What is Brockenbrough Braunwald Morrow sign?
The Brockenbrough–Braunwald–Morrow sign is the paradoxical decrease in pulse pressure during the post-extrasystole beat seen in patients with hypertrophic obstructive cardiomyopathy.
What is the most common presenting symptom of HCM?
The most common presenting symptom of hypertrophic cardiomyopathy is dyspnea. Patients also can develop syncope, palpitations, angina, orthopnea, paroxysmal nocturnal dyspnea, dizziness, congestive heart failure, and sudden cardiac death. The latter represents the most devastating presenting symptom.
Why are there two murmurs in HOCM?
The second murmur is because of turbulent flow through the outflow tract and is present as a mid-systolic, crescendo-decrescendo murmur, often loudest at the left lower sternal border, which can mimic the murmur of aortic stenosis. Maneuvers may enable the differentiation between the two entities.
What is Brockenbrough?
The Brockenbrough phenomenon occurs during left ventricular outflow tract obstruction such as in patients with hypertrophic obstructive cardiomyopathy (HOCM). This phenomenon is defined as an increase in pulse pressure after an ectopic beat (usually a premature ventricular contraction or PVC).
What is normal Lvot gradient?
LVOT obstruction is defined as a peak instantaneous gradient greater than or equal to 30 mm Hg. A gradient greater than or equal to 50 mm Hg is generally recognized as the threshold at which LVOT obstruction becomes hemodynamically significant.
What is the difference between HCM and LVH?
Hypertrophic cardiomyopathy (HCM) is defined as unexplained left ventricular hypertrophy (LVH) in the absence of precipitating factors such as hypertension or aortic stenosis.
Can ECG detect HCM?
Test based on electrocardiograms (ECG) that record the heart electrical activity can help in early detection of patients with hypertrophic cardiomyopathy (HCM) where the heart muscle is partially thickened and blood flow is (potentially fatally) obstructed.
Why is there Sam in HOCM?
Systolic anterior motion (SAM) of the mitral valve is the cause of dynamic outflow obstruction in most patients with hypertrophic cardiomyopathy (HCM). There is agreement that SAM is caused by the action of left ventricular (LV) flow on the protruding mitral valve leaflet (1).
What does Lvot stand for?
Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality.
What is LV outflow gradient?
How do you diagnose HOCM?
Echocardiogram. An echocardiogram is commonly used to diagnose hypertrophic cardiomyopathy. This test uses sound waves (ultrasound) to see if the heart’s muscle is unusually thick. It also shows how well the heart’s chambers and valves are pumping blood.
Why is digoxin contraindicated in HOCM?
Digoxin can increase inotropy which may exacerbate heart symptoms in patients with HCM that have preserved systolic function. In patients that have refractory AF with rapid ventricular rates, atrioventricular node ablation and permanent pacing is an alternative.
What is the difference between HOCM and HCM?
Hypertrophic cardiomyopathy (HCM) is the most common hereditary disease of the heart. The more common obstructive form (HOCM, 70%) of hypertrophic cardiomyopathy can be differentiated from the less common non-obstructive form (HNCM, 30%).
Can you see Hocm on ECG?
The classic ECG finding in hypertrophic obstructive cardiomyopathy is large dagger-like “septal Q waves” in the lateral — and sometimes inferior — leads due to the abnormally hypertrophied interventricular septum. Criteria for left ventricular hypertrophy is usually present.
How is Hocm diagnosed?
An echocardiogram is commonly used to diagnose hypertrophic cardiomyopathy. This test uses sound waves (ultrasound) to see if the heart’s muscle is unusually thick. It also shows how well the heart’s chambers and valves are pumping blood. Electrocardiogram (ECG or EKG).
Why nitrates are contraindicated in HOCM?
Agents to reduce pre- or afterload (such as nitrate, ACE inhibitors, nifedipine-type calcium antagonists) are contraindicated with HOCM due to possible aggravation of the outflow tract obstruction. This often impedes therapy of coexistent arterial hypertension.