AAAAA
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What is the physical finding to differentiate AS and HOC ?
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| AAAAA
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AS aortic stenosis
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| AAAAA
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AS satnds for aortic stenosis
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HOC
Attached Files:
obstructiveform2.jpg (13 KB, 9 downloads)
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| AAAAA
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Triple ripple is for HC
S4, systolic and recovery impulses
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| AAAAA
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Valsalva is very helpful to distinguish at bedside of AS from HOCM
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| AAAAA
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Valsalva is very helpful to distinguish at bedside of AS from HOCM
Anyl nitrate increase the murmur of both AS and HOCM
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Valsalva increases teh murmur of HOCM but decrease the murmur of AS
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| Alina T
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How does amyl nitrite act on CVS to increase the murmurs of AS and HOC and to decrease the murmur in mitral regurgitation? Does anybody know more details about this?
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| AAAAA
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Amyl nitrate is usually stored in the echo lab and given to patient if there is a question echo is not 100% for sure to confirm HOC.
I really have not seen many cardiologist used amyl nitrate at all since color doppler flow ultrasound echocardiogram can always confirm the HOC diagnosis and spiral CT, calcium CT and MRI are used everyday. Amyl nitrate belongs to the lecture hall as a discussion only and may be in the exam but valsalva is a better way !
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| AAAAA
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Amyl nitrate is a vasodilator and will dilate the vascular trees in both venous return and outflow track.
The vasodilation causes "DECREASE" of the venous return and increase the murmur of both AS and HOCM !!!!!
(I hope I can help !)
(Have you seen a case , a real case of HOCM yet ?)
Mayo Clinic is the world largest clinic for HOCM, Mayo Clinic is located in Rochester, Minnesota and has over thousands of patients of HOCM throughout years !!
World-renounced for HOCM !
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| AAAAA
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Amyl nitrate is usually stored in the echo lab and given to patient if there is a question echo is not 100% for sure to confirm HOC.
I really have not seen many cardiologist used amyl nitrate at all since color doppler flow ultrasound echocardiogram can always confirm the HOC diagnosis and spiral CT, calcium CT and MRI are used everyday. Amyl nitrate belongs to the lecture hall as a discussion only and may be in the exam but valsalva is a better way !
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The effect of amyl nitrite on the mitral valve echocardiogram in presumably healthy young adults.
Morise AP, Gibson TC, Davis SM, Bonazinga BJ, Sbarbaro JA.
We analyzed the use of amyl nitrite as a provocative factor in the diagnosis of mitral valve prolapse in a population of healthy young adults. Sixty-five men and 11 women underwent continuous M-mode echocardiographic and phonocardiographic monitoring before, during and after the administration of inhaled amyl nitrite. All of the 76 subjects had normal baseline echocardiograms, and all had a satisfactory hemodynamic response to amyl nitrite. Mitral valve prolapse, defined by echocardiography and phonocardiography, was not provoked in any of the subjects. Therefore, we concluded that, although this technique may be difficult, significant false-positive results should not occur if adherence to strict diagnostic criteria takes place.
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Table 1. Typical physical findings in obstructive hypertrophic cardiomyopathy
Fourth heart sound
Harsh crescendo-decrescendo systolic murmur
Murmur decreased by:
Handgrip
Passive leg elevation
Squatting from standing position
Murmur increased by:
Premature ventricular contraction
Standing from squatting position
Use of amyl nitrite (Amyl Nitrite Aspirols, Amyl Nitrite Vaporole), nitrites, isoproterenol HCl infusion (Isuprel, Medihaler-Iso)
Valsalva's maneuver
Precordial palpation ("triple ripple" thrill)
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Amyl nitrite is a volatile fluid that is administered by crushing open an ampule.
The patient is asked to take repeated deep breaths through the mouth for about 20 seconds.
To prevent lingering odor and further dissemination from the crushed ampule into the room air, there should be proper ventilation with an electric fan, and the used ampule should be quickly discarded into a cup of water.
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References:
Echocardiography 2000 Feb;17(2):105-8
Inhalation of amyl nitrite and the measurement of left ventricular outflow velocity: studies in normal, young adults.
Vandenberg BF, Zink MH, Ayres RW, Lindower PD, Rath LS, Lewis J.
Prairie Cardiovascular Consultants, P.O. Box 19420, Springfield, IL 62740, USA.
Amyl nitrite inhalation is useful in the identification of patients with provocable left ventricular (LV) outflow tract obstruction. However, there are no prospective studies that assess the normal change in LV outflow velocity during this intervention. Eighteen normal subjects (mean age, 34+/-5 years; 9 men and 9 women) inhaled amyl nitrite during measurement of LV outflow velocity. Peak velocity increased from 109+/-16 cm/s to 144+/-24 cm/s (P<0.001). There were no significant gender differences in velocity measurements at baseline or at peak. Our study provides prospective data that may be useful when evaluating young adults for LV outflow tract obstruction with Doppler echocardiography during amyl nitrite inhalation
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| AAAAA
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You tell the patient to inhale Amyl nitrate ampule (the technician broke the small ampule and the patient inhales for 20 seconds) and then you can listen to the heart sounds of the patient to see if there is an increase of the aortic S 2 !
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