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Old 03-05-2013
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Default Indications for ICD in HOCM

A 16 year old boy presents for pre-participation examination prior to athletic training in his college campus. He denies any history of dizziness or palpitations or shortness of breath upon exertion. He denies any syncopal episodes. His father died of cardiac arrest during a marathon at the age of 32 years. Physical examination reveals a systolic murmur that increases with valsalva maneuver. Electrocardiogram reveals changes consistent with left ventricular hypertrophy. An echocardiogram reveals asymmetric septal hypertrophy and Systolic Anterior Motion (SAM) of the Anterior Mitral Leaflet. Which of the following is an indication for Implantable Cardioverter-Defibrillator in this patient?

A) Left Ventricular Thickness of 22mm

B) Increase in blood pressure upon exercise

C) His age

D) Systolic Anterior Motion of Mitral leaflet

E) Decrease in blood pressure during exercise



Sorry guys these are step 3 questions ...but i need your input since the step 3 forum is quite dull!!!
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OzoneZone234 (03-06-2013)



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Old 03-06-2013
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Not sure about this one.
What I know is that the cause of sudden death in HOCM are arrhythmias and NOT the outflow obstruction.
So, my best guess would be E since that points to pre-syncope
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Last edited by Novobiocin; 03-06-2013 at 10:42 AM.
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Old 03-06-2013
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Quote:
Originally Posted by stfidel View Post
A 16 year old boy presents for pre-participation examination prior to athletic training in his college campus. He denies any history of dizziness or palpitations or shortness of breath upon exertion. He denies any syncopal episodes. His father died of cardiac arrest during a marathon at the age of 32 years. Physical examination reveals a systolic murmur that increases with valsalva maneuver. Electrocardiogram reveals changes consistent with left ventricular hypertrophy. An echocardiogram reveals asymmetric septal hypertrophy and Systolic Anterior Motion (SAM) of the Anterior Mitral Leaflet. Which of the following is an indication for Implantable Cardioverter-Defibrillator in this patient?

A) Left Ventricular Thickness of 22mm

B) Increase in blood pressure upon exercise

C) His age

D) Systolic Anterior Motion of Mitral leaflet

E) Decrease in blood pressure during exercise



Sorry guys these are step 3 questions ...but i need your input since the step 3 forum is quite dull!!!
E) Decrease in blood pressure during exercise - which I believe could be a sign of an arrythmia. Well others dont make sense to me unles I'm missing something
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