Analysis On Clinical Diagnosis Of 34 Patients With HOCM

Objective: To investigate the clinical manifestation, diagnosis and improve the diagnostic level of hypertrophic obstructive cardiomypathy (HOCM). Methods: clinical data (symptom, sign, electrocardiographic changes and echocardiographic changes) of 34 patients with HOCM during 1995-2003 were collected and retrospectively analyzed. Result: 1. In this group, there were 31 patients with exertional dyspnea (91.2%), 16 patients with chest pain(47. 1%), 21 patients with palpitation(61. 8%), syncope or presyncope were found in 14 patients (41.2%), proxysmal nocturnal dyspnea were found in 8 patients (23.5%); 11 patients with dizziness (32.4%), 6 patients with fatigue (17.6%), there was 1 patient with cardiac arrest (2.9%); Signs include hars systolic murmur at third or forth interspaces to the left were found in 30 patients (88.2%), enlargment of the heart s border were found in 11 patients (32.4%), crackles on the lung fields were found in 2 patients (5.9%), there were 3 patients with sustained apical impulse (8. 8%), 3 patients with thrill at third or forth interspaces to the left (8.8%), edema were found in 5 patients (14.7%), 1 patient with cyanosis (2.9%) .2. There are 33 (97.1%) patients with electrocardiographical abnormality; 26( 78. 8%)patients with ST segment depression or nagetive T waves, among them, 21 (63.6%) patients with ST segment depression combined nagetive T waves; 11(33. 3%)patients with left ventriclehigh voltage; abnormal Q waves are found in 8 (24. 2%) patients; there were 15(45. 5%)patients with cardiac arrhythmias, frequent premature ventricular beats are found in 5 (15.2%) patients, 2 (6.1%) patients with frequent premature atrial beats, sinus bradycardia were found in 3 (9.1%) patients, 2 (6.1%) patients with CRBBB, 1 (3. 0%) patients with CLBBB, 2 (6. 1%) patients with LAFB, 2 (6. 1%) patients with Second degree AVB Morbiz II, 2(6. 1%) patients with atrial fibrillation were found, there were 1 patient with normal electrocardiogram. 3. Interventricular septal thin(IVST) of all patients in this group≥ 15mm, IVST between 15-32mm(22. 7mm), asymmetric septal hypertropy; IVST/PWT ≥ 1.3 were found in 31 patients(91.2%), IVST/PWT≥1.5 were found in 22 patients (64.7%), 13 patients with IVST/PWT≥2 (38.2%); there were 18 patients with SAM( + )(52. 9%); Pressure gradient (PG) were measured in 29 patients , PG between 8.8-203mmHg(57. 25mmHg), 25 patients' PG>20mmHg(86. 2%), 14 patients' PG ≥50mmHg (48.3%); 4 patients with mild aortic incompetence(11.8%), 6 patients with mild mitral stenosis (17.6%); there were 3 patients who's EF < 50% (8. 8%) . There were 6 patients' PG measured by left ventricular catheter, PG45-170mmHg(85.8mmHg). Conclusion: The most common symptom of HOCM is exertional dyspnea (91.2%); The most common sign is hars systolic murmur at third or forth interspaces to the left (88.2%) ; Electrocardiographic change is depression of ST segment(78. 8%). Echocardiography is invasive and reliable methods for diagnose to the patient with HOCM.