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Myocardial and Pericardial Disease: Difference between revisions
Myocardial and Pericardial Disease (view source)
Revision as of 19:45, 22 January 2012
, 22 January 2012→Clinical diagnosis
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Thinning of the LV wall is present frequently in patients with severe LVH and may account for the lack of marked LVH in the elderly. While mechanisms of LV remodelling in HCM are still to be defined, cavity dilation and hampered systolic function occur in less than 5% of patients. | Thinning of the LV wall is present frequently in patients with severe LVH and may account for the lack of marked LVH in the elderly. While mechanisms of LV remodelling in HCM are still to be defined, cavity dilation and hampered systolic function occur in less than 5% of patients. | ||
=== Clinical diagnosis === | ==== Clinical diagnosis ==== | ||
==== Echocardiography ==== | ===== Echocardiography ===== | ||
Two-dimensional echocardiography is the easiest diagnostic modality for assessment of HCM, but cardiac magnetic resonance imaging (CMR) may be used when echocardiography is inconclusive, or when more detailed anatomic information is needed for clinical decision making. | Two-dimensional echocardiography is the easiest diagnostic modality for assessment of HCM, but cardiac magnetic resonance imaging (CMR) may be used when echocardiography is inconclusive, or when more detailed anatomic information is needed for clinical decision making. | ||
Echocardiographic characteristics include thickening of the left ventricular wall without cavital dilatation, and a normal or hyperdynamic left ventricular chamber. Although some of its synonyms are misleading, left ventricular outflow tract obstruction is not an invariable characteristic of HCM, and although the cut-off for maximal wall thickness is 15 mm for HCM, some underlying mutations are associated with only minor LVH but a high risk of sudden cardiac death. Systolic-anterior motion of the mitral valve is another typical echocardiographic characteristic of HCM. | Echocardiographic characteristics include thickening of the left ventricular wall without cavital dilatation, and a normal or hyperdynamic left ventricular chamber. Although some of its synonyms are misleading, left ventricular outflow tract obstruction is not an invariable characteristic of HCM, and although the cut-off for maximal wall thickness is 15 mm for HCM, some underlying mutations are associated with only minor LVH but a high risk of sudden cardiac death. Systolic-anterior motion of the mitral valve is another typical echocardiographic characteristic of HCM. | ||
'''''Echocardiographic diagnostic criteria for HCM are:''''' | |||
'''Major:''' | '''Major:''' | ||
* LV wall thickness ≥13 mm in the anterior septum or ≥15 mm in the posterior septum or free wall | * LV wall thickness ≥13 mm in the anterior septum or ≥15 mm in the posterior septum or free wall | ||
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==== Electrocardiography ==== | ===== Electrocardiography ===== | ||
Electrocardiographic signs of HCM are typical as the increase in myocardial tissue increases the QRS complexes. Therefore a typical ECG characteristic of HCM is that it meets voltage criteria for LVH and shows changes in repolarization. | Electrocardiographic signs of HCM are typical as the increase in myocardial tissue increases the QRS complexes. Therefore a typical ECG characteristic of HCM is that it meets voltage criteria for LVH and shows changes in repolarization. | ||
'''''Electrocardiographic diagnostic criteria for HCM are:''''' | |||
'''Major:''' | '''Major:''' | ||
* Left ventricular hypertrophy and repolarization changes | * Left ventricular hypertrophy and repolarization changes | ||