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Devender N. Akula, MD Associated Cardiovascular Consultants Our Lady of Lourdes Hospital Camden, New Jersey

Case History. 43-year-old woman referred for HCM She has history of palpitations and near syncopal episode 10 months agoNear syncope was not associated with palpitationsNo history of syncope or CHFFamily history: father died at age 54 secondary to CAD, sister with HCM s/p alcohol septal ablation and has pacemaker.

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Devender N. Akula, MD Associated Cardiovascular Consultants Our Lady of Lourdes Hospital Camden, New Jersey

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    1. Devender N. Akula, MD Associated Cardiovascular Consultants Our Lady of Lourdes Hospital Camden, New Jersey

    2. Case History 43-year-old woman referred for HCM She has history of palpitations and near syncopal episode 10 months ago Near syncope was not associated with palpitations No history of syncope or CHF Family history: father died at age 54 secondary to CAD, sister with HCM s/p alcohol septal ablation and has pacemaker

    3. Exam unremarkable ECG: NSR, LVH, PR 160 ms, QTc 420 ms Holter: NSR, no episodes of NSVT Echo (technically limited): Normal LV systolic function, mild MR, asymmetric LVH, septum 2.3 cm, posterior wall 1.6 cm, gradient with valsalva 44 mm Hg Exercise stress test: no ischemia or arrhythmias, normal blood pressure response to exercise Case History (cont)

    4. What Is the Next Step in This Patient's Management With Respect to Her Risk for SCD? Electrophysiology study to see for inducible ventricular arrhythmias Amiodarone to reduce risk for SCD Alcohol septal ablation to reduce risk for SCD AICD implantation Cardiac MRI Medical management

    5. Discussion After discussing the risk factors for SCD in the setting of HCM, a cardiac MRI was obtained as Echo was technically limited Cardiac MRI: normal LVSF, LVH, septal thickness 1.8 cm, posterior wall 1.3 cm, small areas of gadolinium enhancement was seen At this time it was felt patient did not have high risk factors for SCD, hence AICD was not recommended Yearly Echos and Holter monitoring was advised

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