developing obstruction

[mongo_jones]

hi all,

i haven't posted here in a while but have a quick question or two. i am one of those people who has a significant degree of hypertrophy (>3 cm) but no obstruction (or so i'm told by my non-specialist cardiologist). is this usual/unusual? also, do most people who have obstruction have it pretty much from the time they're diagnosed or can obstruction develop over time?

lisa, i think i am working my way up to finally calling you about specialists in my area. i bet you're very busy right now with the meeting in june coming up so maybe i'll wait till after. did you get any word, by the way, on whether it will be possible to make the text of the doctors' addresses at the meeting available to those of us who're unable to attend?

thanks everyone!

mongo

[Reenie]

Re: developing obstruction

Mongo,

My husband is in the same category as you. His measurement is 3.8 cm and it's mid-septal so it isn't obstructive. As far as I know, the measurement itself isn't what determines obstruction, rather it's the placement of the hypertrophy. If it is high enough it will sort of block the mitral valve, and that's where you get the obstruction. I hope others answer you soon and make this more clear than I have.

Reenie

[Pat]

Re: developing obstruction

Mongo & Reenie,

I want to make a slight correction. If the septal enlargement is high-enough it will act to block the escape of blood from the left ventricle into the aorta through the aortic valve [it doesn't block the mitral valve].

Actually in many or most people the blockage is a result of the septal enlargement and the mitral valve leaflet(s) coming in contact with each other at the time of contraction. This creates a temporary dam of sorts. The ventricle pushes more forcefully to get the blood past the obstruction and that's what creates the gradient we so often consider: the blood pressure in the left ventricle is higher than the blood pressure in the aorta.

In my case, Mongo, the obstruction has worsened over a matter of years. The medications, especially beta-blockers, may slow this process because they relax the heart so it doesn't contract so forcefully. As with any muscle frequent, strong exercise makes it bigger, so beta-blockers keep the heart from such powerful "exercise"!

Pat

[Reenie]

Re: developing obstruction

Pat, thanks for clearing that up. I didn't know that obstructin was also caused by the hypertrophy.

Reenie

[Lisa Salberg]

Re: developing obstruction

I am rather in a rush at the minute--off to the in-laws for a party...it is Adam B-day!

RE the obstruction - only about 25-30% of those with HCM are obstructed and it has NOTHING to do with degree of hypertophy - you can have a very small septal # and a big gradient...and small gratient with large septal #.

Am I busy now...that is an understatment

But I always have time for a call... I will be in the office on Tuesday...call me.
OH re the meeting - looks like it will be on DVD! more on that later!

Lisa

[Reenie]

Re: developing obstruction

Hmmm, I'm thinking, "This is getting curiouser and curiouser." hehehe.

Reenie

[DLCC2]

Re: developing obstruction

To all of the previous posters in this string of messages. I have obstruction and it was explained to me by my cardiologist (who is not a specialist and I am coming to Cleveland to see a specialist) that my septal wall is protruding out enough to cause the heart to work harder in pushing the blood back out and that my mitral valve is also then compromised and that I really didn't have mitral regurgitation.

I had a angio catheter last August, and the hospital report that I got a copy of, said, and I quote; "that I had significant mitral reguritation estimated at 3+ on a scale of 4. That I had HOCM 35mmHg with a 70% ejection fraction and Pulmonary Hypertension".

Looking forward to getting this figured out and understood.

Thats my two cents.

Diana