2. Hypertrophic cardiomyopathy.
1. Overview: It is a hereditary cardiomyopathy, which is anatomically characterized by asymmetric attrophy of the ventricle and is one of the main causes of sudden sports death in adolescents.
2. ** is related to genes, autosomal dominant inheritance.
3. Pathological changes:
Asymmetrical thickening of the ventricular septum 15cm；
Left ventricular hypertrophy;
Anterior movement of the anterior leaflet of the mitral valve aggravates outflow tract stenosis;
diastole) ventricular septal thickness Left ventricular posterior wall thickness 13。
4. Clinical manifestations:
The most common are dyspnea and fatigue on exertion;Chest pain: low blood flow to the aorta reduces coronary blood flow;Arrhythmias: atrial fibrillation (unequal strength of the first heart sound, absolutely irregular heart rhythm, short pulse);Some patients faint.
5. Changes in physical signs:
Obstructive hypertrophic cardiomyopathy: 3-4 intercostal systolic eruption murmurs at the left sternal border.
a.Increased murmur: decreased blood return to the heart: standing position, nitroglycerin. b.Decreased murmur: increased blood flow back to the heart: squatting, receptor blockers.
Mitral regurgitation: apical systolic murmur.
6. Auxiliary examination:
ECG: non-specific, variable.
Echocardiology**: predominant clinical diagnosis with asymmetric ventricular hypertrophy without enlargement of the ventricles and diastolic ventricular septum thickness of 15 mm.
Cardiac magnetic resonance: stenosis of the left ventricular outflow tract, anterior mitral valve displacement of the anterior leaflet, mitral regurgitation.
7. **1) Drugs**:
Alleviate left ventricular outflow tract obstruction: Receptor blockers (xx lol), improve ventricular relaxation, increase ventricular diastolic filling time;Patients who are intolerant may be treated with non-dihydropyridine calcium channel blockers.
For heart failure**: diuretics, ACE inhibitors (xx pril), receptor blockers.
For atrial fibrillation: amiodarone (paroxysmal atrial fibrillation works well).
2) Surgery**:
Ventricular septectomy should be considered in patients with ineffective medications** and cardiac insufficiency (NYHA class III-IV) (left ventricular outflow tract pressure gradient of 50 mmHg at rest or during exercise).
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