How can episodes of near syncope be effectively managed?

Question

Hello doctor,

The patient is a 17-year-old male, 6 feet in height, and weighs 185 pounds. The primary doctor ordered an ECG and an echocardiogram after the patient experienced a couple of episodes of near-syncope recently. The episodes occur after sudden standing, and we were told they might be due to dehydration and orthostatic hypotension. There was no loss of consciousness, and the patient is not on any medications. Blood pressure and pulse values are listed below. The details of the echocardiogram are also provided. The ECG was normal. The echocardiogram reported the following: borderline asymmetric left ventricular hypertrophy (1.2 cm), borderline enlarged LVOT (LVOT 2.2 cm; LVOT velocity 1.97 m/sec), increased mitral valve E/A ratio (consistent with the patient's age), trace-mild pulmonic valve regurgitation, and an abnormal mosaic pattern over the pulmonic valve area during the color flow Doppler examination. The left ventricular, right ventricular, left atrial, and aortic root diameters were normal. The ECG is normal. The patient's blood pressure when sitting is typically 110/61 mmHg, with a heart rate between 58 and 64 beats per minute. Blood pressure when lying down is 87/43 mmHg, with a heart rate between 42 and 45 beats per minute.

My questions are: What does the echocardiogram mean? What is this likely to be? Is it of short-term or long-term concern? What is the least aggressive treatment option? What is the most aggressive treatment option?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Hypertrophic cardiomyopathy (HCM) is a condition characterized by asymmetrical septal hypertrophy. The LVOT (left ventricular outflow tract) velocity is 1.97 m/s, indicating no LVOT obstruction. For long-term management, a follow-up echocardiogram is needed to assess any increase in the thickness of the septum. In the short term, additional tests for risk stratification may be required, such as a Holter monitor, tilt table test, and genetic testing for HCM (if available). Treatment options for orthostatic hypotension include increased salt intake, avoiding prolonged standing, and medications such as fludrocortisone. Aggressive treatment options will depend on the results of the tests mentioned in the first paragraph. The abnormal mosaic pattern over the pulmonary valve should be correlated with the anatomy of the pulmonary valve and the velocity across it, which has not been provided in detail.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

You can start treatment for near-syncope. However, as the report shows changes suggestive of HCM, it should be evaluated further as soon as possible. The mosaic pattern across the pulmonary valve is likely related to mild pulmonic regurgitation (PR).

Thanks and regards.