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Re: Sparing of Posterior Basal wall in HOCM

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  • Conrad F
    I just did a pt today with a septum measuring 1.9cm, SAM and a classic dagger shaped wave form with a velocity of 6ms. the posterior wall measuerd 1.5cm
    Message 1 of 8 , Dec 1, 2010
      I just did a pt today with a septum measuring 1.9cm, SAM and a classic dagger shaped wave form with a velocity of 6ms. the posterior wall measuerd 1.5cm (clearly hypertrophied). so this pt has HOCM and the posterior was not spared. Now you can have LVH that causes LVOT obstruction and that is not HOCM per se. But if you have ASH then this is HOCM. A septum measuring 1.9cm and a posterior wall measuring 1.5cm is ASH. I will try to post images but time constraints might not let me.

      Conard F RDCS RVT
      --- In echocardiography@yahoogroups.com, Terry Zwakenberg <tjzwak@...> wrote:
      >
      > I have seen many instances where the mid ventricular posterior and septal
      > walls thicken and create apical trapping wth increased
      > velocities. especially when the patient gets a little hyperdynamic or
      > dehydrated. ASH, SAM, and midsystolic closure of the aortic valve are the
      > hallmarks of IHSS not just subvalvular obstruction. the patient in question
      > has hypertrophy of the posterior wall so could not be classified as having
      > ASH. again not an unusual finding for HCM, or even HOCM.
      >
      > ...TJ
      >
      > To handle yourself, use your head. To handle others, use your heart.
      >
      >
      > On Fri, Nov 26, 2010 at 5:50 PM, Xufang Bai <xufangbai@...> wrote:
      >
      > >
      > >
      > > By definition, HOCM means 1)the pt has HCM; 2)hypertrophied septum caused
      > > LVOT obstruction.
      > >
      > >
      > > A lonely Tau hunter <http://www.xufangbai.com/>
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      > > ------------------------------
      > > *From:* Gershom Lichtenberg <gershomsl@...>
      > > *To:* "echocardiography@yahoogroups.com" <echocardiography@yahoogroups.com
      > > >
      > > *Sent:* Fri, November 26, 2010 12:57:02 PM
      > > *Subject:* Re: [echocardiography] Sparing of Posterior Basal wall in HOCM
      > >
      > > To the best of my knowledge, there is no such thing as "should have
      > > been spared." Basically any wall including the apex can be involved.
      > >
      > > In addition, even if the posterior wall is not involved in the initial
      > > process it could thicken as a result of the pressure overload caused
      > > by the LVOT obstruction.
      > >
      > >
      > > Gershom Lichtenberg, RDCS
      > > Echocardiographer
      > > Rambam Healthcare Campus
      > > Haifa, Israel
      > >
      > > On Thursday, November 25, 2010, syed r <d_raza1@...> wrote:
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      > > > Recently I performed an echo of a post myomectomy HOCM patient. In
      > > the echo posterior basal wall was perhaps 1.4 cm. Why was it thickened while
      > > it should be spared in HOCM? I can load the picture/video clip but i don't
      > > know how to do that. thanks
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      > > ------------------------------------
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      > > Yahoo! Groups Links
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    • Brian Stockard
      If I remember correctly, ASH is defined by the IVS being at least 1.35 times the thickness of the posterior wall. This example does not qualify. While this
      Message 2 of 8 , Dec 2, 2010
        If I remember correctly, ASH is defined by the IVS being at least 1.35 times the thickness of the posterior wall.  This example does not qualify.   While this is not the varient of HOCM we always called IHSS (idiopathic hypertrophic subaortic stenosis),  this is HOCM based on the gradient within the left ventricle portrayed as that typical dagger shaped signal.  As in T J's example, HOCM includes more than just IHSS.

        Brian



        From: Conrad F <ultra1066@...>
        To: echocardiography@yahoogroups.com
        Sent: Wed, December 1, 2010 10:49:19 PM
        Subject: [echocardiography] Re: Sparing of Posterior Basal wall in HOCM

         


        I just did a pt today with a septum measuring 1.9cm, SAM and a classic dagger shaped wave form with a velocity of 6ms. the posterior wall measuerd 1.5cm (clearly hypertrophied). so this pt has HOCM and the posterior was not spared. Now you can have LVH that causes LVOT obstruction and that is not HOCM per se. But if you have ASH then this is HOCM. A septum measuring 1.9cm and a posterior wall measuring 1.5cm is ASH. I will try to post images but time constraints might not let me.

        Conard F RDCS RVT

        --- In echocardiography@yahoogroups.com, Terry Zwakenberg <tjzwak@...> wrote:
        >
        > I have seen many instances where the mid ventricular posterior and septal
        > walls thicken and create apical trapping wth increased
        > velocities. especially when the patient gets a little hyperdynamic or
        > dehydrated. ASH, SAM, and midsystolic closure of the aortic valve are the
        > hallmarks of IHSS not just subvalvular obstruction. the patient in question
        > has hypertrophy of the posterior wall so could not be classified as having
        > ASH. again not an unusual finding for HCM, or even HOCM.
        >
        > ...TJ
        >
        > To handle yourself, use your head. To handle others, use your heart.
        >
        >
        > On Fri, Nov 26, 2010 at 5:50 PM, Xufang Bai <xufangbai@...> wrote:
        >
        > >
        > >
        > > By definition, HOCM means 1)the pt has HCM; 2)hypertrophied septum caused
        > > LVOT obstruction.
        > >
        > >
        > > A lonely Tau hunter <http://www.xufangbai.com/>
        > >
        > >
        > >
        > >
        > >
        > >
        > >
        > >
        > >
        > >
        > > ------------------------------
        > > *From:* Gershom Lichtenberg <gershomsl@...>
        > > *To:* "echocardiography@yahoogroups.com" <echocardiography@yahoogroups.com
        > > >
        > > *Sent:* Fri, November 26, 2010 12:57:02 PM
        > > *Subject:* Re: [echocardiography] Sparing of Posterior Basal wall in HOCM
        > >
        > > To the best of my knowledge, there is no such thing as "should have
        > > been spared." Basically any wall including the apex can be involved.
        > >
        > > In addition, even if the posterior wall is not involved in the initial
        > > process it could thicken as a result of the pressure overload caused
        > > by the LVOT obstruction.
        > >
        > >
        > > Gershom Lichtenberg, RDCS
        > > Echocardiographer
        > > Rambam Healthcare Campus
        > > Haifa, Israel
        > >
        > > On Thursday, November 25, 2010, syed r <d_raza1@...> wrote:
        > > >
        > > >
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        > > >
        > > >
        > > >
        > > >
        > > >
        > > >
        > > >
        > > >
        > > > Recently I performed an echo of a post myomectomy HOCM patient. In
        > > the echo posterior basal wall was perhaps 1.4 cm. Why was it thickened while
        > > it should be spared in HOCM? I can load the picture/video clip but i don't
        > > know how to do that. thanks
        > > >
        > > >
        > > >
        > > >
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        > > >
        > > >
        > > >
        > > >
        > > >
        > > >
        > >
        > >
        > > ------------------------------------
        > >
        > > Yahoo! Groups Links
        > >
        > >
        > >
        > >
        > >
        > >
        >


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