A 21 Year old male presented with syncope on exertion

Brockenbrough–Braunwald–Morrow sign

A 21 Year old male presented with syncope on exertion. Family history positive for Sudden Cardiac Death. Examination revealed Ejection Systolic Murmur at left sternal border and brisk carotid upstroke (not radiating to neck). Murmur accentuated on standing. ECG showing dagger like Q waves in anterolateral leads.

a) What is the most likely diagnosis?

b) What is brocken brough phenomenon?

c) What are the risk factors for Sudden Cardiac Death in this disease?

d) Name two treatment options available and which will you consider for this patient and why?

Answers:

a.      Hypertrophic cardiomyopathy

b.      Severe increase in the Left ventricular aortic gradient in the beat after a premature ventricular contraction (PVC) due to increase in contractility and decrease in afterload during the post PVC beat.

c.       Risk factors for sudden death

Previous Cardiac arrest
Sustained VT
Prolonged or repetitive episodes of non-sustained VT on holter
Wall thickness >30mm
Family history of SCD
No change or decrease in BP with exercise
Syncope or near syncope

d. Medical therapy – beta blockers. Septal Myectomy, Alcohol Septal Ablation

Reference:

1. Chapter 10, page 172– Hypertrophic cardiomyopathy - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC

2. Figure 10.1, Chapter 10, page 166. - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC

Comments

STEMI ECG Criteria and Universal Definition of MI

STEMI ECG Criteria and the Universal Definition of Myocardial Infarction: A Complete Guide for Clinicians Early and accurate diagnosis of acute myocardial infarction (AMI) remains the cornerstone of reducing morbidity and mortality in patients presenting with chest pain. Among all forms of acute coronary syndromes (ACS), ST-elevation myocardial infarction (STEMI) represents the most time-sensitive emergency, requiring immediate reperfusion therapy. This article provides a clinically relevant summary of the STEMI ECG criteria and the Universal Definition of Myocardial Infarction (UDMI), based on the latest consensus guidelines from the ESC, ACC, AHA, and WHF. --- 1. Understanding STEMI: Why Accurate ECG Interpretation Matters A 12-lead ECG remains the first and most critical diagnostic test when evaluating suspected myocardial infarction. STEMI is identified when there is evidence of acute coronary artery occlusion, producing transmural ischemia and characteristic ST-segment eleva...

2025 AHA/ACC Hypertension Guidelines Key points

2025 AHA/ACC Hypertension Guidelines Explained: A Clear Summary for Clinicians and Students Hypertension remains one of the most significant contributors to cardiovascular morbidity and mortality worldwide. With continual refinement of evidence and risk-based strategies, the 2025 AHA/ACC Hypertension Guidelines bring an updated, practical approach that clinicians can use in daily practice. To make learning easier, I’ve created a clean and modern infographic summarizing all major recommendations. You can download it below and use it for study, teaching, or clinical reference. Download Infographic (PNG): 2025 Hypertension Guideline Infographic This post breaks down the key points from the guidelines and complements the infographic for a complete understanding. --- BP Categories: Understanding the Updated Thresholds The guidelines maintain the well-established classification of blood pressure: Normal: <120 / <80 Elevated: 120–129 / <80 Stage 1 Hypertension: 130–139 and/or 8...

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚 in Patient with AF and acute IS/TIA European Heart Association Guideline recommends: • 1 days after TIA • 3 days after mild stroke • 6 days after moderate stroke • 12 days after severe stroke Early anticoagulation can decrease a risk of recurrent stroke and embolic events but may increase a risk of secondary hemorrhagic transformation of brain infarcts. The 1-3-6-12-day rule is a known consensus with graded increase in delay of anticoagulation between 1 and 12 days after onset of ischemic stroke or transient ischemic attack(TIA), according to neurological severity based on European expert opinions. However, this rule might be somewhat later than currently used in a real-world practical setting.

Dr. Usman's Cardiology Notes

Search This Blog