A Patient of Recurrent Syncope 97-2003 Ppt

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/Myocardium


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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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THANKYOU

A Patient of Recurrent Syncope 97-2003 Ppt

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Transcript of A Patient of Recurrent Syncope 97-2003 Ppt