HCM

شو الحل النهائي لحل مشكلةHYPERTROPHY CARDIOMYOPATHY؟
ما هي العلاجات المقدمة لتحسين الاعراض؟
ممكن نعطيه مدرات او نترات ؟

outpatient until time for myocardial transplant
or treatment of severe HF

ACEi + diuretics are the current treatment of choice

but my question is:

What about digoxin???

the treatment of choice is beta locker not diuretics or Ace inhibitor and these patient don't go to heart transplant
there is another surgical treatment for them like cutting part of septum surgically

طيب دكتور الفاروق
أول شي أنا حكيت عن العلاج الشافي وهو زرع القلب وما حكيت عن الخيارات العلاجية المتاحة

تاني شي صح معك حق العلاج الأمثل حسب ما كنت دارس هو حاصرات بيتا ولكن اليوم الصبح قريت بكتاب 5mcc
أنو حاصرات الخميرة والمدرات هي الخط الأول في المعالجة

I am sorry to tell you that 5mcc was wrong
the following from uptodate 20007

Medications to be avoided or used with caution — In patients with significant LV outflow obstruction, hemodynamics can be compromised by the following medications: Vasodilators — Vasodilators, such as as nifedipine, nitroglycerin, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers, can produce a fall in peripheral resistance, with an increase in outflow obstruction and filling pressures, thereby resulting in hypotension and/or worsening heart failure. Diuretics — By reducing preload, diuretics can result in less LV filling, a smaller LV chamber, and therefore greater outflow obstruction. However, as noted above, cautious use of diuretics may be attempted in patients with persistent heart failure and volume overload.

والله أنا أهم سي دي بعتمد عليه هو الuptodate
بس شو هالاختلاف الكبير من أدوية تستخدم بحذر لعلاج الخط الأول
شكرا الفاروق

I have read in the cicel about treatment of hcm with refractory symptoms that "insertion of a dual-chamber pacemaker may help relieve the obstruction".
does any body know what is dual chamber pacemaker?

Dual chamber pacemakers typically use two leads, one placed in the right atrium and the second one placed in the right ventricle. The electrical pulses delivered to the heart are timed so that the atria are stimulated to contract just before the ventricles. The timing ensures the atria and the ventricles are beating "in sync" with one another.

single chamber pacemaker(most of the pacemaker
use one lesd in the R ventricle

the reason why dual chamber helps obstructive crdiomyopathy cause they keep the atrial contraction in the right time
right before the ventricle contracts
this wll help filling the ventricle and alleviating some diastolic dysfunction