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Pathology of hypertrophic obstructive cardiomyopathy degree of left ventricular obstructive lesions of varying severity. The typical lesions in the upper ventricular septal hypertrophy the most significant, the vertical cut happy septum, hypertrophy of the heart that is to the left and right ventricular cavity bulging. Ventricular septum is the thickest part of the free edge of anterior mitral valve leaflet below the ventricular septum in the area due to collision with each other before the valve leaflets and showed the limitations of fibrosis intimal thickening. Myocardial hypertrophy in ventricular septal thickness up (aortic rings), down (apex) decreased, lower left ventricular outflow tract obstruction in cardiac hypertrophy with a ventricular septal leaflet between the free edge. Cardiac contraction, hypertrophy of the heart into the ventricular septum convex cavity, close to the forward of the anterior mitral valve leaflets, resulting in left ventricular outflow tract obstruction, sometimes associated with regurgitation. Early systolic outflow tract obstruction to a lesser extent, at this time of ventricular cardiac output more. Anterolateral part of the left ventricular free wall and apex uniform hypertrophy, left ventricular posterior wall thickness is less, ventricular septum and left ventricular posterior wall thickness ratio up to 3:1, smaller left ventricular cavity. Middle of the ventricular septal thickening was dumbbell-shaped ventricular cavity. Advanced s


tage disease, due to severe myocardial infarction or chronic heart failure, left ventricular possible expansion of the left atrial cavity often enlarged heart wall thickening, thickened anterior mitral valve leaflets, chordae rupture or may be associated with congenital malformations. Right ventricular hypertrophy due to heart broke into the right ventricle can cause ventricular outflow tract obstruction. Right ventricular free wall course of the elderly may be due to obstructive lesions or thickening of the pulmonary circulation rising pressure. Ventricular septal and ventricular wall of the coronary artery wall thickening often, the lumen is small, may lead to transmural myocardial obstruction. Clinical symptoms were shortness of breath after exertion, syncope or dizziness, and angina after the event, and is similar to aortic stenosis. About 10% of cases because of paroxysmal or persistent atrial fibrillation, or palpitations caused by circulation embolism. Appeared in advanced cases of congestive heart failure, orthopnea and pulmonary edema. Common symptoms are increased apical pulse, the shift to the lower left, lifting impulse or dual common sexual impulses. The lower left sternal border or apex can be heard mid-ejection systolic murmur transmitted to the base of the heart, often accompanied by tremor. Cases were associated with mitral regurgitation systolic murmur apical area were completely, 2 split heart sounds, heart sounds can be heard 3 or 4 heart sounds. But can not hear systolic ejection sound like s. Strong shock waves around the artery, disappearance of smaller waves, and water will pulse similar. Auxiliary, chest X-ray: increased heart shadow, left ventricular increased, but no aortic enlargement or signs of calcification in the leaflets. Advanced cases, the left atrium and right ventricle can increase lung field of blood vessels Yu. ECG: shows left ventricular hypertrophy and strain, and sometimes chest leads aVL and I showed abnormal Q waves. Some patients showed complete right bundle branch, left bundle branch or left anterior half branch block and left atrial hypertrophy. Cardiac catheterization: right heart catheterization showed pulmonary artery pressure can be increased or signs of right ventricular outflow tract obstruction. Cardiac catheterization showed the left ventricular end-diastolic pressure increased significantly, the left ventricular cavity and outflow tract systolic pressure gradient between. Aortic or peripheral arterial pressure waveform shows increased support rapid rise, showing two peaks, and then slowly decline. Ventricular extrasystoles after the aortic pulse pressure decreased. Taking nitroglycerin, amyl nitrite, isoproterenol, digitalis, and manual labor, and Valsalva maneuver to enhance myocardial contractility, increased left ventricular outflow tract obstruction, can lead to noise loudness strengthened, increasing systolic pressure gradient . Selective angiography of left ventricular outflow tract can be displayed before the top of the uplift of the ventricular septal hypertrophy and outflow tract of the posterior wall of the anterior mitral valve leaflet, left ventricular cavity bending, end-systolic left ventricular volume small and thick papillary muscle. Left ventricular angiography with or without mitral regurgitation can still be ascertained. Adult patients should undergo coronary angiography, in order to understand whether coronary artery disease. Echocardiography: shows marked thickening of left ventricular wall, ventricular septal hypertrophy more than the ventricular wall, left ventricular cavity is small, outflow tract obstruction and systolic anterior mitral valve leaflet when the forward displacement. Differential diagnosis of patients with ventricular outflow obstruction due to a characteristic clinical manifestations, diagnosis is not difficult. Echocardiography is extremely important non-invasive diagnostic methods, both of obstructive and nonobstructive patients are helped, interventricular septum thickness 18mm and a mitral systolic forward enough to distinguish between obstructive and nonobstructive cases. Cardiac catheterization showed poor left ventricular outflow tract pressure to establish diagnosis. Also valuable in the diagnosis of left ventricular angiography. Clinically, the left lower sternal border in the systolic murmur should consider this disease, or drugs with the physical action of hemodynamic changes in the observation noise diagnosis. In addition, must make the following diagnosis. (A) ventricular septal defect systolic murmur similar parts, but for the whole systole, the apex more no noise, echocardiography, cardiac catheterization and angiocardiography can be different. (B) of the symptoms of aortic stenosis and the noise of a similar nature, but the high noise area, and often the aortic valve area systolic ejection sound, second sound diminished, there may be early diastolic murmur. X-ray showed expansion of the ascending aorta. Physical action or drugs had little effect on the noise. Left heart catheterization showed systolic pressure difference exists in the aortic valve before and after. Echocardiography is clear lesion. (C) of the murmur of rheumatic mitral regurgitation were similar, but more for the whole contraction, vasoconstriction, enhancing drug or squat to noise, often accompanied by atrial fibrillation, large left atrium, echocardiography, ventricular septal defect does not appear. (Iv) angina pectoris, ECG ST-T changes and abnormal Q wave both there, but no features of coronary heart murmur, widened or more calcified aorta, hypertension and high cholesterol and more; echocardiography map not septal thickening, but there may be segmental wall motion abnormalities. Treatment of hypertrophic obstructive cardiomyopathy can show symptoms at any age, the most common age of onset before 20 years of age. Transcatheter examination of cases diagnosed in the 10 years of age only 10% presented with severe symptoms, more than 50 years of age increased to 70%. In some cases, the condition can be stable or sustainable development for many years become increasingly serious. After atrial fibrillation or congestive heart failure often show circulation embolism. Without showing clinical symptoms and arrhythmia surgery cases, about 15% at 5 years after the death of 25% in 10 years after the death. Most patients with sudden death, only a few cases, died of heart failure or infective endocarditis. Clinical symptoms, medical therapy does not work, resting left ventricular cavity and outflow tract systolic blood pressure difference exceeds 6.6kPa (50mmHg) should be the purposes of surgical treatment, removal of ventricular septal myocardial hypertrophy to remove the obstruction. Huayu Decoction group 1 side hypertrophy: hypertrophic Huayu decoction of 23 herbs synthesis, following a detailed brief for you, want to help you. Radix, the system one and, Schisandra, fried citrus aurantium, the system Mou large littoralis, Poria, Chuanxiong, a bead, red peony, loofah, wheat, Zao Ren, Bo Ziren, Wulingzhi, Panax, Puhuang, saffron, leech, gall stars, Polygalaceae, amber, cinnabar. Shu Chu Chang Fang a meridian, through the orifices of customs; Panax stasis to stop bleeding, reduce swelling and pain; leeches Poxue, stasis, pass through; over the shamisen Fang, Chinese-based medicine; Ophiopogon YangYinShengJin, Run Lung pure heart; system one and mitogenic effect; Schisandra convergence Guse, Qi Sheng Jin, kidney Ningxin; fried citrus aurantium phlegm San ruffian, broken gas consumer product; system Mou Tai promoting blood circulation, blood stasis and relieve pain; littoralis Yangyinqingfei, stomach fluid; more Chinese-based party Liu Wei Chen medicine; Poria and Water Shenshi, spleen Ning Xin; Chuanxiong blood circulation of qi, chills and pain relief, to appease nervous; TPG Qingreliangxue , Sanyu pain; loofah through the meridians, detoxification swelling; wheat support Anshen, Chufan; Zaoren nourishing the heart, nerves, sweat convergence; Bozi Ren Yang Xin sedative, laxative; Wulingzhi blood stasis ; Puhuang bleeding, blood, Tonglin; saffron and blood circulation, removing blood stasis, pain; gall star clear phlegm fire, Anticonvulsant be obstinate disease; Polygala puzzle sedative, expectorant, swelling; more than twelve herb-based party rank and file medicine; amber sedative, diuretic, blood; cinnabar city, pure heart, soothe the nerves; these two herb-based side to medicine. Complications (1) the more common arrhythmias, including ventricular arrhythmias and atrial fibrillation requiring treatment. (2) a low incidence of endocarditis is due to the adhesion of bacteria in the blood disorder at the heart caused by blood flow, such as the aortic valve, mitral valve. (3) heart block can occur in the sinus node and atrioventricular node, the more common, but also one of the factors influencing drug therapy. (4) less sudden death, which may not have any symptoms. Systematic remay help to identify such high-risk patients. Hypertrophic cardiomyopathy but is the most serious complications, ventricular tachycardia most common cause of ventricular fibrillation, severe bradycardia is not to be ignored. Prognosis of disease develops slowly, the prognosis is uncertain. The same can be stable for many years, but once symptoms can gradually worsen. Sudden death and heart failure as the main cause of death. Sudden death more common in children and young people, their appearance and physical activities, and whether there are obstructive symptoms or related to the heart muscle wall thickness of a high degree of family history of sudden death, there were sustained ventricular tachycardia as the risk of sudden death factor, the possible mechanism of sudden death include rapid ventricular arrhythmia, sinus node disease and cardiac conduction disturbances, myocardial ischemia, diastolic dysfunction, hypotension, before the two most important. The incidence of atrial fibrillation can promote heart failure. A small number of patients with infective endocarditis or embolism. Because prevention of unknown etiology, prevention more difficult. Cases detected by echocardiography after the recessive genetic data can be used for research. For the prevention of disease should avoid exertion, excitement, a sudden force. Where the enhanced myocardial contractility drugs such as digitalis, receptor stimulant such as isoproterenol, as well as to reduce cardiac stress, such as nitroglycerin and other drugs that increase the left ventricular outflow tract obstruction, try to do. Mitral regurgitation, if any, should be prevention of infective endocarditis.


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