Ghidul privind diagnosticul şi managementul sincopei - Romanian ...

Romanian Journal of Cardiology
Vol. 26(21), No. 2, 2011
Cornelia Cãlinescu et al
Risk factors for sudden death
Figura 1. ECG: sinus rhythm HR 70 bpm, QRS axis + 20 degrees, left atrial anomaly, LV hypertophy with secondary ST-T changes: biphasic T waves in V2,
negative T waves in DI, DII, aVL, V3-V6 (Note that the setting of the amplitude is half the standard in the precordial derivations, 0.5 mm / mV)
In conclusion, we established the following diagnosis:
Biventricular obstructive hypertrophic cardiomyopathy.
Stable angina Canadian Class II. Moderate
mitral regurgitation.
Analyzing the above mentioned clinical and echocardiographic
data, in the presence of major risk factors
for sudden death (family history of early sudden
death, LV parietal thickness >30 mm, the presence of
LV outfl ow tract obstruction) we established that the
patient would have maximum benefi t from the implantation
of a cardioverter defi brillator and dual-chamber
pacing (Figure 5, 6). Th e procedure was performed without
complications and the patient will be reassessed
(clinically and by echocardiography) aft er one month
from the intervention.
A B
DISCUSSION
Aft er 50 years of recognition and study, it is obvious
that hypertrophic cardiomyopathy (HCM) is a particularly
heterogeneous and unpredictable disease. Sudden
death (SD) continues to be the most devastating complication
of HCM5. Although earlier studies indicated
a risk of sudden death in hypertrophic cardiomyopathy
between 3-5% per year, latest data are more optimistic
indicating a risk of about 1% per year3 . Th us, a very
important aspect in patients with hypertrophic cardiomyopathy
is sudden death risk assessment. Risk factors
for sudden death are:
When the risk for SCD is judged by contemporary
criteria to be unacceptably high and intervention is needed,
the ICD is the most eff ective and reliable treat-
Figura 2. Bidimensional transthoracic echocardiography A. Parasternal long axis view - massive hypertrophy of the interventricular septum (41 mm) and
posterior LV wall B. Th e M mode in parasternal long axis view showing the systolic anterior motion of the mitral valve (arrow).