Related Experiment Videos
[Diastolic murmur in non-obstructive hypertrophic cardiomyopathy]
Insights
Diastolic murmurs (DM) occur in 15% of non-obstructive hypertrophic cardiomyopathy (non-obst HCM) patients. Assessing these murmurs aids in evaluating non-obst HCM, particularly in younger patients with impaired function.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Heart Murmurs
Context:
- Non-obstructive hypertrophic cardiomyopathy (non-obst HCM) presents unique diagnostic challenges.
- Diastolic murmurs (DM) are often overlooked or mischaracterized in non-obst HCM.
- Understanding the characteristics and mechanisms of DM is crucial for patient management.
Purpose:
- To investigate the incidence, phonocardiographic features, underlying mechanisms, and clinical associations of diastolic murmurs (DM) in patients with non-obstructive hypertrophic cardiomyopathy (non-obst HCM).
- To determine the clinical utility of auscultatory and phonocardiographic assessment of DM in non-obst HCM patients.
Summary:
- Diastolic murmurs (DM) were identified in 17 of 115 (15%) patients with non-obstructive hypertrophic cardiomyopathy (non-obst HCM), presenting as mid-diastolic, presystolic, or combined types.
- Mechanisms include impaired left ventricular (LV) filling due to reduced LV compliance and decreased diastolic descent rate (DDR), with mitral regurgitation contributing in some cases.
- DM were more prevalent in younger patients with a family history, sudden death, and reduced physical capacity, indicating clinical significance.
Impact:
- Auscultatory and phonocardiographic evaluation of diastolic murmurs provides valuable clinical insights for managing patients with non-obstructive hypertrophic cardiomyopathy.
- This study highlights the importance of detailed cardiac auscultation in the comprehensive assessment of non-obst HCM.
- Findings can guide further research into the hemodynamic consequences and therapeutic targets for diastolic dysfunction in non-obst HCM.
Abstract:
Diastolic murmur (DM) in patients with non-obstructive hypertrophic cardiomyopathy (non-obst HCM) was studied regarding incidence, phonocardiographic disposition, mechanism, and also clinical characteristics of patients with DM. The results were as follows: 1) DM was recorded in 17 of 115 patients with non-obst HCM (15%), and was classified into three types of a mid-diastolic murmur, presystolic murmur, presystolic murmur and these combination. Mid-diastolic murmur showed low-pitched character mimicking a flow rumble around apical area in most patients. On the other hand, a presystolic murmur was relatively medium-pitched and spindle-shaped over the 4th left sternal border. Additionally, there were 7 patients of mitral opening sound coincided with the "O" point of the apex cardiogram, and 3 patients of an undefined sound or vibration during atrial contraction. 2) Impaired left ventricular (LV) compliance by pressure-volume analysis and decreased diastolic descent rate (DDR) in the mitral echocardiogram observed in patients with DM suggested that mechanism of these DM is mainly attributed to the disturbance of LV filling. Furthermore, mitral regurgitation was detected by LV angiography in a half of patients, indicating that DM might be partially related to increased mitral flow. 3) Clinically, DM was more common in younger patients of familiar occurrence and death, and with impaired physical work capacity. Therefore, auscultatory or phonocardiographic assessment of DM was clinically useful in the evaluation of patients with non-obst HCM.