, 6 tweets, 9 min read Read on Twitter
Hypertrophic Obstructive Cardiomyopathy #HOCM🚧

Profound exertional dyspnea

▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst

▪️Brockenbrough-Braunwald-Morrow sign, explained

▪️Alcohol🍷septal ablation #RadialFirst
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?

After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?

Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
Answer: @iamritu @alenghat &others explained:

In #HCM, while post PVC diastolic filling time increases, the benefit of
↑LV volume is outweighed by ↑contractility via intracellular calcium🥛& #FrankStarlingCurve

Net result: ↑obstruction, ↓arterial pulse pressure.
I should also shout📢 out my clinical/academic mentor @EdKasper3 who got me energized about #HCM &guides me on treatment of patients we encounter in our clinic.

The historical perspective & debate about #obstruction in HCM is fascinating and always a treat to hear about.
Regarding #Treatment

This particular case utilized alcohol septal ablation which worked beautifully for our patient.

Of course, surgical myectomy😷 is another option & can be more preferable depending on the case, having a great surgeon around

Especially w/ MV pathology
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