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Heart Disease (Expert Forum)
Re: Hypertrophic Obstructive Cardiomyopathy
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Re: Hypertrophic Obstructive Cardiomyopathy
by CCF CARDIO MD APS, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD-APS on September 08, 1998 at 10:07:21:
In Reply to: Hypertrophic Obstructive Cardiomyopathy posted by Patrick on September 01, 1998 at 19:22:19:
I recently underwent an echo. I have had Hypertrophic Obstructive Cardiomyopathy for the past 15 years. There was a significant thickening of the septum within the past year(from 1.4 CM to 1.9 CM. My Cardiologist recommended surgery if the septum would increase in thickness much more. I would like to share the results of my latest echo and ask you for your advice Left Ventricle: Diastolic 4.5 CM Systolic 2.3 CM Septum 1.9 CM
Posterior Wall 0.9 Cm Left Atrium 3.8 CM Aortic Root 3.4 CM Aortic Root Excursion 1.9 CM. Estimated Ejection Fraction 73%.
Interpretation by M-Mode and 2-D: Aortic Root Non dilated Aortic Valve-Normal. Left Ventricle- Shows moderately severe asymmetric septal hypertrophy localized to the subaortic region. Left Ventricular systolic function is normal. Mitral Valve-Normal. Left Atrium-Top Normal. Right Ventricle-Normal Tricuspid Valve-Normal Right Atrium-Normal.
Interpretation by Doppler Tricuspid - No regurgitation Mitral Valve-No regurgitation. Aortic Valve- LV outflow gradient less than 10 and no regurgitation.
____
Dear Patrick,
The advice given any HOCM patient is based on a number of factors, not on the echocardiographic
findings alone. For instance, if the patient is symptomatic-has had syncope or episodes of 'almost
passing out', one is likely to be more aggressive in treatment. The gradient of 10mmHg is very unlikely to
cause any problems in anyone, however in HOCM patients one usually test for a provocable gradient, that is
one that increases significantly with administration of amyl nitrate while doing the echo. Other things to
look for that you mention not, are the function of the anterior mitral valve leaflet in relation to the septal
thickening, whether or not the relaxing properties of the heart called diastolic function are impaired, and the list
goes on. Actually their are quite a few tests other than the echo that should be done and combined with the
history and physical in order to make specific management decisions.
In short a history, an echo, an ecg, 48hour ecg monitoring, and an exercise test
are all that is necessary to put together a management plan for the patient. The goal of the
clinical management of course is to provide relief of symptoms and prevent future complications.
The main management options are medicines(pharmacologic) and surgical, plus some 'others' that are less proven so to speak.
Without knowing more of your symptomatic history nor your gradient properties (does it increase when given amyl nitrate?) I
really can comment no more. Feel free to resubmit further information and questions. Good Luck.
Information provided in the heart forum is intended for general medical informational
purposes only, actual diagnosis and treatment can only be made by your physician(s).
In Reply to: Hypertrophic Obstructive Cardiomyopathy posted by Patrick on September 01, 1998 at 19:22:19:
I recently underwent an echo. I have had Hypertrophic Obstructive Cardiomyopathy for the past 15 years. There was a significant thickening of the septum within the past year(from 1.4 CM to 1.9 CM. My Cardiologist recommended surgery if the septum would increase in thickness much more. I would like to share the results of my latest echo and ask you for your advice Left Ventricle: Diastolic 4.5 CM Systolic 2.3 CM Septum 1.9 CM
Posterior Wall 0.9 Cm Left Atrium 3.8 CM Aortic Root 3.4 CM Aortic Root Excursion 1.9 CM. Estimated Ejection Fraction 73%.
Interpretation by M-Mode and 2-D: Aortic Root Non dilated Aortic Valve-Normal. Left Ventricle- Shows moderately severe asymmetric septal hypertrophy localized to the subaortic region. Left Ventricular systolic function is normal. Mitral Valve-Normal. Left Atrium-Top Normal. Right Ventricle-Normal Tricuspid Valve-Normal Right Atrium-Normal.
Interpretation by Doppler Tricuspid - No regurgitation Mitral Valve-No regurgitation. Aortic Valve- LV outflow gradient less than 10 and no regurgitation.
____
Dear Patrick,
The advice given any HOCM patient is based on a number of factors, not on the echocardiographic
findings alone. For instance, if the patient is symptomatic-has had syncope or episodes of 'almost
passing out', one is likely to be more aggressive in treatment. The gradient of 10mmHg is very unlikely to
cause any problems in anyone, however in HOCM patients one usually test for a provocable gradient, that is
one that increases significantly with administration of amyl nitrate while doing the echo. Other things to
look for that you mention not, are the function of the anterior mitral valve leaflet in relation to the septal
thickening, whether or not the relaxing properties of the heart called diastolic function are impaired, and the list
goes on. Actually their are quite a few tests other than the echo that should be done and combined with the
history and physical in order to make specific management decisions.
In short a history, an echo, an ecg, 48hour ecg monitoring, and an exercise test
are all that is necessary to put together a management plan for the patient. The goal of the
clinical management of course is to provide relief of symptoms and prevent future complications.
The main management options are medicines(pharmacologic) and surgical, plus some 'others' that are less proven so to speak.
Without knowing more of your symptomatic history nor your gradient properties (does it increase when given amyl nitrate?) I
really can comment no more. Feel free to resubmit further information and questions. Good Luck.
Information provided in the heart forum is intended for general medical informational
purposes only, actual diagnosis and treatment can only be made by your physician(s).
