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hypertrophic cardiomyopathy and you


electro's horse

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Hypertrophic cardiomyopathy, herefore referred to as HCOM, is a congenital thickening of the heart wall. The severity of this issue depends on where the thickening occurs, how thick it is, and what is the relative demand on the heart. firstly, a quick physiology lesson. 

detail_heart4.jpg

deoxygenated blood enters the right atrium, goes through the tricuspid valve in the right ventricle, pumped out through the pulmonary valve into the lungs where it grabs some O2, enters the left atrium, cross the mitral valve into the L ventricle, then pumped out into circulation through the aortic valve. For our purposes, we're going to stay in the LV.

the wall between the left and right ventricle is called the ventricular septum. As blood from the LV pushes up into the aorta, it sorta passes past the ventricular side of the septal wall. it's fine. there's a tube above it. it's no big deal.

In HCOM, that hyperplasia can extend out from the ventricular septum and get in the way of blood going into the aorta. Normally this isn't a problem unless there is increased cardio demand. 

The first place blood goes after it leaves the aorta is the cardiac arteries. if someone is running real fast and the heart starts beating, the demand on the heart might outpace what can physically be pumped out past the growth obstructing the path into the aorta. It becomes a feedback loop where the heart works harder to pump out less blood which makes it pump harder to pump out less blood etc. The result is sudden cardiac death, and that's all she wrote. If the heart loses blood, you will die. if you ever hear about highschool athletes dying out of nowhere, this is why. 

This is generally diagnosed early in childhood. It's an easy murmur to hear. Then it's an easy echo or mri. 

you treat with alcohol ablation. basically you put a stint up the femoral artery, inject the overgrown area with EtOH, and force an infarction in the tissue so it will atrophy and die. Of course, this is more an art than a science, but it's a pretty good surgery. 

now, what does this mean for the carolina panthers? it depends. we don't really have enough information about where the growth is to make the decision. this latest leak doesn't make any sense to me. Echos are cheap and easy and i can't imagine anyone fuged that up. MRIs are definitive. 

oh well we'll see soon. parents get your kids tested to make sure they don't have this. 

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2 minutes ago, Michaelinraleigh said:

Really?

My son has SVT and the doc said if they need to do ablation it was a 30 to 45 min deal and he would be back on the field in a couple of weeks.

Is this that much worse than SVT?

do you mean a supraventricular tachycardia?

SVT is caused by a miscommunication of electrical signals. so when they correct that they basically go in and burn/freeze away the conduction paths so the electrical signals from the top of the heart have to go down the correct way. heart is basically just a big fuging circuit board. 

that's relatively quick. they wont even put your son under for that. 

what sweat might need is for heart tissue to literally atrophy and die off. huge risk for embolus, huge risk for shitty cardiac remodeling, he'd probably have to go back in and have it cleaned up, he'd probably be on warfarin the rest of his life, etc. 

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4 minutes ago, Michaelinraleigh said:

Really?

My son has SVT and the doc said if they need to do ablation it was a 30 to 45 min deal and he would be back on the field in a couple of weeks.

Is this that much worse than SVT?

This isn't related to SVT at all in any way except that both are heart conditions. This isn't ablating a small ectopic pacemaker, it's pretty significant structural heart surgery. HOCM is one of the more common causes of sudden death in athletes. Chances are, if you've heard of a teenage or young adult athlete suddenly going into cardiac arrest while playing a sport it was HOCM. 

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