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The diagnosis of left ventricular outflow tract obstruction is usually made by echocardiographic assessment and is defined as a peak left ventricular outflow tract gradient of ≥ 30 mmHg. [37] Another, non-obstructive variant of HCM is apical hypertrophic cardiomyopathy (AHCM or ApHCM), [39] also called Yamaguchi syndrome.
A ventricular outflow tract obstruction is a heart condition in which either the right or left ventricular outflow tract is blocked or obstructed. These obstructions represent a spectrum of disorders. Majority of these cases are congenital, but some are acquired throughout life. [1]
The right outflow tract is called "conus arteriosus" from the outside, and infundibulum from the inside. In the left ventricle the outflow tract is the "aortic vestibule". They both possess smooth walls, and are derived from the embryonic bulbus cordis [3] In both left and right ventricle there are specific structures separating the inflow and ...
A forceful apex beat indicates left ventricular pressure overload, while a right ventricular heave suggests right ventricular pressure overload. Other signs provide evidence for specific causes of pressure overload. Hypertension is diagnosed by sphygmomanometry.
Weight reduction – through physical activity and dietary modification, as obesity is a risk factor for heart failure and left ventricular hypertrophy. Effective weight management has been shown to significantly improve the heart's functional status and reduce the risk of all-cause mortality. [5]
For example, the Valsalva maneuver (phase II) increases the intensity of hypertrophic cardiomyopathy murmurs, namely those of dynamic subvalvular left ventricular outflow obstruction. This is due to the decreased preload in this phase, worsening the obstruction and thus accentuating the murmur. [3]
As a result, this decreases left ventricular filling. With HOCM, the outflow obstruction increases with a decrease in preload. This will increase the loudness of the murmur with HOCM. [14] Post ectopic potentiation; Inhaled amyl nitrite. This is a vasodilator that diminishes systolic murmurs in left-to-right shunts in ventricular septal defects.
Mid-ventricular and left ventricular outflow obstruction: It has been suggested that a mid-ventricular wall thickening with outflow obstruction is important in the pathophysiology. [33] A quarter of unselected patients with TTS who presented to an emergency department were found to have obstructive hypertrophic cardiomyopathy (HCM) on blinded ...