do u think urself clever?

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do u think urself clever?

Post  Ahmed Al-Kaisy on Mon Dec 24, 2007 11:25 am

A 21-years old man presents with exertional dyspnea and presyncope. he is quite athletic; however he notes that over the past several months he has become light-headed and short of breath when playing competative sports. his BP is 116/78. there is no increase in his JVP. his lungs are clear. his LV impulse is prominent. there is normal S1, S2 with a soft S4. there is a systolic murmur at the left sternal bordrer that doesnt radiate but worsens during the strain phase of valsalva. an ECG reveals LV hypertrophy. an echo is performed and reveals moderate LVH and RVH with a dunamic gradient in LVOT.

1- what is the probable diagnosis?

2-the best medical treatment for this condition is:a- diuretics.
b-calcium channel blockers.
c-ACE inhibitors.
d-nitroglycerin.
e-antiplatelet agents.

Ahmed Al-Kaisy

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Dear Ahmed:

Post  Mohammad Tayeb on Wed Dec 26, 2007 12:34 pm

1- The Dx is HOCM (Hypertrohic Obstructive Cardiomyopathy).
2- The best treatment is calcium channel blockers, mainly rate limiting agents, specifically Verapamil as it has negative inotropic effect thereby decreasing LVOT obstruction so decreasing the symptoms.

Mohammad Tayeb

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what a case

Post  sufyan on Wed Dec 26, 2007 8:36 pm

I will add nothing to what have been said
Hi mohamed keep going

sufyan

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Re: do u think urself clever?

Post  Ahmed Al-Kaisy on Thu Dec 27, 2007 12:10 am

that's right dear, we can use also other negative inotropic drugs as beta-blockers...if these are ineffective we can use disopyramide.....

Ahmed Al-Kaisy

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Re: do u think urself clever?

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