Faculty of Medicine

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    Dynamic Left Ventricular Outflow Tract Obstruction - when to Intervene?
    (International Medical Journal Corp., 2021)
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    Siljanovski, Nikola
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    Left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM), most commonly is provoked by the contact between the hypertrophied basal interventricular septum (IVS) and the systolic anterior motion (SAM) of the anterior leaflet of mitral valve, during systole, thus narrowing the left ventricular outflow tract (LVOT). Several theories have been proposed to explain the occurrence of SAM and LVOTO, the “drag effect” theory is widely accepted. Despite SAM, one of the others morphological features that can contribute to LVOTO is an insertion of an accessory muscle bundle extending from the apex to the basal anterior septum of free wall of the left ventricle. In this case report we present a case of 71-year-old man with dyspnea and syncope, exercise induced, as a result of severe dynamic LVOTO. The LVOTO was a result of HCM, mostly affecting the basal IVS, with concomitant insertion of an accessory muscle bundle at the basal segment of IVS, that was additionally thickening the IVS, and SAM of the anterior mitral lealflet (AML), that were narrowing the LVOT and causing high LVOT gradients (86,3 mm Hg) at rest. The patient was symptomatic, he had dyspnea and syncope, exercise induced. The patient underwent a septal myectomy and mitral valve repair, which successfully reduced the gradients and relieved the patient of the symptoms.
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    А rare case of left ventricular hypertrophy and non-compaction cardiomyopathy in an adult: diagnostic approach
    (Macedonian Society of Cardiology, 2021-03)
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    Zafirovska, P
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    Risteski, D
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    Left ventricular non-compaction cardiomyopathy (LVNC) is a rare form of primary genetic cardiomyopathy which is characterized by prominent trabeculations and intertrabecular recesses that communicate with the cavity of the left ventricle. The prevalence is between 0.014%-1.3% in the general population. LVNC is associated with different genetic mutations and may have a genetic overlap with the phenotype of other cardiomyopathies, including hypertrophic cardiomyopathy (HCM). In this case report we present a 26-year-old female patient presenting to emergency room with bradycardia and syncope. The transthoracic echocardiography revealed hypertrophy and trabeculations with prominent recesses of the left ventricle. Cardiovascular magnetic resonance imaging (MRI) was performed to confirm the diagnosis of LVNC. The genetic analysis showed mutation of PRKAG2 gene indicating hypertrophic cardiomyopathy with conduction disturbance. In the last years, LVCN and HCM are diagnosed more frequently due to improvements in imaging methods. Although there are many diagnostic tools including contrast ventriculography, CT and MRI, echocardiography is the main imaging method used for diagnostic evaluation of LVNC and HCM. Key words: left ventricular non-compaction cardiomyopathy, hypertrophic cardiomyopathy, echocardiography, cardiovascular magnetic resonance imaging