Hypertrophic cardiomyopathy in special clinical scenarios

WikiDoc Resources for Hypertrophic cardiomyopathy in special clinical scenarios
Articles
Most recent articles on Hypertrophic cardiomyopathy in special clinical scenarios Most cited articles on Hypertrophic cardiomyopathy in special clinical scenarios Review articles on Hypertrophic cardiomyopathy in special clinical scenarios Articles on Hypertrophic cardiomyopathy in special clinical scenarios in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Hypertrophic cardiomyopathy in special clinical scenarios Images of Hypertrophic cardiomyopathy in special clinical scenarios Photos of Hypertrophic cardiomyopathy in special clinical scenarios Podcasts & MP3s on Hypertrophic cardiomyopathy in special clinical scenarios Videos on Hypertrophic cardiomyopathy in special clinical scenarios
Evidence Based Medicine
Cochrane Collaboration on Hypertrophic cardiomyopathy in special clinical scenarios Bandolier on Hypertrophic cardiomyopathy in special clinical scenarios TRIP on Hypertrophic cardiomyopathy in special clinical scenarios
Clinical Trials
Ongoing Trials on Hypertrophic cardiomyopathy in special clinical scenarios at Clinical Trials.gov Trial results on Hypertrophic cardiomyopathy in special clinical scenarios Clinical Trials on Hypertrophic cardiomyopathy in special clinical scenarios at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Hypertrophic cardiomyopathy in special clinical scenarios NICE Guidance on Hypertrophic cardiomyopathy in special clinical scenarios NHS PRODIGY Guidance FDA on Hypertrophic cardiomyopathy in special clinical scenarios CDC on Hypertrophic cardiomyopathy in special clinical scenarios
Books
Books on Hypertrophic cardiomyopathy in special clinical scenarios
News
Hypertrophic cardiomyopathy in special clinical scenarios in the news Be alerted to news on Hypertrophic cardiomyopathy in special clinical scenarios News trends on Hypertrophic cardiomyopathy in special clinical scenarios
Commentary
Blogs on Hypertrophic cardiomyopathy in special clinical scenarios
Definitions
Definitions of Hypertrophic cardiomyopathy in special clinical scenarios
Patient Resources / Community
Patient resources on Hypertrophic cardiomyopathy in special clinical scenarios Discussion groups on Hypertrophic cardiomyopathy in special clinical scenarios Patient Handouts on Hypertrophic cardiomyopathy in special clinical scenarios Directions to Hospitals Treating Hypertrophic cardiomyopathy in special clinical scenarios Risk calculators and risk factors for Hypertrophic cardiomyopathy in special clinical scenarios
Healthcare Provider Resources
Symptoms of Hypertrophic cardiomyopathy in special clinical scenarios Causes & Risk Factors for Hypertrophic cardiomyopathy in special clinical scenarios Diagnostic studies for Hypertrophic cardiomyopathy in special clinical scenarios Treatment of Hypertrophic cardiomyopathy in special clinical scenarios
Continuing Medical Education (CME)
CME Programs on Hypertrophic cardiomyopathy in special clinical scenarios
International
Hypertrophic cardiomyopathy in special clinical scenarios en Espanol Hypertrophic cardiomyopathy in special clinical scenarios en Francais
Business
Hypertrophic cardiomyopathy in special clinical scenarios in the Marketplace Patents on Hypertrophic cardiomyopathy in special clinical scenarios
Experimental / Informatics
List of terms related to Hypertrophic cardiomyopathy in special clinical scenarios

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Management of HCM in presence of hypotension and cardiovascular collapse

The first patient I (C. Michael Gibson, M.D.) treated as a medical student was an 18 year old woman who had HOCM. She had just entered college and had partied throughout the night. She was vomiting, developed new atrial fibrillation at a rate of 180 beats per minute. She had a syncopal episode and had a systolic blood pressure of 60 mm Hg. This young lady had sustained hemodynamic collapse as a result of volume depletion and tachycardia.

Precipitants of Hemodynamic Collapse

• Volume depletion or dehydration which can be due to:

• Vomiting
• Diuretics
• Hemorrhage

• Reduced pre-load which can be due to:

• Sepsis
• Venodilators such as nitrates
• Following epidural blockade

• Tachycardia
• Withdrawal of beta-blockers or calcium channel blockers
• Decreased afterload due to:

• Vasodilator therapy
• Sepsis

Physical examination Findings in Hemodynamic Collapse

A rapid, weak pulse is present in the patient who is hypotensive. The JVP is flat. A systolic murmur is present.

Echocardiographic Findings in Hemodynamic Collapse

• A small hypercontractile left ventricle is present

• Prolonged systolic anterior motion of the mitral valve is present

• Mitral regurgitation with a posterior directed jet

Treatment of Hemodynamic Collapse

Initial treatment includes the following:

• Avoid nitrates even though it appears the patient is in heart failure!
• Avoid vasodilators again even though it appears the patient is in heart failure! Both these agents could cause further hemodynamic compromise.
• Administer beta-blockers to slow the heart rate and fluids to raise the left ventricular filling pressures.
• Elevate the legs to increase venous return and raise the preload

If the patient does not respond to these measures, then the following can also be administered:

• Intravenous phenylephrine at a rate of 100 to 180 µg/min, which is then reduced to 2 to 3 mL/min (40 to 60 drops/min).

• How to mix the phenylephrine: Make a solution that contains 10 mg (1 mL of 1 percent phenylephrine) of phenylephrine diluted in 500 mL of D5W. Administer at a rate of 5 to 9 mL/min (i.e. 100 to 180 drops/min assuming there are 20 drops/mL). This solution provides a phenylephrine drip of 100 to 180 µg/min.

• Outside of the US, intravenous disopyramide at a dose of 50 mg over one to five minutes can be administered.