Hypertrophic Cardiomyopathy Đánh giá ban đầu

Symptoms of hypertrophic cardiomyopathy can range from patients being asymptomatic to mildly or significantly symptomatic with pre-syncopal or syncopal episodes, palpitations, chest pain, decreased exercise tolerance, symptoms of pulmonary congestion (eg fatigue, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea), and symptoms of end-stage heart failure or cardiac arrest.

 

Inquire from the patient about symptoms related to angina, arrhythmias, or heart failure. In the family history, review at least three to four generations of the family tree to help in the diagnosis, identify the underlying etiology, determine the inheritance pattern, and identify family members at risk of the disease. Focus on events such as heart failure, cerebrovascular accidents (particularly in those <50 years old), cardiac transplantation, defibrillator and pacemaker implants, sudden cardiac death and its risk factors, and evidence for systemic disease (eg diabetes, deafness, renal dysfunction, and skeletal muscle weakness).

Patients examined demonstrate a pulse that rises and falls rapidly, a prominent LV impulse, an abnormal carotid pulse, a fourth heart sound, and an apical systolic murmur that increases with the Valsalva maneuver. Examine also for extracardiac signs that may suggest a phenotypic mimic such as cataracts and corneal opacities in Anderson-Fabry disease, gait disturbance in Friedreich ataxia, and sensorineural deafness and learning difficulties in Noonan syndrome with multiple lentigines.