Hypertrophic cardiomyopathy diagnostic study of choice: Difference between revisions
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=== Study of choice === | === Study of choice === | ||
There is no single diagnostic study of choice for the diagnosis of hypertrophic cardiomyopathy, but hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, | There is no single diagnostic study of choice for the diagnosis of hypertrophic cardiomyopathy, but hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, and genetic testing.In fact, a series of studies are indicated the time of diagnosing HCM among them are Echocardiography and ECG. Echocardiography is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, MRI might detect HCM sooner, and as mentioned above genetic tests are also helpful. | ||
The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy: | The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy: | ||
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* LVH | * LVH | ||
*Systolic anterior motion of the mitral valve | *Systolic anterior motion of the mitral valve | ||
*Asymmetric thickening of the | *Asymmetric thickening of the interventricular wall. | ||
* Out follow obstruction, Pseudo sub-aortic stenosis | * Out follow obstruction, Pseudo sub-aortic stenosis | ||
*LVOT obstruction | *LVOT obstruction | ||
*LA enlargement (increase adverse effects of HCM including development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume) | *LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)<ref name="pmid24589281">{{cite journal| author=Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH et al.| title=Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. | journal=Am J Cardiol | year= 2014 | volume= 113 | issue= 8 | pages= 1394-400 | pmid=24589281 | doi=10.1016/j.amjcard.2013.12.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589281 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Diagnostic Study of Choice
There is no single study of choice in the diagnosis and management of patients with HCM. In fact a series of studies are indicated the time of diagnosing HCM among them are Echocardiograhy and ECG.
ESC Recommended tests in patients with definite or suspected HCM[1]
- Standard 12-lead electrocardiography.
- Trans-thoracic 2-D and Doppler echocardiography (including assessment of left ventricular outflow tract obstruction at rest and during Valsalva manoeuvre in the sitting and semi-supine positions).
- Upright exercise testing
- 48-hour ambulatory ECG monitoring.
- Cardiac magnetic resonance imaging should be considered if local resources and expertise permit.[1]
The followings are fundamentals of diagnostic studies:
- Diagnosing HCM
- To study the presence or severity of left ventricular outflow tract (LVOT) obstruction
- Tostudy the presence or severity of mitral regurgitation
- To evaluate the risk of developing arrhythmia (either SVT or VT)
- To examine LV function
Study of choice
There is no single diagnostic study of choice for the diagnosis of hypertrophic cardiomyopathy, but hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, and genetic testing.In fact, a series of studies are indicated the time of diagnosing HCM among them are Echocardiography and ECG. Echocardiography is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, MRI might detect HCM sooner, and as mentioned above genetic tests are also helpful.
The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy:
- LVH
- Systolic anterior motion of the mitral valve
- Asymmetric thickening of the interventricular wall.
- Out follow obstruction, Pseudo sub-aortic stenosis
- LVOT obstruction
- LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)[2]
Investigations:
- Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most sensitive test for diagnosis.
- Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most efficient test for diagnosis.
The comparison of various diagnostic studies for Hypertrophic cardiomyopathy
| Test | Sensitivity | Specificity |
|---|---|---|
| Test 1 | ...% | ...% |
| Test 2 | ...% | ...% |
[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity
Diagnostic results
The following finding(s) on performing [investigation name] is(are) confirmatory for Hypertrophic cardiomyopathy:
- [Finding 1]
- [Finding 2]
Sequence of Diagnostic Studies
The [name of investigation] must be performed when:
- The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
- A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
- [Initial investigation]
- [2nd investigation]
Name of Diagnostic Criteria
It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
Hypertrophic cardiomyopathy is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of Hypertrophic cardiomyopathy.
OR
There is no single diagnostic study of choice for Hypertrophic cardiomyopathy, though Hypertrophic cardiomyopathy may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of Hypertrophic cardiomyopathy is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of Hypertrophic cardiomyopathy is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
Hypertrophic cardiomyopathy may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
OR
IF there are clear, established diagnostic criteria
The diagnosis of Hypertrophic cardiomyopathy is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of Hypertrophic cardiomyopathy is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of Hypertrophic cardiomyopathy is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
IF there are no established diagnostic criteria
There are no established criteria for the diagnosis of Hypertrophic cardiomyopathy.
References
- ↑ 1.0 1.1 Authors/Task Force members. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F; et al. (2014). "2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)". Eur Heart J. 35 (39): 2733–79. doi:10.1093/eurheartj/ehu284. PMID 25173338.
- ↑ Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH; et al. (2014). "Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance". Am J Cardiol. 113 (8): 1394–400. doi:10.1016/j.amjcard.2013.12.045. PMID 24589281.