Pre PACES Podcast #37 Hypertrophic cardiomyopathy
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Jun 19, 2022 Dr. Omar Asghar, a consultant cardiologist specializing in inherited cardiac conditions, discusses hypertrophic cardiomyopathy (HCM) and its variants, including obstructive and non-obstructive types. He dives into genetic implications and how to spot red flags during examinations. Omar details diagnostic investigations, risk stratification, and treatment options ranging from lifestyle advice to invasive procedures. The conversation also includes a fun quiz where Omar reveals his passion for Liverpool FC, showcasing his versatile expertise beyond cardiology!
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Look For Scars, Devices And Phenocopies
- Inspect for prior cardiac scars and implanted devices including subcutaneous ICDs in the left axilla.
- Consider phenocopies that cause LVH and look for multisystem signs that suggest alternate diagnoses.
Contemporary HCM Has Few Classic Peripheral Signs
- Palpation may reveal a parasternal heave or double apical impulse in sinus rhythm, while apex displacement usually appears only in late 'burnt‑out' HCM.
- Many classic textbook peripheral signs (e.g., 'jerky' pulse) are uncommon in contemporary patients.
Use Valsalva To Reveal Dynamic Murmurs
- Auscultate for a systolic ejection murmur and mitral regurgitation from systolic anterior motion (SAM).
- Provoke the murmur with Valsalva or posture changes to accentuate LVOT obstruction and demonstrate dynamic physiology.