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Cardiomyopathy, Hypertrophic, Emergency Medicine

L. Kristian Arnold Reviewed 06/2017
 


Basics

Description

  • Hypertrophic cardiomyopathy (HCM):

    • Genetic disorder affecting the sarcomere:

      • Various mutations

      • Many phenotypic variations

    • Hypertrophied (regionally or globally), nondilated left or, rare...

Diagnosis

Signs and Symptoms

History

  • Obstructive symptoms correlate with exertion or suddenly assuming upright position—activities that decrease venous return or ventricular filling.

    • Severity depends on ...

Treatment

Consider HCM in patients who decompensate during standard treatments for CHF, ischemia, or supra-VT, and in young athletes who collapse during or just after exertion—rule out heat stroke. HC...

Follow-Up

Disposition

Admission Criteria

  • Unexplained syncope, especially in younger adults.

  • ICU admission:

    • Syncopal episodes

    • CHF

    • Angina

    • Hemodynamically significant tachydysrhythmia

Discharge Criteria

When incr...

Pearls and Pitfalls

  • Increasing awareness of genetic and phenotypic variants with implications in definition of “normal variant”:

    • Some authors advocate cardiac ECHO screening for any youth participation...

Additional Reading

  • Bos  JM, Ommen  SR, Ackerman  MJ. Genetics of hypertrophic cardiomyopathy: One, two, or more diseases? Curr Opin Cardiol.  2007;22(3):193–199.

  • Drezner  JA, Ashley  E, Baggish  A...

Codes

ICD9

425.18 Other hypertrophic cardiomyopathy 

ICD10

I42.2 Other hypertrophic cardiomyopathy 

SNOMED

  • 233873004 Hypertrophic cardiomyopathy (disorder)

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