0:00

the case number five I'm going to

0:03

first provide these two still images

0:07

case number five is a 45 year

0:10

old woman with a history of syncopy.

0:14

So these images on the left, we have

0:17

a four chamber view on the right. We have delayed enhancement in

0:20

the short axis plane. I'm going to now play some cine images

0:23

for this case.

0:24

It is the Fortune review.

0:34

here is the

0:35

shot axis

0:38

in delayed enhancement

0:43

so a

0:45

45 year old woman with Syncopy. I'm going to go back to the

0:48

still images now.

0:49

I'm just put this image up while we look at

0:52

the questions the correct

0:55

diagnosis. Here we have.

0:57

Five choices. Can we put the question up?

0:59

The question correct diagnosis, it can be the choices

1:02

are hypertrophic cardiomyopathy hypertensive heart

1:05

disease athletes heart cardiac amyloidosis

1:08

or fabric disease. It's just take

1:11

a few seconds and then we'll go on to the answer. Can we

1:14

take a poll of the answers please hypertrophic cardio of

1:17

the excellent. That's the correct Choice notice that there's asymmetric

1:20

simple hypertrophy amyloid the

1:23

Other possibility would have been

1:26

AMOLED yes, or even the others but let's let's

1:29

focus between hypertrophic cardiomy within amyloid.

1:32

Notice that there's asymmetric Supple hypertrophy as

1:35

opposed to concentric hypertrophy which typically occurs and cardiac amyloidosis.

1:38

The symptom is asymmetrical the thicken compared

1:41

to the lateral wall and notice the patch areas of enhancement in

1:44

the interventricular septum and the junction points of the two ventricles typical

1:47

findings of hypertrophic cardiomyopathy hypertrophic conduit

1:51

obstructive and on abstractive in this particular case, it is not

1:54

obstructive. Typically one of the intervented less Neptune.

1:57

The other choices are not not correct hypertensive cardiomarketypical

2:00

leads to concentric hypertrophy.

2:03

The amount of enhancement here

2:06

is very extensive in general hyperte hypertensive heart

2:09

disease is not lead to well thickness of 15 millimeters

2:12

and this particular case the wall thickness was well over 15. Yes.

2:15

There's not a way for two measure on these images. But continue that

2:18

the wall thickness was in the approaching 20 millimeters here

2:21

asymmetrics Apple hypertrophy

2:24

typically greater than 15 millimeters one has

2:27

to consider hypertrophic cardiomyopathy unless proven otherwise typical

2:30

areas of enhancement are they interventricular snapdrum

2:33

and the hypertrophy Freedom September the junction

2:36

points of the right and left ventricles amyloid leads

2:39

to diffuse enhancement in The myocardium concentric hypertrophio

2:42

to Global sub in the Cardinal enhancement athletes heart

2:46

can lead to hypertrophy but it's not typically asymmetric Supple

2:49

hypertrophy same with hypertensive heart disease. Typically, it's

2:52

a concentric hydratory disease can

2:55

make hypertrophic cardiometry. However, they enhancement pattern

2:58

is in the inferior lateral not in the septum.

3:01

Typically not in the substance the case.

3:03

Typical case of hypertrophic cardiomyopathy asymmetric

3:06

Surplus hypertrophy enhancement involving the

3:09

hypertrophy tissue The Junction points or the ventricles.

3:12

Any questions in this case should be

3:15

no doubt that this is hypertrophic cardiomyopathy. We

3:18

do have two more questions pertaining to this case hypertrophic

3:21

cardio Market is very commonly seen in clinical practice

3:24

particularly in referral centers for cardiac, Mr.

3:28

And cardiacomar has a very important role in

3:31

the evaluation of hypertrophic cardiomyopathy. There are

3:34

very many advance of cardiacomar except one

3:37

of the following in this in this question question. Number

3:40

two, put any case five the correct

3:44

answers actually e so all all the first

3:47

four advantages of cardiacomar it allows one to

3:50

accurately measure LV wall thickness and mass Mr. Is

3:53

more accurate than a geography for evaluation

3:56

of LV.

3:58

For evaluation of left ventricular wall thickness

4:01

in hypertrophic cardiomyopathy which can be underestimated by

4:04

Echo. And in fact Echo may not be able to review all

4:07

areas of the heart such as the base and the Apex which

4:10

are better evaluated with cardiac Mr. A market

4:13

evaluate fibrosis the late gallium enhancement indicates fibrosin

4:16

hypertrophic cardiomyopathy, which is a risk for certain death.

4:19

And often differentiate hits yam from phenocrompties when we meet,

4:22

you know, what we mean by Phenom compasses think is other diseases

4:25

that look alike. For example Fabrics disease

4:28

can look look similar to hypertrophic condominopathy athletes hot

4:31

hypertensive heart disease amyloidosis. However,

4:35

they enhancement pattern and the nature of and

4:38

the location of the hypertrophy may help to differentiate.

4:41

Hit CM from not HCM related

4:44

diseases. So it carnegamar particularly delay enhancement

4:47

can help to evaluate them off from phenocopies cardiacomato. Sorry

4:51

hypertrophic cardio Market, we can lead to left ventricular

4:54

outflow tractor obstruction because the hypertrophied septum

4:57

can obstruct the left ventricular outflow

5:00

tract region.

5:02

So gradients can occur in the lvot. So

5:05

typically measured in millimeters my cream grind or 50

5:08

million meters is considered very significant for evaluation

5:12

of lvot gradients echo

5:15

car geography or invasive Catherine geography is

5:18

a test of choice because Mr. Is not very accurate particularly when

5:21

there's very high flow and D phase in face contrast

5:24

Imaging does not work very well. So for measurement of art protract

5:27

gradients either Echo geography or

5:30

Catholic geography is a test of choice not only come off.

5:33

However, Mr. Is very important

5:36

for cardiac for hypertrophic cardiometry accurate measurement to

5:39

walk thickness.

5:40

Confirmation of the diagnosis measurement of wall thickness accurately

5:43

and mass and for detection of fibrosis which

5:46

which is a risk for certain there. Okay. There is

5:49

one last question pertaining to hypertrophic cardiomyopathy

5:52

hypertrophic cardiomyopathy the most important

5:55

feared complications certain cardiac death.

5:58

And there are certain risk factors for certain death. One

6:01

of these is not a major risk factor. There are five

6:04

choices here.

6:06

While thickness over 30 millimeters family history of seven deaths

6:09

sustained VT or resuscated ventric of fibrillation on its

6:12

planes and copy and atrial fibrillation.

6:14

There are four atrial fibrillation very good. So atrial

6:17

fibrillations regarded as a soft feature or

6:20

soft risk factor for a sudden death the major risk

6:23

factors for certain death in hypertrophic cardiomatically a massive hypertrophy

6:26

over 13 millimeters the family history of

6:29

Southern chronic death the personal history of Syncopy related

6:32

to to the heart not due to

6:35

neural humeral factors a personal history or sudden

6:38

death 360 or VF

6:41

and hypertensive responses to exercise. Those are the

6:44

five.

6:45

Risk factor certain death atrial fibrillation can

6:48

be a complication but by itself, it's not considered a major

6:51

risk factor for Sunday by by the American Heart Association

6:54

guidelines.

6:55

But certainly if there's massive hypertree with

6:58

30 millimeters family history of certain day or sustained

7:01

video we have in ICD maybe indicated that's

7:04

case number. I think

7:07

we are going on to case number six now we're finished

7:10

five cases almost halfway through the session at any

7:14

questions.

7:15

Hypertrophic cardiomyopathy asymmetric Circle, hypertrophy enhancement

7:18

in the habitrophy deceptum. This is

7:21

the chat box. I did not see any questions. So we're going to go on to

7:25

going to case number six.