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Journal of Cardiovascular Nursing:
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Hypertrophic Cardiomyopathy: A Review of Etiology and Treatment

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GENERAL PURPOSE: To provide registered professional nurses with current information on recognizing, screening, and treating patients who have hypertrophic cardiomyopathy.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

1. Delineate the prevalence, clinical findings and complications associated with hypertrophic cardiomyopathy.

2. Discuss the current recommended treatments for hypertrophic cardiomyopathy.

1. Which of the following statements about hypertrophic cardiomyopathy (HCM) is accurate?

a. It is a genetic cardiovascular disorder.

b. It was first diagnosed in the late 1800s.

c. Patients with HCM have more risk factors for coronary artery disease.

d. Approximately 50% of all patients experience sudden cardiac death.

2. HCM is most commonly characterized by

a. aortic stenosis.

b. tricuspid regurgitation.

c. right atrial enlargement.

d. left ventricular hypertrophy.

3. The estimated prevalence of HCM in the general population is

a. 1:250.

b. 1:500.

c. 1:1,000.

d. 1:2,000.

4. A 2005 study examining the relationship between gender and HCM found that

a. men have a greater degree of left ventricular outflow obstruction.

b. women are less likely to progress to heart failure.

c. women suffer stroke more often.

d. men are older at presentation.

5. Approximately 25% of patients with HCM will present with

a. collateral coronary circulation.

b. systolic anterior motion of the mitral valve.

c. left ventricular outflow tract (LVOT) obstruction.

d. symmetrical septal hypertrophy involving the base of the heart.

6. What is the most commonly sustained dysrhythmia in patients with HCM?

a. atrial fibrillation

b. sinus bradycardia

c. first-degree heart block

d. second-degree heart block

7. Of those with HCM, the patient most likely to receive heart transplantation is one with

a. myocardial scarring.

b. ventricular arrhythmias.

c. coronary vessel narrowing.

d. a dilated-hypokinetic ventricle.

8. A frequent complaint of patients with HCM is

a. a dry cough.

b. atypical chest pain.

c. swelling of the feet.

d. a red rash on the palms.

9. Which of the following statements about end-stage HCM is accurate?

a. It is most responsive to septal alcohol ablation.

b. It develops in approximately 25% of those with HCM.

c. It is characterized by ventricular remodeling, myocardial wall thinning, and chamber enlargement.

d. It is the result of coronary vessel narrowing, impairment of normal compensatory vasodilatation, and impaired coronary reserve.

10. Which of the following is a sign of severe LVOT?

a. hypertrophy greater in the septal wall than the posterior free wall of the left ventricle

b. a 40-point rise in the patient's systolic blood pressure during exercise

c. a 30-mm Hg pressure gradient between the patient's aorta and left ventricle

d. left ventricular hypertrophy greater than 15 mm

11. Which of the following heart sounds are you likely to hear when assessing a patient with HCM?

a. midsystolic click

b. pericardial friction rub

c. early diastolic murmur

d. systolic ejection murmur

12. HCM usually presents during

a. early childhood.

b. adolescence.

c. middle adulthood.

d. late adulthood.

13. Which of the following statements about pharmacologic therapy for patients with HCM is accurate?

a. Beta-blockers are generally recommended as the initial therapy.

b. Calcium channel blockers are effective for treating patients with severe LVOT obstruction.

c. Beta-blockers are effective for treating patients who also have reactive airway disease.

d. Calcium channel blockers in conjunction with beta-blockers are recommended as initial therapy in children.

14. Which of the following calcium channel blockers is recommended for use in patients with HCM?

a. verapamil (Calan)

b. diltiazem (Cardizem)

c. amlopidine (Norvasc)

d. nifedipine (Procardia)

15. Amiodarone hydrochloride is used in patients with HCM

a. to help provide afterload reduction.

b. to provide peripheral vasoconstriction.

c. who have atrial fibrillation.

d. who do not respond to beta-blocker therapy.

16. What is the goal of surgery for a patient with HCM?

a. to increase life expectancy

b. to reduce LVOT obstruction

c. to improve blood flow through the aortic valve

d. to abolish irritable foci causing ventricular dysrhythmias

17. What is considered the gold standard for treating LVOT?

a. septal myectomy

b. septal alcohol ablation

c. dual-chamber pacemaker

d. implantable cardiac defibrillator

18. Compared to septal myectomy, it would be correct to state that septal ablation

a. provides quicker symptomatic relief.

b. has a higher risk of postoperative death.

c. results in a greater reduction of LVOT gradient.

d. is much more likely to cause complete atrioventricular block.

19. Accepted treatment for the prevention of sudden cardiac death in an at-risk patient with HCM is

a. septal myectomy.

b. septal alcohol ablation.

c. administration of amrinone (Inocor) and placement of a dual chamber pacemaker.

d. administration of amiodarone (Cordarone) and placement of an implantable cardiac defibrillator.

20. A minor and major risk factor is present in the patient with HCM who has

a. atrial fibrillation and unexplained syncope.

b. elevated triglycerides and pulmonary hypertension.

c. an LVOT gradient of 10 mm Hg at rest and a systolic murmur.

d. left ventricular thickness of 20 mm and systolic hypertension.

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