Fast Five Quiz: Can You Recognize Subtle and Surprising Signs of Heart Conditions?

Yasmine S. Ali, MD, MSci


July 11, 2017

Orthopnea and paroxysmal nocturnal dyspnea are early signs of congestive heart failure and, although relatively uncommon, are observed in patients with severe hypertrophic cardiomyopathy. They result from impaired diastolic function and elevated LV filling pressure. Orthopnea and paroxysmal nocturnal dyspnea result from pulmonary venous congestion.

Double apical impulse results from a forceful left atrial contraction against a highly noncompliant left ventricle. This occurs quite commonly in adults. Triple apical impulse results from a late systolic bulge that occurs when the heart is almost empty and is performing near-isometric contraction. This is a highly characteristic finding of hypertrophic cardiomyopathy; however, it occurs less frequently than does the double apical impulse.

Congestive heart failure is relatively uncommon but is observed in patients with severe hypertrophic cardiomyopathy. It may occur as a result of a combination of impaired diastolic function and subendocardial ischemia. Systolic function in these patients is almost always well-preserved.

Dizziness may be secondary to arrhythmia-related hypotension and decreased cerebral perfusion. Nonsustained arrhythmias often cause dizziness, lightheadedness, and presyncope, whereas sustained arrhythmias are more likely to lead to syncope, collapse, and/or sudden cardiac death.

For more on the presentation of hypertrophic cardiomyopathy, read here.


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