Essay on Hypertrophic Cardiomyopathy ( Hcm )

Essay on Hypertrophic Cardiomyopathy ( Hcm )

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Hypertrophic cardiomyopathy (HCM) is an inherited structural cardiac disease which results in the hypertrophy of the myocytes in the cardiac myocardium. The non-obstructive variant of this cardiomyopathy results in uniform enlargement of the ventricles, rather than asymmetric enlargement of the septum only. Normal physiology of the heart defines cardiac output (CO) as a function of both heart rate and stroke volume. When the heart needs to increase CO to meet increased demands of the body, it can do so by either increasing the heart rate or the stroke volume. In HCM, however, the heart is unable to meet the need of increased CO by increasing stroke volume because of structural limitations, so the heart has to primarily rely on increasing the heart rate to raise CO. Unfortunately, in a HCM heart, tachycardia will not help increase cardiac output either, since the amount of filling time during diastole decreases as the heart rate increases which only exacerbates the problem of a reduced LVEDV. Despite this limitation, many patients with HCM are asymptomatic until the body is stressed to the point that the heart is no longer able to compensate, at which point they will develop symptoms. Since HCM is an inherited disease, and patients don’t necessarily know they have it until they are symptomatic, this is a disease which is increasingly screened for in high school athletes because of the high risk for sudden cardiac death (SCD) from unknown HCM.
Characteristic Signs and Symptoms
The characteristic signs and symptoms of HCM reflect the inability of the heart to effectively fill during diastole and mimic the symptoms of heart failure or valvular disease. The reduced LVEDV results in an inadequate cardiac output to meet the oxygen dema...


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...cker therapy, even if asymptomatic, as an attempt to prevent severe pressure gradients which could lead to SCD. However, if concern for SCD is strong, the prevailing recommendation is for ICD placement.
Non-Pharmacologic Treatments
In patients that are considered at high risk of developing fatal ventricular arrhythmias, an implanted cardioverter-defibrillator (ICD) may be recommended to reduce the risk of SCD. The function of an ICD in patients with HCM is to prevent SCD by terminating fatal ventricular arrhythmias. This is either done as primary prevention, for patients at high risk for SCD, or secondary prevention, for patients with documented tachy-arrhythmias or a past episode of SCD. Interventions used for HOCM, the obstructive variety of HCM, such as ethanol ablations or myectomies, are not routinely offered for patients with the non-obstructive form of HCM.

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