Pearls from Dr. Mat Maurer

HOCM patient with syncope

2016-06-01

  • Diagnostic Pivot --> Syncope is different from fall given LOC

    Syncope Dx:
    -Vasovagal --> elderly have less vagal tone/symptoms 
    -Arrhythmia
    -Seizure (post-ictal and lateral tongue laceration most specific sign/symptom)
    -Valvular Disease 

    Most important test for syncope --> orthostatics
    -48 hours of tele is reasonable to catch arrhythmia (yield doubles from 24-48 hrs but diminishing returns after this)

    Posted 06/03/16 01:58:28 PM by Adam Faye

  • 4 Phases of valsalva (blow against higher pressure than CVP)
    - Systolic pressure rises against increased intro-thoracic pressure
    - Venous return declines
    - Systolic pressure declines
    - Venous return increases and BP increases (reflex brady, measure of barorecepter function). IF in chronic CHF (elevated CVP), no stage 2-4 (square root sign)

    Posted 06/03/16 02:05:28 PM by Adam Faye

  • HCM:
    - Reduction in preload increases LVOT/murmur --> valsalva or squat to stand
    - Increasing afterload (handgrip) decreases gradient and reduces murmur

    SAM - Systolic anterior motion; MV presses against septum causing obstruction of LVOT during systole
     (Venturi effect, dragging, or enlarged pappilary muscle/chordae that mechanically block LVOT)

    Therapy (Gradient above 50 considered high)
    -Disopyramide - initiate in hospital to monitor QTc; usually used to treat atrial arrhythmias; has negative inotropic effect to lower gradient 
    -Beta Blocker increases filling time in HOCM



    Posted 06/03/16 02:09:16 PM by Adam Faye

  • Risk Stratification for HCM:
    5 high risk features (if you have 2 or more, your risk of sudden death outweighs risk of AICD. 1/5 is 1-2% risk of sudden death)
    - Family history of sudden death
    - Septum > 3cm
    - Syncope
    - non-sustained VT on a holter (more predictive in younger patients)
    - Drop in BP with exercise

    Posted 06/03/16 02:17:17 PM by Adam Faye

  • For further reading...

    HCM Review
    NEJM HCM case 

    Posted 06/03/16 02:23:20 PM by Adam Faye

  • 65 y/o gentleman with restrictive disease- IgG4 Pericarditis

    2017-02-22

  • Nesiritide for acute heart failure:

    Posted 02/22/17 01:49:13 PM by Adam Faye

  • IgG4 Related Disease:

    Posted 02/22/17 01:52:11 PM by Adam Faye

  • HFpEF- 80-90% MCC is HTN

    Posted 02/22/17 01:56:20 PM by Adam Faye


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