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External carotid pulse recordings in hypertrophic obstructive cardiomyopathy
Insights
Carotid pulse tracings are valuable for diagnosing hypertrophic obstructive cardiomyopathy (HOCM). Specific pulse patterns, like midsystolic dipping, indicate left ventricular outflow obstruction in HOCM patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiac condition.
- Accurate diagnosis and monitoring of left ventricular outflow obstruction are crucial for HOCM management.
Purpose of the Study:
- To evaluate the diagnostic utility of external carotid pulse tracings in patients with suspected HOCM.
- To correlate pulse wave characteristics with the severity of intraventricular gradients.
Main Methods:
- Analysis of external carotid pulse tracings in 15 patients diagnosed with HOCM via left heart catheterization.
- Observation of pulse wave morphology, including upstroke velocity and presence of midsystolic dipping.
Main Results:
- A typical bifid pulse with midsystolic dipping was observed in 9 out of 12 patients with resting intraventricular gradients.
- Midsystolic dipping also occurred in beats following extrasystoles in one patient without a resting gradient (Brockenbrough phenomenon).
- Rapid pulse wave upstroke distinguished HOCM from valvular aortic stenosis; left ventricular ejection time showed correlation with gradients but was not consistently indicative of HOCM.
Conclusions:
- Carotid pulse registration offers significant diagnostic value for suspected HOCM.
- Observed pulse changes correlate with left ventricular outflow obstruction, suggesting potential for serial tracings in monitoring disease progression and treatment efficacy.
Abstract:
External carotid pulse tracings were examined in 15 patients with hypertrophic obstructive cardiomyopathy (HOCM), the diagnosis being confirmed by catheterization of the left heart. Of 12 patients with intraventricular gradients at rest, 9 had a typical bifid pulse with midsystolic dipping. In one patient without a gradient at rest, midsystolic dipping occurred only in beats following extrasystoles (Brockenbrough phenomenon). The upstroke of the pulse wave was rapid in all the patients, a finding that distinguishes them from patients with valvular aortic stenosis. There was a correlation between the length of the left ventricular ejection time and the intraventricular gradient (r = 0.71) but as more than half the patients had normal or shortened ejection times, the diagnosis of HOCM cannot be based on measurements of this parameter. It is concluded that carotid pulse registrations are of considerable diagnostic value in patients suspected of having HOCM. As the pulse changes are correlated to the degree of left ventricular outflow obstruction, it is suggested that repeated pulse tracings may be used as a means for controlling the degree of obstruction once the diagnosis has been established in the individual patient.