CC: palpitation
Diagnosis:
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Clinical signs:
Pulse is jerky
Double apical impulse
Area to examine ?
The Heart
Differential diagnosis:
Aortic stenosis
Mitral regurgitation
What will you do ?
ECG: LVH and T- inversion in most leads
TTE: asymmetrical septal hypertrophy and systolic anterior motion ( SAM ) of the anterior mitral
leaflet
Cardiac MRI
Genetic tests: sarcomeric protein mutation
Management:
Asymptomatic
Avoid strenuous exercise, vasodilators and dehydration
Symptomatic and LVOT gradient > 30 mm HG
B-blocker
Pacemaker
Alcohol septal ablation
Surgical myomectomy
Other options
ICD
Heart transplant
Poor prognosis:
Young age at diagnosis
Syncope
Family history of sudden death
Septal thickness > 3 cm
Remember:
Genetic counseling for first degree relatives ( this is autosomal dominant )
Include HOCMB in the differential diagnosis of the murmurs of AS, MR and MVP and VSD
