Thread by @mariovar55

OK sunday quiz and tweetorial folllow the thread @almasthela @AnastasiaSMihai @strain_rate @ash71us @MusaSharkawi @SBarrosGomes @SBarrosGomes @maxb1953 @onco_cardiology @HeartOTXHeartMD @ecocardio_cl @purviparwani @Wikimagen @venkmurthy @VietHeartPA @iamritu @RezaEmaminia

@VazyurVasquez @VLSorrellImages
58 yo , asymptomatic, small SS, cgheck the ekg and what do you see in the CFP??

Ok I´m sure youre very smart and have the diagnosis. It´s an Color M Mode from apex to base, check the mid ventricular aliasing in late diastole and late sistole. Diagnosis clear?

Of course hypertrophic cardiomyopathy with mid ventricular obstruction, easy task for 2d and color doppler

Check color.

PWD aceleration in diastole to the apex and CWD define the flow pattern

Is this frequently?, how good or how bad is the evolution and prognosis of these patients, same as LVOT obstruction o no obstruction?
Beleive me not much in literature, a beautiful review on JACC 2011 of japanese group following more than 490 patientes with HCM

9-10% has mid ventr obstruction, 1/4 to 1/3 has apical aneurysm, prognosis worse than LVOT or no obstruction. More HCM associated deads, more sudden death and dangerous arryhtmia with or without aneurysm

With or without aneurysm increased risk of death in multivariate analysis

Chronic mid ventr obstr--->apical LV wall stress increased---> fibrosis intramural-----> aneurysm -----> hig risk of death
TIME TO RELIEVE MID LV OBSTRUCTION EARLY BEFOR DAMAGE?

Several recent review papers of Dr. MAron (NEJM, JACC HF) and others just dedicate few worsds of this rare variant

On friday when i planning this tweetorial receive another patient with the same pattern. Hope yu enjoy this smal tweetorial , and share awareness about this kind of HCM with MV obstruction. HAve a very nice sunday my fantastic friends

For those spanish spoken check the last entry of my blog about this case
ecodeldia.blogspot.com