Thank you Harry, Prashant, and Swalpa for sharing 3 amazing echocardiograms in report today! We discussed echo findings and pathophysiology of mitral valve endocarditis, hypertrophic cardiomyopathy, and atrial masses!
Top Pearls from Today:
- YY’s pearl: Mitral valve leaflets tend to be more mobile than those of other valves in the heart, and carry a higher risk of embolic phenomenon in the setting of endocarditis.
- Harry’s pearl: Staph Aureus not only causes endocarditis, but also can extend into the myocardium, causing myocarditis!
For those of you craving more… HOCM and Atrial Masses!
- Remember that histopathology in patients with HOCM show myocardial disarray – hypertrophied myocytes arranged in a chaotic and disorganized fashion
- Clinical manifestations: many patients are asymptomatic, but others can develop one or more symptoms of DOE, fatigue, angina, syncope, palpitations, or acute hemodynamic collapse : Both supraventricular arrhythmias (primarily atrial fibrillation) and ventricular arrhythmias occur
- Echo findings of HOCM: LV hypertrophy, systolic anterior motion of the mitral valve (SAM), left ventricular outlet tract (LVOT) obstruction
- Counseling of Families: HOCM is an autosomal dominant disorder, with a high degree of penetrance : first-degree family members of affected patient should be evaluated for possible inheritance. : Evaluation includes history, examination, ECG, and echocardiogram : Routine genetic screening of first-degree relatives is not recommended unless a definite HOCM-causing mutation has been identified in the index patient.
Flashback to our prior pearls on atrial masses!
- >75% of primary cardiac tumors are benign
- Most are myxomas (80% are left atrial)
- Management is surgical, and urgency depends on symptoms and tumor type
- Myxoma always requires surgery due to high risk of embolic/cardiac complications
- Most common primary malignant cardiac tumor is sarcoma (rapidly progressive)
- Metastatic malignancy to the heart is more common than primary malignancy
- Evernote: https://www.evernote.com/shard/s338/sh/7cdb7e4c-a0dc-4ea8-ae80-2e36d535839b/5f1a78a81109d111f7cbeb608508683b