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Early Detection of Hypertrophic Cardiomyopathy

Early Detection of Hypertrophic Cardiomyopathy. Katie Wilson, Heather Dixon Lindsey, Aneta Petri, Kaycee Stone. Objectives. Define causes of hypertrophic cardiomyopathy Identify signs & symptoms Discuss differential diagnosis compared to typical athlete ’ s heart

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Early Detection of Hypertrophic Cardiomyopathy

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  1. Early Detection of Hypertrophic Cardiomyopathy Katie Wilson, Heather Dixon Lindsey, Aneta Petri, Kaycee Stone

  2. Objectives • Define causes of hypertrophic cardiomyopathy • Identify signs & symptoms • Discuss differential diagnosis compared to typical athlete’s heart • Discuss physicals, deconditioning, EKG, and advanced cardiac imaging

  3. What is Hypertrophic Cardiomyopathy (HCM)? • Autosomal dominant (Chun et al., 2010) • Most common genetic heart disease • 11 genetic mutations (Maron, 2009) • Males>Females (Corrado et al., 2005) • Left ventricular hypertrophy (Chun et al., 2010) • 1/3 of sudden deaths in U.S. (Corrado et al., 2005)

  4. Normal Heart vs. HCM From: Mayo Clinic, http://www.mayoclinic.com/health/medical/IM00586

  5. Signs and Symptoms • Chest pain/discomfort • Syncope (Chun et al., 2010) • Irregular heartbeat/palpitations • Shortness of breath/dyspnea • Fatigue out of proportion to exertion • Positive family history (Corrada et al., 2005)

  6. Differential Diagnosis of HCM in Athletes: Challenges Typical Athletic Heart Athletic Heart with HCM LV thickness >15 mm (Chun et al., 2010) Positive genetic testing/ family history (Maron, 2009) Abnormal LV filling L atrial enlargement Bizarre ECG changes • Adaptations to training (Neary et. al, 2011) • LV remodelling <13 mm (Maron, 2009) • L atrial enlargement • Bizarre ECG changes

  7. Our Investigation P: Athletes with family history of HCM or experienced cardiac S/S I: Cardiac Imaging C: Traditional medical sports physicals O: Early detection of HCM

  8. Traditional Sports Physicals in the U.S. • Personal history • Family history • Physical examination • Heart sounds and rhythm • Musculoskeletal features (Marfan syndrome) • Blood pressure and femoral pulses (Corrado et al., 2006)

  9. 12-lead EKG • Mandatory part of European sports physicals (Corrado et al., 2005) • 26-year Italian study on pre-screening athletes (Corrado et al., 2006) • 89% decrease in incidence of sudden CV death over period of study From: Corrado et al., 2005

  10. T-wave Inversion From: Neary et al., 2011

  11. Deconditioning Period • Forced detraining 8-12 weeks (Printz, 2012) • Non-invasive diagnostic method • Athletic heart: physiological changes after • HCM heart: no physiological changes after

  12. Advanced Cardiac Imaging • Exercise echocardiograph stress testing (Printz, 2012) • Cardiac CT scan • Cardiac MRI (Neary et al.,2011) • Ballistocardiography • Doppler ultrasound (Maron, 2009)

  13. Conclusions • Adding 12-lead EKG to sports physicals can detect cardiac abnormalities • Study: Saved 360 kids before age 21(Anderson et al., 2013) • Cost limitations of implementing in U.S. • Advanced cardiac imaging is still needed for diagnosis

  14. For More Information • http://www.youtube.com/watch?v=MhxkyUV6NSA&list=PL39C030C007545A9 • Cleveland Clinic: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/hypertrophic-cardiomyopathy/

  15. References • Anderson BR, McElligott S, Polsky D, Vetter VL. Electrocardiographic screening for hypertrophic cardiomyopathy and long QT syndrome: the drivers of cost-effectiveness for the prevention of sudden cardiac death. Pediatr Cardiol. Sept 5 2013[Epub ahead of print]. • Chun EJ, Choi SI, Jin KN, Kwag HJ, et al. Hypertrophic cardiomyopathy: assessment with MR imaging and multi-detecter CT. RadioGraphics. 2010;30(5):1309-1328. • Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for a prevention of sudden death: proposal for a common European protocol. Eur Heart J. Feb 2005;26(5):516-24. • Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593-1601. • Maron BJ. Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remondeling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med. 2009;43:649-656. • Neary JP, MacQuarrie DS, Jamnik V, Gledhill N, Gledhill S, Busse EFG. Assessment of mechanical cardiac function in elite athletes. Open Sports Med J. 2011;5:26-37. • Printz BF. Noninvasive imaging modalities and sudden cardiac arrest in the young: can they help distinguish subjects with a potentially life-threatening abnormality from the normals? Pediatr Cardiol. 2012;33(3):439-51.

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