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8/12/2019 A Patient of Recurrent Syncope 97-2003 Ppt
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WELCOME
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A PATIENTOF
RECURRENTSYNCOPE
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SALIENTFEATURES:
Mr . Abdul Mazid, 30 yrs old male, healing from
Saidullahpur, Gaibandha, presented with complains
several attacks of syncope in last 3 years, wasassociated with dyspnoea on effort, exertional
tirdness and intermittent mild chest pain. He had
recovered completely from syncope within 2 minutes
on each occasion without neurological sequelae or
transient confusion. He had no notable past medical
history, was not taking any medications, and had nofamily historyof either syncope or sudden death.
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SALIENTFEATURES(CONT.)
On examination , his pulsewas 96beats per minute
(Regular), BP was 110/60 mm Hg with no postural
drop, pallor was absent, he was non-icteric and
non-cyanosed. Finger clubbing was absent , JVP-
Not raised and Ankle oedema was absent. His
neurological examination was unremarkable andcardiovascular examination revealed , visible
apical pulsation. Thrusting apical impulse on
palpation with double impulse and slight shifting
towards left.
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SALIENTFEATURES(CONT.)
There was no palpable thrills or RV heave. On
auscultation, Heart sound s1 and s2 were audiblein all four areas , with a pan-systolic murmer heard
over mitral and tricuspid area and radiates towards
axila. All ther systemic examination revealed
nothing abnormal.
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DIFFERENTIALDOAGNOSIS:
1. VSD
2. Aortic Stenosis
3. Hypertrophic
Cardiomyopathy(HCM)
4. Mitral Vulvular Diseases
(MVD).
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INVESTIGATION: CBC
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INVESTIGATIONS: CXR P/A VIEW
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INVESTIGATION: ECG
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ECHOCARDIOGRAPHY
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ECHOCARDIOGRAPHY(REPORT)
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CONFIRMATORYDIAGNOSIS:
HyopertrophicCardiomyopathy
(HCM)
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HYPERTROPHICCARDIOMYOPATHY
The most common form of cardiomyopathy.
Prevalence of 100 per 100 000 population.
Hypertrophic cardiomyopathy (HCM) is a primary
disease of the myocardium(the muscleof
the heart) in which a portion of the myocardium
ishypertrophied(thickened) without any obvious
cause.
http://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Left_ventricular_hypertrophyhttp://en.wikipedia.org/wiki/Left_ventricular_hypertrophyhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Myocardium8/12/2019 A Patient of Recurrent Syncope 97-2003 Ppt
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HCM
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PATHOPHYSIOLOGYInappropriate and elaborate left ventricular hypertrophy
with malalignment of the myocardial fibers.
The hypertrophy may be generalized or confined largely
to the interventricular septum (asymmetric septal
hypertrophy) or other regions (apical hypertrophic
cardiomyopathy).
Heart failure may develop because the stiff non-
compliant ventricles impede diastolic filling.
Septal hypertrophy may also cause dynamic left
ventricular outflow obstruction (HypertrophicObstructive cardiomyopathy or HOCM ).
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PATHOPYSIOLOGY(CONT)
HCM has genetic prevalence, genemutation causes ventricular hypertrophy,
Troponin mutation associated with
myocardial fibre mal-alignement and
Myosine-binding protein c mutationassociated with hypertension and
arrythmia.
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CLINICALFEATURESSymptoms
Angina on effort
Dyspnoea on effort
SyncopeSudden death
Signs
Jerky pulse
Palpable left ventricular hypertrophy
Double impulse at the apex
Pansystolic murmur at apex ( due to MR )
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DIAGNOSIS: .
ECG : Shows LVH , T-wave
inversion.
Echocardiography : is diagnostic .
Genetic testing.
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TREATMENT
Asymptomatic: Avoid physical work, regular
screening.
Medical treatment : beta-blockers, rate-
limiting calcium antagonist ( Verapamil
),disopyramides and anti-arrythmics to treatarrythmias.
Surgical: Outflow tract obstruction can be
improved by partial surgical resection ( eg.
Myomectomy, septal ablation )ICD: should be considered in patients with
clinical risk of sudden death.
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