HYPERTROPHIC​ ​CARDIOMYOPATHY​ ​CASE​ ​VIGNETTES

MarkTuttleMD.com

1. A​ ​68​ ​year​ ​old​ ​man​ ​with​ ​hypertension,​ ​dyslipidemia​ ​presents​ ​with​ ​a​ ​syncopal​ ​episode​ ​and​ ​is​ ​admitted​ ​to a​ ​telemetry​ ​bed​ ​for​ ​monitoring.​ ​ ​Echocardiography​ ​demonstrates​ ​symmetric​ ​hypertrophy​ ​of​ ​16mm​ ​and no​ ​obstruction/LVOT​ ​gradient. →​ ​Does​ ​this​ ​patient​ ​have​ ​hypertrophic​ ​cardiomyopathy? →​ ​How​ ​should​ ​we​ ​manage​ ​this​ ​patient? 2. A​ ​48​ ​year​ ​old​ ​man​ ​with​ ​known​ ​hypertrophic​ ​cardiomyopathy​ ​presents​ ​with​ ​a​ ​syncopal​ ​episode.​ ​ ​He takes​ ​no​ ​medications.​ ​ ​Vital​ ​signs​ ​are​ ​normal.​ ​ ​Echocardiography​ ​demonstrates​ ​a​ ​large​ ​60​ ​mmHg obstructive​ ​gradient​ ​at​ ​rest​ ​which​ ​worsens​ ​with​ ​provocative​ ​maneuvers.​ ​ ​This​ ​is​ ​suspected​ ​to​ ​be​ ​the cause​ ​of​ ​his​ ​syncope. →​ ​Should​ ​we​ ​ask​ ​Roger​ ​Laham​ ​to​ ​perform​ ​an​ ​alcohol​ ​septal​ ​ablation​ ​on​ ​this​ ​patient? 3. A​ ​59​ ​year​ ​old​ ​woman​ ​presents​ ​for​ ​the​ ​evaluation​ ​of​ ​hypertrophy​ ​seen​ ​on​ ​echocardiography.​ ​ ​Her echocardiogram​ ​demonstrates​ ​a​ ​isolated​ ​hypertrophy​ ​(18​ ​mm)​ ​of​ ​the​ ​apex​ ​without​ ​any​ ​evidence​ ​of obstruction.​ ​ ​She​ ​is​ ​started​ ​on​ ​a​ ​beta​ ​blocker.​ ​ ​Holter​ ​monitoring​ ​demonstrates​ ​NSVT. →​ ​Should​ ​we​ ​ask​ ​Peter​ ​Zimetbaum​ ​to​ ​put​ ​an​ ​ICD​ ​in​ ​this​ ​patient? 4. An​ ​81​ ​year​ ​old​ ​woman​ ​with​ ​hypertrophic​ ​cardiomyopathy​ ​is​ ​admitted​ ​to​ ​BIDMC​ ​with​ ​gastroenteritis. She​ ​develops​ ​atrial​ ​fibrillation​ ​with​ ​rapid​ ​ventricular​ ​response,​ ​hypotension​ ​(80/40​ ​mmHg). →​ ​How​ ​should​ ​she​ ​be​ ​managed?