The dynamic variation in LVOT gradient in HOCM depends on the left ventricular contractility and the loading conditions. But getting a good echocardiographic image during these maneuvers may be challenging. Various manoeuvers like isometric handgrip, Valsalva maneuver and standing can bring out the gradient well when it is low in the basal state. When the left ventricular cavity is small due to hypovolemia or dehydration, the gradient can rise significantly. The delayed peaking in systole is quite evident (marked by the asterisk).ĭynamic variation of LVOT gradient in hypertrophic cardiomyopathy (HCM)ĭynamic variation of LVOT gradient in hypertrophic cardiomyopathy (HCM) can be quite variable. The gradient progressively increases as the systole progresses, to produce this characteristic appearance. The shape of the jet indicates the dynamic nature of LVOT obstruction in hypertrophic cardiomyopathy. The CW jet in HOCM is described as dagger shaped or sickle shaped, unlike the symmetrical tongue shaped jet in fixed obstruction of aortic stenosis. Continuous wave (CW) Doppler cursor is then aligned along the LVOT colour jet of HOCM. Initially the apical 5C view is obtained and then the colour Doppler flow mapping (CFM) is done to locate the flow in LVOT. Left ventricular outflow tract gradient (LVOT) in hypertrophic obstructive cardiomyopathy (HOCM) is usually measured from the apical five chamber view (apical 5C) in echocardiography. LVOT gradient in HOCM – Doppler echocardiogram
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