An otherwise healthy athlete complaints of chest pain and dyspnea during routine training, on examination has a double impulse at the apex, undergoes sudden death. Likely diagnosis
(A) HOCM # Symptoms of chest pain and dyspnea and findings of double impulse at the apex with sudden death suggest features of HYPERTROPHIC CARDIOMYOPATHY (HCM).> Hypertrophic cardiomyopathy (HCM) clinical features:> The clinical course of HCM is highly variable.> Many patients are asymptomatic or mildly symptomatic and may be relatives of patients with known disease.> Unfortunately, the first clinical manifestation of the disease may be sudden death, frequently occurring in children and young adults, often during or after physical exertion.> In symptomatic patients, the most common complaint is dyspnea, largely due to increased stiffness of the left ventricular walls, which impairs ventricular filling and leads to elevated left ventricular diastolic and left atrial pressures.> Other symptoms include angina pectoris, fatigue, and syncope.> Symptoms are not closely related to the presence or severity of an outflow pressure gradient.> Most patients with gradients demonstrate a double or triple apical precordial impulse, a rapidly rising carotid arterial pulse, and a fourth heart sound.
HOCM
Marfan syndrome
Myocardial Infarction
Valvular heart disease
Miscellaneous