Hypertrophic cardiomyopathy

Overview hypertrophic cardiomyopathy is characterized by cardiac hypertrophy. According to left ventricular outflow tract obstruction can be divided into any obstruction (obstructive) and non-obstructive (Non - obstructive) hypertrophic cardiomyopathy, asymmetric septal hypertrophy induced aortic valve stenosis were called idiopathic hypertrophic subaortic stenosis (Idiopat hic hypertrophic subaortic stenosis IHSS). The etiology is unknown, possible factors are : a genetic one family can have people contracting the disease, suggesting that related to genetic factors. Matsumori HLADRW4 found that the disease detection rate as high as 73.3% and the control group was extremely low. HLADR genetic system is one of the immune response with the adjustment that the disease is related to heredity. 2, endocrine disorders Aeromonas casein tumor cells in patients with hypertrophic cardiomyopathy were more, Human large infusion of norepinephrine can be induced myocardial necrosis. Animal experiments catecholamine infusion can be induced myocardial hypertrophy. Berlin was hypertrophic cardiomyopathy is caused by endocrine disorders. Pathological lesions of the major cardiac hypertrophy, especially the lower part of the aortic valve papillary muscles and ventricular septal most obvious, thus creating the left ventricular outflow tract obstruction. Ventricular cavity was often narrow S-shaped slit-like, interventricular septum thickness and left ventricular wall thickness ratio greater than 1.5, called asymmetric septal hypertrophy. The site of myocardial hypertrophy also had an outstanding performance at the apex of the heart and other parts, myocardial hypertrophy, disarray Pathological changes of this one. When a significant mitral regurgitation, the secondary will have thickened mitral leaf. Performance of a clinical symptoms of the disease between men and women are significant differences, most of the 30 -40 years of symptoms, With age, symptoms become more pronounced, the main symptoms ① dyspnea, exertional dyspnea, was serious respiratory center or paroxysmal nocturnal dyspnea, is due to myocardial hypertrophy in lower compliance, left ventricular end-diastolic pressure increased, thereby increasing left atrial pressure, pulmonary congestion have caused. ② angina; Often typical angina, after the onset of labor. Chest pain lasted for a long time, the use of nitroglycerin with not only ineffective and aggravating. Angina attack, probably due to myocardial hypertrophy in small coronary insufficiency cardiac compression. and myocardial hypertrophy due to increased aerobic. ③ syncope and dizziness; More tired, the mechanism is unknown, perhaps because of decreased left ventricular compliance, Sympathetic tired after the positive inotropic effect enhanced, resulting in left ventricular compliance worse ventricular diastolic filling less blood, Left ventricular outflow tract obstruction increased cardiac output decrease caused due to cerebral insufficiency. It may also be due to over-stimulation of left ventricular pressure sensors, caused reflex vasodilation. Blood pressure decrease, the occurrence of the slow-speed or arrhythmia, it can cause dizziness and syncope. ④ palpitations; Beating heart patients feel strong, particularly in the left decubitus more obvious, arrhythmia, or perhaps because changes in cardiac function. 2, signs common signs ① apical systolic pulse; As myocardial hypertrophy, can be seen beating increase. Because of left ventricular compliance decreased atrial contraction increased, the impact of left ventricular wall flow, the apical systolic have before impulse. Then after the first heart sound systolic second pulse, systolic form of double pulse. ② systolic small tremor; More apex. Systolic small tremor, left ventricular outflow tract obstruction more heavier. ③ systolic murmur; In the lower left sternal edge or apex medial in a "rough briefing" contraction advanced noise Because the Department of left ventricular outflow tract obstruction induced. Where enhanced myocardial contractility or reduce arterial resistance factors, can make between the left ventricle and aorta pressure difference increases, enhanced noise, who can reduce cardiac contractility or increased arterial resistance factors, can make pressure gradient decreased noise diminished. Upon reflection increased output, reduced noise. Upon reflection reduce noise output increase. ④ apical systolic murmur; The disease associated with about 50% of mitral regurgitation, thus apex of shrinkage advanced noise or total systolic murmur. ⑤ third heart sound and fourth heart sounds. 3, laboratory and other tests (1) X-ray inspection or normal heart size increases, heart and heart size and left ventricular outflow tract between the pressure gradient is positive, the greater the pressure gradient, the greater heart. Mainly left ventricular hypertrophy, aortic not widened, pulmonary of no more prominent, lung congestion mostly lighter, Common mitral valve calcification. (2) ECG heart ischemia, myocardial repolarization anomalies, the ST-T changes in common, Left ventricular hypertrophy and left bundle branch block also see more, probably due to ventricular septal hypertrophy and cardiac fibrosis arising Q-wave, The disease is often all types of arrhythmia. (C) Echocardiography is an important non-invasive diagnostic methods. ① is mainly manifested abnormal septal thickening, and the end-diastolic thickness of the interventricular septum "15mm. ② septal campaign has been notably reduced, in general less than 5mm. ③ septal thickness / left ventricular posterior wall thickness ratio of up to a .5-2.5:1, it is generally believed that the ratio of "1.5 : have a diagnosis. ④ left ventricular end-systolic diameter smaller than normal. ⑤ contraction starting time compartment with mitral anterior leaflet from the often narrow. ⑥ mitral systolic prior to the campaign to close to the ventricular septum, in the second heart sound before termination. ⑦ aortic contraction in the mid-closed, probably due to early contraction velocity fast, Since the late contraction obstruction and increase blood flow velocity slowed suddenly, attract the role (Ventureeffect) caused. 7 above shall comprehensive analysis, in order to draw the right conclusion, it should be noted hypertension, hypothyroidism, may cause similar performance. (4) cardiac catheterization and angiocardiography cardiac catheterization, the left ventricular and left ventricular outflow tract between the pressure gradient. left ventricular end-diastolic pressure increased, the pressure gradient and left ventricular outflow tract obstruction was significantly correlated. Angiocardiography, muscular ventricular septal hypertrophy obvious, visible ventricular cavity was strip-like cracks change in the diagnosis meaningful.