Clinical Profile of Hypertrophic Cardiomyopathy in a Tertiary Level Hospital.
Loading...
Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background- Hypertrophic cardiomyopathy (HCM) is a genetically transmitted disease with diverse
natural history for which the potential to produce adverse consequences has been emphasized. However,
the possibility of this disease remaining clinically dormant for many years has not been as widely appreciated.
Certainly, the clinical recognition of previously undiagnosed patients with HCM may be advantageous by
permitting risk stratification for sudden cardiac death or for timely pharmacologic therapy when symptoms
intervene. The purpose of this study was to assess the disease pattern and the extent to which hypertrophic
cardiomyopathy (HCM) exists undetected in a suspected group of population never diagnosed to have any
cardiovascular disease, referred from the primary care facilities to one of the largest tertiary level hospital
of Bangladesh.
Methods-We prospectively conducted an echocardiographic survey in 3648 cases between 19-03-2009 to
03-08-2010 (18 months) in the cardiac centre of Combined Military Hospital, Dhaka, Bangladesh.
Results- A total of 3648 cases referred by primary care physicians underwent echocardiogram either to
confirm a new diagnosis or to exclude obvious cardiovascular abnormalities. Hypertrophic cardiomyopathy
was identified in 148 patients (4.06%) who was not known have any cardiac disease before. At diagnosis,
age ranged from 20 to 83 years (mean 52.19) with male gender preponderance (85.81%). Ninety eight
patients (67%) had no functional limitation and the remaining fifty patients reported with symptoms
mostly giving multiple responses like chest pain (39.2%), palpitation (18.9%), dyspnoea (22.3%), unusual
fatigability (16.9%) and syncope (6.8%). Twelve patients had strong suspicion of familial predisposition
depending on the symptomatology of the familial tree but were confirmed only in 03 cases by
echocardiography. Basal left ventricular outflow obstruction (gradients 20 to 76 mm Hg) was evident in 14
patients (9.45%). Relatively variable phenotypic expression of the disease was substantiated by diffuse
thickening of left ventricular wall occurring more commonly than localized distributed hypertrophy (56.08%
vs. 43.94%, respectively). Electrocardiogram was abnormal in almost 95% of cases and typical pattern of
left ventricular hypertrophy was observed in 25.68% cases.
Conclusion -This prospectively assembled data show that HCM cases may remain asymptomatic, clinically
dormant and undetectable for many years (often to advance ages) in our community. The actual prevalence
of the disease in our community needs to be ascertained which might exceed the prevalence mentioned in
the text books.
Description
Keywords
Hypertrophic cardiomyopathy, Electrocardiogram, Echocardiogram
Citation
Malek M A, Iqbal S A, Khan Z, Haque A F M S, Sultana S A. Clinical Profile of Hypertrophic Cardiomyopathy in a Tertiary Level Hospital. Cardiovascular Journal. 2014; 7(1): 31-37.