Hypertrophic Obstructive Cardiomyopathy Blogs This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

An elderly patient with stuttering chest pain. Don't jump to conclusions.
I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis:What do you think?I went to the patient ' s chart:Elderly woman with stuttering chest pain and SOB, and dizziness.What do you think now?This is a very typical ECG for Hypertrophic Cardiomyopathy. I sent it to our EKG Nerdz group and Jesse McLaren replied: " Apical HOCM "It reminded me of many other cases I have seen, such as this one: Left Bundle Branch Block with Less Than 1 mm of Concordant ST Elevation (in the Setting of Hypertrophic Cardiomyopathy)HOCM that mimicked LBBB with OMI (concordant STE in V5)Case continu...
Source: Dr. Smith's ECG Blog - December 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Continuous prolonged generalized weakness, lightheadedness, and presyncope. What might you suspect from the ECG?
A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. There was some dyspnea but no chest pain. Here is his ECG. This shows LVH, with high voltage.LVH can have very thick-walled ventricles and a correspondingly small LV cavity. LVH is a common etiology of heart failure with preserved ejection fraction, as it may results in a stiff ventricle with poor diastolic relaxation.See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review)One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in pa...
Source: Dr. Smith's ECG Blog - October 28, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

“ Low quality ” Interventions in “ high quality ” cath labs
Recently, I visited a seven-star cardiology center. It had a fascinating lab with a near-360-degree roaming arm and floor (even the roof, I think!). The lab also had provision for optional thoracotomy support by surgeons and a CT scan. What’s more, I was told that an adorable robot will soon be added to the cath lab workforce to assist in delivering and maneuvering catheters. It’s truly amazing to see the advancements in science! I asked the chief staff nurse how many procedures are being performed per day. She pulled out an Excel chart from a gesture-controlled touch panel. It was clocking about 20 to 25 ca...
Source: Dr.S.Venkatesan MD - October 20, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized comparative efficacy trials cost effectiveness in medicine ethics in medicine EVO;LUTE PRO SAPIENS XT health economics HYBRID CATH LAB TAVR TAVI VALVE IN VALVE Source Type: blogs

This was texted to me in real time. The patient has acute chest pain.
This was texted to me in real time. The patient has acute chest pain.What do you think?Here was my answer:" Not ischemia. Chronic. Maybe HOCM or another form of LVH. I would not activate cath lab. Get serial troponins "It is a scary ECG, with a lot of ST Elevation and what appear to be hyperacute T-waves in inferior leads, and profound reciprocal ST Depression in aVL. There are Q-waves in V4-V6, with what appear to be hyperacute T-waves. Any objective, rule-based analysis of this ECG would scream " STEMI " or " OMI " . But, alas, ECGs are like faces. No measurements can t...
Source: Dr. Smith's ECG Blog - July 5, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it. Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate. Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is this strange looking ECG in a young woman?
I was reading EKGs on the system and saw this one,with no other information.What was my interpretation of these apparently abnormal precordial leads?Smith: Normal variant ST Elevation and T-wave inversion, probably in a young African American male.The Queen of Heart PM Cardio Bot also states: " Not OMI with High Confidence "Additionally, as Ken notes below, the limb leads are reversed.I later went into the chart:This was recorded in a young African American female with altered mental status (severe agitation) due to an unidentified intoxicant. She rapidly awoke and was discharged home. Electrolytes wer...
Source: Dr. Smith's ECG Blog - May 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Right Bundle Branch Block and Posterior OMI????
This 39 year old patient presents with syncope.What do you think?Thereappears to be RBBB with excessively discordant ST depression (2-2.5 mm) in V2 and V3, suggestive of RBBB with posterior OMIWhenever you see abnormal ST-T (ST elevation, ST depression, hyperacute T-waves), you MUST look at the entire ECG (rhythm, rate, P-waves, intervals, and QRS) to see if there is some abnormality among these which can explain the ST-T. One ' s first impression is that this is RBBB (tall R-wave in V1). But that is ONLY if you don ' t look at it closely, and don ' t look at the intervals.Differential of a Tall R-wa...
Source: Dr. Smith's ECG Blog - December 16, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

What is the role of Disopyramide in HCM?
Disopyramide is a class Ia antiarrhythmic agent which can be used in hypertrophic obstructive cardiomyopathy when beta blockers alone are ineffective. Disopyramide has a negative inotropic action and is useful in reducing left ventricular outflow tract gradients in hypertrophic obstructive cardiomyopathy and does not increase the risk of sudden cardiac death. Dose reduction is recommended when QTc exceeds 480 ms. It should be avoided in those with glaucoma and men with prostatic symptoms in view of its anticholinergic action. Anticholinergic action is responsible for increase in ventricular rate with atrial fibrillation. ...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Abnormal exercise blood pressure response in HOCM
Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been defined as failure to rise at least 20 mm Hg or fall of at least 20 mm Hg from peak level. Please note that exercise testing in HOCM could be risky and needs due precautions. Abnormal exercise blood pressure response in hypertrophic obstructive cardiomyopathy has been associated with increased risk of sudden cardiac death in younger individuals below the age of 40 years. Progressive increase in blood pressure upto peak exercise is the normal physiological response to exercise. Reference 1. Elliott PM, Anastasakis A, Borger M...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Which type of beta blocker is not ideal for HOCM?
Vasodilating beta blockers are not an ideal choice for the treatment of hypertrophic obstructive cardiomyopathy. Non vasodilating betablockers are recommended for the treatment of hypertrophic obstructive cardiomyopathy (Class I, Level of Evidence B, as per European Society of Cardiology Recommendations 2014). Other class I drug recommendation when beta blockers are not tolerated is verapamil. Disopyramide has a class I recommendation in combination with betablocker or verapamil. Reference 1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna W...
Source: Cardiophile MD - November 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is Morrow procedure?
Ventricular septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is otherwise known as Morrow procedure. In Morrow procedure, a rectangular trough is created in the basal left ventricular septum from below the aortic valve to a point beyond the point of contact of the anterior mitral leaflet to the septum (point of SAM septal contact). It is the procedure of choice for symptomatic drug refractory HOCM, provided it is done in centers with adequate experience with the procedure. Reference 1. Morrow AG, Reitz BA, Epstein SE, Henry WL, Conkle DM, Itscoitz SB, Redwood DR. Operative treatment in hypertrophic subao...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Role of beta blockers in hypertrophic obstructive cardiomyopathy (HOCM)
Beta blockers are the mainstay of medical treatment in hypertrophic cardiomyopathy with or without obstruction. They reduce the dynamic left ventricular outflow obstruction, angina, exertional dyspnea and the risk of ventricular arrhythmias [1]. Reduction in left ventricular outflow obstruction is mostly due to the negative inotropic effect of beta blockers [2]. Reduction in heart rate by beta blockers increases diastolic filling time. Sympatholytic effect of beta blockade can also reduce ventricular stiffness. Non-vasodilating beta blockers titrated to maximum tolerated dose is considered for those with symptomatic left ...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

In which condition is a hyperkinetic pulse associated with a normal pulse volume?
Hyperkinetic pulse usually has a high pulse volume but in hypertrophic obstructive cardiomyopathy, is it associated with a normal pulse volume. A hyperkinetic pulse in HOCM is due to rapid initial rate of development of left ventricular pressure. Volume is not high because left ventricular outflow obstruction sets in soon. A hyperkinetic pulse with normal pulse volume may also be noted in mitral regurgitation. Here again the dilated left ventricle empties rapidly, but volume is not high because part of the blood goes back into the left atrium and not the aorta. In all other conditions with hyperkinetic puls...
Source: Cardiophile MD - November 3, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is a myocardial bridge? Cardiology Basics
Normally the coronary arteries are located outside the myocardium. Occasionally a segment of the coronary artery passes through the myocardium. This causes a narrowing of that region in systole and is known as myocardial bridging. Myocardial bridging can be recognized as narrowing of a region of the coronary artery in systole which normalizes in diastole. Usually myocardial bridges do not cause myocardial ischemia as normally the blood flow into the myocardium occur mostly during diastole. Still myocardial bridges can rarely cause myocardial ischemia and cause chest pain. Rarely this may need recurrent hospital admi...
Source: Cardiophile MD - October 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

A man in his 60s with syncope. In syncope, what are we looking for on the ECG, and why?
Submitted and written by Rachel Plate M.D., with some edits by Smith and Meyers A man in his 60s with history of type 2 diabetes, obesity, obstructive sleep apnea requiring nightly CPAP, and hypertension presented for evaluation following a witnessed syncopal episode at home. The patient noted this occurred after standing and he did have prodromal symptoms including lightheadedness. EKG was obtained and shown below.What do you think? The ECG shows sinus rhythm a bifascicular block, both a right bundle branch block and a left anterior fascicular block. The P waves are hard to discern with the artifact ...
Source: Dr. Smith's ECG Blog - January 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs