Significance of Postprandial Symptom Exacerbation in Hypertrophic Cardiomyopathy

Adams, Jonathon C.; Ommen, Steve R.; Klarich, Kyle W.; Tajik, A. Jamil; Nishimura, Rick A.

doi:10.1016/j.amjcard.2009.11.016

Cited by 14 publications

(16 citation statements)

References 11 publications

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“…These changes directly or indirectly lead to worsening of the outflow tract obstruction and elevation of filling pressure, similarly to that observed on exertion 32 . The severity of symptoms presents great daily variation.…”

Section: Clinical Picturementioning

confidence: 60%

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

Mattos¹,

Torres²,

Rebelatto³

et al. 2012

Arq. Bras. Cardiol.

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Hypertrophic cardiomyopathy is a prevalent genetic disease characterized by left ventricular hypertrophy, presenting dynamic obstruction of outflow tract with subaortic gradient happening at rest in 30% of the cases. It is attributed to the intricate interaction between the anterior mitral leaflet, the interventricular septum and altered flow vectors generated in left ventricle along with changes in outflow tract geometry. Mitral regurgitation in varying degrees is found with or without association with structural deformities of the valve apparatus. The exercise echocardiogram evidences latent obstruction easily induced by exercise in 60 to 75% of nonobstructive forms. The determination of the gradient under this condition must be considered in routine investigation of patients with mild or no obstruction at rest. The evaluation of hypertrophic cardiomyopathy incorporates methods based on the ultrasound image, which, along with MRI, allow recognizing ventricular obstruction generating mechanisms, thus facilitating the diagnosis and management of obstructive and latent obstructive forms.

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Section: Clinical Picturementioning

confidence: 60%

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

Mattos¹,

Torres²,

Rebelatto³

et al. 2012

Arq. Bras. Cardiol.

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“…All echocardiograms were performed at a single tertiary referral center, as described previously (2). Briefly, baseline echocardiographic features of the study population were compared.…”

Section: Methodsmentioning

confidence: 99%

Relation Between Temperature Extremes and Symptom Exacerbation in Patients With Hypertrophic Cardiomyopathy

Bois

Adams

Kumar

et al. 2016

The American Journal of Cardiology

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Warm temperatures induce peripheral vasodilatation, decrease afterload, and may concurrently increase the left ventricular outflow tract (LVOT) gradient. We aimed to assess the impact of subjective ambient temperature on hypertrophic cardiomyopathy (HC) symptoms and determine whether they were associated with LVOT gradient, patient quality of life (QOL), and risk of sudden cardiac death (SCD). We identified consecutive patients with HC presenting to a tertiary referral center. Of the 173 patients in the study, 143 (83%) had HC symptoms, with ambient temperature change worsening symptoms for 72 patients (50%). Symptom exacerbation occurred only with heat for 57 (79%), whereas symptoms were exacerbated with cold only or with cold and heat equally for 15 (21%). Patients affected by any temperature exacerbation more commonly were women (P=.009), had a lower QOL (P=.04), had a family history of HC (P=.007), or underwent myectomy (P=.01). A greater proportion of patients with heat-only exacerbation had a family history of HC (P=.005) and SCD (P=.05). The presence of an LVOT gradient either at rest or with provocation was similar among all groups. In conclusion, although no appreciable difference in LVOT gradients were observed between patient groups, approximately half of the patients with HC reporting symptoms at baseline noted worsening of symptoms with temperature changes, with >75% describing heat-induced symptom exacerbation. Furthermore, affected patients more frequently were women, underwent surgical intervention and device implantation, and had an overall lower QOL.

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“…Outflow gradients are highly influenced by left ventricular size and contractility, loading conditions, and peripheral vascular resistance [22]. They may increase after heavy meals [23] or alcohol intake [24], explaining postprandial symptom exacerbation [25]. Increases in LVOT gradients can be provoked using several physiological maneuvers, such as the standing position, Valsalva maneuver, or exercise [26].…”

Section: Clinical Impact Of Dynamic Obstructionmentioning

confidence: 99%

Dynamic obstruction in hypertrophic cardiomyopathy

Popescu

Roşca

Schwammenthal

2015

Current Opinion in Cardiology

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Echocardiography represents a versatile, continuously evolving, and easily repeatable technique, allowing truly dynamic imaging studies, and is therefore most appropriate to evaluate a dynamic disease condition such as LVOT obstruction in HCM. It provides profound insights into the pathophysiology of LVOT obstruction, information on its clinical impact, and guidance for its relief by interventional strategies.

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Significance of Postprandial Symptom Exacerbation in Hypertrophic Cardiomyopathy

Cited by 14 publications

References 11 publications

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

Relation Between Temperature Extremes and Symptom Exacerbation in Patients With Hypertrophic Cardiomyopathy

Dynamic obstruction in hypertrophic cardiomyopathy

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