6.Progression of hypertrophic cardiomyopathy to dilated cardiomyopathy: a case reports and review of the literatures.
Kyung Hee CHANG ; Jong Won HA ; Nam Sik CHUNG ; Seung Yun CHO
Yonsei Medical Journal 1998;39(1):61-66
Left ventricular systolic function in hypertrophic cardiomyopathy (HCMP) does not usually deteriorate even in the end stage of the disease. However, occasionally cases of HCMP progress to a similar form of dilated cardiomyopathy (DCMP) with a decreased systolic function and dilated left ventricle. We report two cases of HCMP which progressed to DCMP during follow-up. Our cases have been documented by serial M-mode echocardiography which shows a prominent decrease in the left ventricular systolic function and a chamber enlargement of the left ventricle. There are various explanations of the pathogenesis of the functional and morphological myocardial deterioration of HCMP progressing to DCMP, and more cases should be studied to determine the pathogenesis and prevention of this end-stage feature of HCMP.
Adolescence
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Adult
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Cardiomyopathy, Congestive/etiology*
;
Cardiomyopathy, Hypertrophic/complications*
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Case Report
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Echocardiography
;
Follow-Up Studies
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Human
;
Male
7.Infective endocarditis in patients with hypertrophic obstructive cardiomyopathy: five cases report.
Li-hua ZHANG ; Li-gang FANG ; Jing YANG ; Yong-tai LIU ; Qi MIAO ; Chao-ji ZHANG ; Wen-ling ZHU ; Shu-yang ZHANG
Chinese Journal of Cardiology 2012;40(3):209-213
OBJECTIVETo analyze the clinical characteristics of infective endocarditis in patients with hypertrophic obstructive cardiomyopathy.
METHODSClinical characteristics from 5 patients with infective endocarditis and hypertrophic obstructive cardiomyopathy hospitalized from January 2000 to December 2010 in our hospital were analyzed.
RESULTSFour patients were diagnosed with left ventricular outflow tract obstructive cardiomyopathy with outflow pressure gradient from 36 to 140 mm Hg (1 mm Hg = 0.133 kPa) and left atrial size 44 - 68 mm. Another patient was diagnosed as ventricular hypertrophic cardiomyopathy with significant right-ventricular outflow tract hypertrophy (30 mm), high pressure gradient (164 mm Hg) and enlarged right atrial (56 mm × 53 mm), there was a 17 mm × 8 mm vegetation on right-ventricular outflow tract in this patient. Blood cultures were positive for streptococcus viridans in all five patients, and enterococcus faecium was revealed in one aortic valve vegetation culture. Transthoracic echocardiogram was performed 2 - 4 times for each patient, the vegetations of two patients was detected only by transesophageal echocardiography. The mitral valve vegetation was detected in two patients, the aortic and mitral valve vegetations were detected in one patients, mitral and tricuspid vegetations in one patient and right ventricular outflow tract vegetation in one patient. The four hemodynamically stable patients were successfully treated with antibiotic therapy, one patient received urgent surgery (replacement of the aortic and mitral valve as well as septal myectomy). All patients recovered and follow-up (1 - 6 years) was available in 4 patients and no complication was observed.
CONCLUSIONThe risk of infective endocarditis complicating hypertrophic obstructive cardiomyopathy is the highest in patients with both outflow obstruction and marked valve insufficiency, these patients should receive prophylactic antibiotic therapy during procedures that predispose to infective endocarditis.
Adult ; Aged ; Cardiomyopathy, Hypertrophic ; complications ; microbiology ; pathology ; Endocarditis, Bacterial ; complications ; pathology ; Female ; Humans ; Male ; Middle Aged
10.Risk stratification for sudden death in hypertrophic cardiomyopathy.
Chinese Journal of Cardiology 2009;37(4):294-297
The natural history of hypertrophic cardiomyopathy (HCM) is extremely heterogeneous. Many patients remain asymptomatic throughout life, some develop severe symptoms of heart failure, but others die suddenly, often in the absence of previous symptoms and at a young age. Therefore, identification of those patients at high risk of sudden death represents a major clinical problem and has become an even greater challenge since the implantable cardioverter-defibrillator (ICD) has proved to be highly effective in preventing sudden death in HCM. Patients who have survived a cardiac arrest, or one or more episodes of sustained ventricular tachycardia, are considered to be at high risk and are candidates for an ICD. However, this patient subset represents a small proportion of the HCM population. The greatest difficulty concerns the identification of high risk patients who are candidates for primary prevention of sudden death with a prophylactic ICD. Decisions are based on generally accepted clinical markers which are associated with increased risk, including: family history of sudden death, extreme left ventricular (LV) wall thickness ( > or =30 mm), nonsustained ventricular tachycardia on Holter monitoring, unexplained (non-neurocardiogenic) syncope particularly in young patients, and hypotensive blood pressure response to exercise. Patients with end-stage HCM or a LV apical aneurysm represent important arrhythmogenic subsets also associated with substantially increased risk. Multiple or single strong risk markers are associated with increased sudden death risk and justify consideration for a prophylactic ICD.
Cardiomyopathy, Hypertrophic
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complications
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Death, Sudden
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etiology
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Humans
;
Risk Assessment
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methods
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Risk Factors
Result Analysis
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