[SCD-FORUM] 71S HCM in 49-year-old man. Dr. Madias

[SCD Symposium]

Dear Dr. Rafael S Leon de la Torre:

It is possible that your very interesting patient with symptomatic HOCM
may be benefited from a comprehensive tierred management approach, which
could include:

1)  Continuation of the current drug regimen.

2) Echo-based assessment of the stability and location of the gradients
at rest, and following a stress test.

3)  Insertion of a dual chamber temorary pacing system, with echo-based
  assessment of the gradients at rest and after exercise, employing a
range of AV delays.

4) If unsuccessful with the above, consider alcohol septal ablation,
with  post-ablation echo-based assessment of the gradient(s), at rest
and after stress testing.

5) If still there is a persistence of gradient(s), you should refer
your patient to a center experienced in myectomy.

Warmest Regards,

John E. Madias, MD, FACC, FAHA,
Professor of Medicine (Cardiology)
Mount Sinai School of Medicine
of the New York University,
Cardiology Division,
Elmhurst Hospital Center
Tel:(718) 334-5005
FAX:(718) 334-5990
email:madias at nychhc.org

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


>
> First of all, greetings. Congratulations for such an interesting  
> event.
> I have a case I would like to share. It is a young man (49 years  
> old) with hypertrophic cardiomyopathy diagnosed years ago.
> Now he is very symptomatic, with angina in rest and crises of  
> palpitations accompanied by dizziness, and we could not document  
> which type they are. In echocardiogram I have found besides septal  
> hypertrophy of 23 mm, double gradient, one in LVOT, peak of 68  
> mmHg, and another intraventricular, of 145 mmHg. He is being  
> treated with propranolol 40 mgs per 8 hours.
> My question is: would he benefit with a dual chamber pacemaker?  
> Would it be essential to implant ICD? Which of the options is more  
> appropriate (pacemaker, myectomy, or septal ablation)?
> Once again, congratulations,
> Dr. Rafael S. León de la Torre
> Cardiólogo-Ecocardiografista
> Centro de atención cardiovascular de Camaguey
> Cuba
>
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