LVH & Heart murmurLVH & Heart murmur

• Murmur– Increased w/ standing

– Decreased w/ supine leg raising, squatting

– Markedly increased with Amyl Nitrite**Don’t try this at home

CardiomyopathyCardiomyopathy

• Cardiomyopathy– Restrictive– Dilated– Hypertrophic

• Hypertrophic cardiomyopathy (HC)– AKA:

• Idiopathic Hypertrophic Subaortic IHSS

• ASH

Hypertrophic cardiomyopathy (HC)

Hypertrophic cardiomyopathy (HC)

• Asymmetric abnormal septal growth associated with subaortic obstruction.

• Dynamic obstruction– Increases w/ decreased ventricle size

• Often presents in 3rd decade but can range from infants –elderly

• Etiology ?• Autosomal Dominant

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy

• Symptoms – None –> sudden death– Implicated in sudden death of athletes– Dyspnea, palpatations, angina,

syncope

ExamExam

• Can be normal• Signs LVH• Murmur

– Harsh crescendo –decrescendo systolic murmur at the apex

– Increased w/ standing, tachycardia, Amyl Nitrite, NTG, exercise

– Decreased w/ squatting, isometric hand grip, beta blockade

EKGEKG

• Pseudoinfarct patterns with noninfarctional Q waves and ST-T-wave changes

• “Differentiating the EKG pseudoinfarctional patterns of IHSS from AMI may be impossible. “

EvaluationEvaluation

• Echo

• Thalium (may show defects w/ nl coronary arteries)

• Cardiac cath

TreatmentTreatment

• Reduce contractility, increase ventricular volume

• Beta blockers, Calcium channel blockers

• Avoid sports or strenuous activity

Why is this important for us?Why is this important for us?• Sudden death in a young person is bad

– Difficult to predict• Syncope is ominous in kids, not a predictor in

adults• HX NSVT is a predictor in adults

• Relatives should be evaluated• Avoid certain drugs• Difficult to differentiate from normal

hypertrophy seen in athletes