HYPERTROPHIC CARDIOMYOPATHY


Introduction

A condition in which the heart muscle becomes abnormally thick. HOCM is not common in children, there may be familial involvement.

Pathophysiology


  • It involves 4 interrelated processes:
  • Left ventricular outflow obstruction.
  • Diastolic dysfunction.
  • Myocardial ischemia.
  • Mitral regurgitation.

Clinical features

  • Patient present with exertional dyspnea.
  • Angina type chest pain.
  • Palpitation.
  • Syncope.
  • Arrhythmias.

Diagnosis

  • Physical examination: Pulse has upstroke with bisferiens character. Heaving of apex beat.4th heart sound is palpable at apex. Pansystolic murmur heard at apex and ejection systolic murmur at left sternal boarder
  • ECG shows left ventricular hypertrophy. ECG shows disproportionate hypertrophy of ventricular septum.
  • Cardiac catheterization and angiography confirm diagnosis.

Treatment

  • Treatment with beta blockers and verapamil to decrease obstruction.
  • Amiodarone or disopyramide use for control of arrhythmias.

Digitalis and diuretics are contraindicated in patient with HOCM.