Hospital therapy. Clinical presentation and diagnosis of hypertrophic cardiomyopathy (HCM) (most important)

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Hospital therapy. Clinical presentation and diagnosis of hypertrophic cardiomyopathy (HCM) (most important)

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12. Clinical picture and diagnosis of hypertrophic cardiomyopathy (HCM)

clinical picture. HCM is characterized by an extreme variety of symptoms, which is the cause of erroneous diagnosis. The presence and timing of the appearance of complaints in HCM are mainly determined by 2 factors: the form of HCM and the localization of the lesion. The most powerful chamber of the heart is the left ventricle, therefore, with hypertrophy of the myocardium of its walls, complaints may not appear for a long time. The isolated defeat of a right ventricle of heart meets extremely seldom.

The clinical picture of HCM is:

1) signs of ventricular myocardial hypertrophy (mainly left);

2) a sign of insufficient diastolic ventricular function;

3) variable signs of left ventricular outflow tract obstruction.

Diagnostics. In the process of diagnostic search, the most significant is the detection of systolic murmur, altered pulse and displaced apex beat.

For the diagnosis of HCM, echocardiography data are of the greatest importance, allowing to clarify the anatomical features of the disease, the severity of myocardial hypertrophy, obstruction of the outflow tract of the left ventricle. The following signs are revealed: asymmetric hypertrophy of the IVS, more pronounced in the upper third, its hypokinesis; systolic movement of the anterior leaflet of the mitral valve in the anterior direction; contact of the anterior leaflet of the mitral valve with the IVS in diastole.

Nonspecific signs are: hypertrophy of the left atrium, hypertrophy of the posterior wall of the left ventricle, a decrease in the average speed of the diastolic cover of the anterior leaflet of the mitral valve.

On the ECG, any specific changes are found only with sufficiently developed left ventricular hypertrophy.

X-ray diagnostics is important only in the advanced stage of the disease, when an increase in the left ventricle and left atrium, an expansion of the descending part of the aorta can be determined.

On the phonocardiogram, the amplitudes of I and II tones are preserved, which is a differential sign of HCM from stenosis of the aortic orifice, and systolic murmur of varying severity is also detected.

Invasive research methods (probing of the left parts of the heart, contrast angiography) are currently not mandatory, since echocardiography provides quite reliable information for making a diagnosis.

Cardiac probing is used under X-ray television control. Technique for performing the method: by puncturing a large artery under local anesthesia with the further introduction of a special catheter into the heart cavity, the pressure gradient (difference) between the left ventricle and the aorta departing from it is measured. Normally, this gradient should not be.

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