HOCM
Background
- Autosomal dominant (♂=♀) aymmmetrical septal hypertrophy
- Septal hypertrophy = obstruction but also SAM
- SAM = Systolic Anterior Motion of the anterior leaflet of the mitral valve - the valve hits the hypertrophied septum
- As pressure gradients ↑ (exercise) the obstruction worsens. Coronary vessels are filled during diastole ⇒ ischaemia ±arrhythmia
Clinical
Presents as:
- Chest pain, palpitations or pre-syncope during excecise
- Ask about FHx of HOCM or sudden cardiac death
Examination
- ↑JVP
- S4 or split second heart sound
- Crescendo-decrescendo systolic murmur (↑ with valsalva)
- Mitral regurg. murmur
- Resp. exam. normal
Investigations
- CXR not indicated - usually normal (rarely shows LVH)
- ECG = LVH (any QRS in any lead >27mm)
- May present as AF or VT
- ECG often normal - Hx important
- Dx in ED = ECHO (defintive = cardiac MRI as out patient)
Management
- If well, in sinus, discharge and GP to refer cardiology OPD
- If AF or VT - call EM senior
- Advise to avoid strenuous exercise until cardiology OPD
- Avoid/stop nitrates/ACEI
- Cardiology OPD may advise β-blockers ±surgery
Content by Dr Íomhar O' Sullivan 31/08/2018. Last review Dr ÍOS <8/02/25-->.