the loss of your sister.  Unfortunately, sudden cardiac death is often the first "presentation" for patients with HOCM.
1)Since there is no predicting whether or not your brother's hypertrophy will progress, 6 months is a very sensible time to wait.  For all we know he can have a very mild form like your father, i.e. it will never develop in to the significant HOCM that it sounds like your sister had.  Keep  in mind Karen that for patients with HOCM (HCM is just another abbreviation that means the same thing), the risk of sudden death from an arrhythmia is there regardless of the degree of hypertrophy, and we have no current way of figuring out which patients are most likely to have sudden death from an arrhythmia (i.e. it does not seem to correlate with anything on the ecg, the echo, or anything in the history.)  So it would benefit your family to discuss with the doctor specifically, the risk of sudden death from an arrhythmia, even though as I say the medical profession is way behind the eight ball on this subject.
2)There are certain criteria for HOCM/HCM, and I am sure that the doctor simply does not want to give your brother a diagnosis as such unless he really has it.
3)The chances of the muscle tissue hypertrophying further and thereby obstructing the flow of blood in his heart is completely unpredictable.
4)If diagnosed with HOCM, more than likely, yes he would require drug therapy, but keep in mind, if your brother develops HOCM and has no symptoms of blood flow obstruction, then likely he will not require drug therapy until he does develop symptoms.  On the other hand and completely separate from the "obstructive" aspect of the disease, the doctor may choose to place him on a drug that s/he believes might reduce the risk of sudden death from an arrhythmia.
5)As answered above, there is a concern for arrhythmia, however, we do not fully understand the triggers, who is at greater risk, etc.  
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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