LVOT gradient in HOCM – Doppler echocardiogram

LVOT gradient in HOCM – Doppler echocardiogram Left ventricular outflow tract gradient in hypertrophic obstructive cardiomyopathy Left ventricular outflow tract gradient (LVOT) in hypertrophic obstructive cardiomyopathy (HOCM) is usually  measured from the apical five chamber view (apical 5C) in echocardiography. Initially the apical 5C view is obtained and then the colour Doppler flow mapping (CFM) is done to locate the flow in LVOT. Continuous wave (CW) Doppler cursor is then aligned along the LVOT colour jet of HOCM. The CW jet in HOCM is described as dagger shaped or sickle shaped, unlike the symmetrical tongue shaped jet in fixed obstruction of aortic stenosis. The shape of the jet indicates the dynamic nature of LVOT obstruction in hypertrophic cardiomyopathy. The gradient progressively increases as the systole progresses, to produce this characteristic appearance. The delayed peaking in systole is quite evident (marked by the asterisk). Dynamic variation of LVOT gradient in hypertrophic cardiomyopathy (HCM) Dynamic variation of LVOT gradient in hypertrophic cardiomyopathy (HCM) can be quite variable. When the left ventricular cavity is small due to hypovolemia or dehydration, the gradient can rise significantly. Various manoeuvers like isometric handgrip, Valsalva maneuver and standing can bring out the gradient well when it is low in the basal state. But getting a good echocardiographic image during these maneuvers may be challenging. The dynamic variation ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Echocardiogram Library Echocardiography Dynamic variation of LVOT gradient in hypertrophic cardiomyopathy Source Type: blogs

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Conclusions: Our case series underscores the efficacy of ASA at relieving LVOT obstruction and improving symptoms in properly selected HOCM patients, with acceptably low procedural and long term mortality and morbidity. PMID: 31204591 [PubMed - as supplied by publisher]
Source: Acta Cardiologica - Category: Cardiology Tags: Acta Cardiol Source Type: research
There has been debate on the importance and pathophysiologic effects of the dynamic subaortic pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM). The study was conducted to elucidate the hemodynamic abnormalities associated with the dynamic pressure gradient in HOCM.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Source Type: research
Authors: Horiuchi H, Doman T, Kokame K, Saiki Y, Matsumoto M Abstract The blood glycoprotein von Willebrand factor (VWF) plays an important role in hemostasis and thrombosis.VWF is produced and secreted as large multimers by endothelial cells and megakaryocytes. It is then cleaved in a sheer-stress dependent manner by a specific protease, ADAMTS13, into multimers consisting of 2-80 subunits. Among VWF multimers, high molecular weight (HMW) multimers play important roles in platelet aggregation. Therefore, their loss induces a hemostatic disorder known as von Willebrand disease (VWD) type 2A. Various cardiovascular ...
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
ConclusionsPatients with aortic stenosis most often develop symmetric hypertrophy; however, a small subset has asymmetric septal hypertrophy leading to left ventricular outflow tract obstruction. In cases of severe aortic stenosis, however, evidence of left ventricular outflow tract obstruction via both symptoms and echocardiographic findings may be minimized due to extremely high afterload on the left ventricle. Diagnosing a left ventricular outflow tract obstruction as the cause of hemodynamic instability during transcatheter aortic valve replacement, in the absence of abnormal findings on echocardiogram preoperatively, ...
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
This study aimed to report a case of hypertrophic obstructive cardiomyopathy causing an illusion of aortic stenosis on imaging. Patient concerns: A 71-year-old woman presented with chest tightness after activity for 1 year and coughing for 2 months. A systolic 3/6 grade murmur was found in the third intercostals of the left border of sternum. Transthoracic echocardiography, transesophageal echocardiography, and magnetic resonance imaging (MRI) were all suggestive of aortic stenosis and left ventricular outflow tract stenosis. Diagnosis: The patient was diagnosed with “severe aortic stenosis (bicuspid deformity)...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Differentiation of supravalvar aortic stenosis from valvular and subvalvular variety Murmur Murmur of subvalvular aortic stenosis is unlikely to radiate to the carotids. Murmur of supravalvar aortic stenosis may radiate more to the right carotid. Murmur of valvular aortic stenosis radiates to both carotids. Ejection click Ejection click is in favour valvular aortic stenosis. Associated aortic regurgitation Supravalvar aortic stenosis is unlikely to be associated with aortic regurgitation, while it can occur in valvular and subvalvular variety. In fact aortic regurgitation may be seen in almost half of those with subvalvula...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Anisosphygmia Aortic regurgitation Aortic stenosis subvalvar aortic stenosis supravalvar aortic stenosis Source Type: blogs
CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it's worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?Th...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Severe gastrointestinal bleeding can occur in those with severe aortic stenosis (Heyde’s syndrome). The initial description was in 1958 [1]. An important mechanism for the bleeding is deficiency of large von Willebrand factor multimers. This is due to the structural damage to the large protein when blood passes through the severely stenotic aortic valve as a high velocity jet. Loss of large multimers can be measured as the large von Willebrand factor multimer index and it is significant if it is less than 80% [2]. Anemia due to Heyde’s syndrome improves after aortic valve replacement. The gastro intestinal blee...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
Management of supraventricular tachycardia with Wolf Parkinson White syndrome is frequently challenging. A 67-year-old Hispanic male was brought to the emergency department by ambulance with complaints of chest pain and palpitations that began 2 hours prior to arrival. Past medical history included Wolf Parkinson White with accessory pathway ablation, coronary artery disease with single vessel bypass graft surgery, hypertrophic obstructive cardiomyopathy (post-myectomy), aortic valve replacement for aortic stenosis, diabetes mellitus type II, and hypertension.
Source: The American Journal of Medicine - Category: Journals (General) Authors: Tags: Diagnostic Dilemma Source Type: research
Management of supraventricular tachycardia with Wolff-Parkinson-White syndrome is frequently challenging. A 67-year-old Hispanic man was brought to the emergency department by ambulance with symptoms of chest pain and palpitations that began 2 hours before arrival. His medical history included Wolff-Parkinson-White with accessory pathway ablation, coronary artery disease with single-vessel bypass graft surgery, hypertrophic obstructive cardiomyopathy (postmyectomy), aortic valve replacement for aortic stenosis, diabetes mellitus type II, and hypertension.
Source: The American Journal of Medicine - Category: Journals (General) Authors: Tags: Diagnostic dilemma Source Type: research
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