MRCP revision battle 51.6: Hypertrophic cardiomyopathy

Hypertrophic obstructive cardiomyopathy is a condition in which there is left ventricular outflow tract obstruction due to asymmetric septal hypertrophy.

It is inherited in an autosomal dominant fashion but 50% of cases are sporadic.
 
Presentation may be with:

• angina
• syncope
• shortness of breath
• sudden death
• palpitations

Signs include:

• jerky pulse
• ESM radiating to axilla
• increases with valsalva, decreases with squatting
• large a waves
• double apical beat
• ?MR
• ?split S2

On ECG look for:

• LVH
• TWI
• Q waves
• possibly AF

Associations include:

• WPW
• phaechromocytoma
• Friedreichs ataxia

Poorer prognosis if:

• younger
• family history of sudden death
• syncope

No correlation between degree of LVOT obstruction and prognosis.


On angio look for a difference between the LV and aortic systolic pressures - in a normal patient they should be the same, in HCOM aortic pressure will be lower than LV pressure.


Management is:

• avoid 
• nitrates
• ACE-i
• inotropes
• atropin
• give beta blockers
• ?amiodarone
• ?ICD
• ?surgery

Annual mortality is 2.5% in adults, 6% in children.



Lets finish on the smelly topic of bacterial vaginosis...