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The Brockenbrough-Braunwald-Morrow sign
Alejandro R Trevino1, John Buergler1
1Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas.
Hypertrophic cardiomyopathy (HCM) patients with outflow obstruction can improve with beta-blockers or procedures. Alcohol septal ablation (ASA) offers an alternative to surgery for symptom relief and obstruction reduction.
Area of Science:
- Cardiology
- Genetics
Background:
- Hypertrophic cardiomyopathy (HCM) is a common genetic heart condition.
- While often asymptomatic, 25% of patients develop left ventricular outflow tract (LVOT) obstruction, leading to symptoms like angina, syncope, or heart failure.
Observation:
- Beta-blockade typically improves symptoms in HCM patients.
- For medically refractory cases, surgical myectomy or alcohol septal ablation (ASA) can provide further relief and reduce obstruction.
Findings:
- Nonrandomized studies and meta-analyses suggest ASA is comparable to surgical myectomy.
- The Brokenbrough-Braunwald-Morrow sign accurately assesses LVOT obstruction in patients undergoing ASA, even without baseline obstruction.
Implications:
- ASA is a viable therapeutic option for obstructive HCM.
- The Brokenbrough-Braunwald-Morrow sign is a valuable tool for guiding and monitoring ASA procedures.
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