hypertrophic cardiomyopathy
TRANSCRIPT
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Hypertrophic cardiomyopathy with mid-cavity obstruction and
apical aneurysm
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56 yo AAM with PMH of HTN who presented to Washington Hospital Center after an abnormal stress test.
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History of Present Illness
• Patient’s medical history begins in 1999 when he presented to Southern Maryland with nausea and vomiting. – Patient underwent a full cardiac workup
including an echocardiogram that was significant for LVH and a cardiac catheterization that was reportedly normal.
– He was discharged with a diagnosis of vertigo.
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History of Present Illness
• For the next eleven years the patient was followed by a private cardiologist.– He reports that he underwent yearly echocardiograms
during this time period.– Upon questioning, the patient denies chest pain, but
does report feeling occasionally lightheaded.
• This year his private cardiologist passed away and a new cardiologist that took over his care.– On an initial visit his ekg was found to be abnormal.
This prompted a stress test.
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History of Present Illness
• During the exercise stress test the patient developed VT. On the stress test, the patient was able to exercise for 8 min and reached a max HR 142 bpm. Nuclear images found a fixed apical wall defect w/ small inferior wall ischemia. Patient was found to have a dyskinetic apex consistent with aneurysm.
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History of Present Illness
• Patient had echo was found to have LVEF 68% with an apical aneurysm.
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History
• PMH: as above
• Medications: Verapamil 240 mg daily, Atenolol 100 mg daily, ASA 81, Nexium
• Family History: Brother CAD, Mother CAD with defibrillator
• Social History: +smoker (quit 3 weeks prior to current admission), social drinker, works as chemical engineer
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Admission Exam and Labs
Physical Exam
Gen: pleasant, NAD
36.9 118/77 56 18 98% RA
HEENT: MMM
Neck: -JVD
Chest: RRR –m, -g
Lungs: CTAB
Abd: soft
Ext: edema
Labs:
139 104 15
3.6 24 1.6109
6.613.2
39.2220
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