Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1114 Other Cardiomyopathies Other Clotting Factor Deficiencies

■Hypertrophic cardiomyopathy: invasive interventions only required

by 5–10% of patients

➣Beta blockers: improve symptoms, probably reduce risk of sud-

den death

➣Calcium channel blockers: alternative to beta blockers, usually

verapamil

➣Dual chamber DDD pacemaker: assist with reduction of outflow

tract gradient; improve symptoms

➣AICD: use in patients with sustained VT or aborted sudden death

➣Septal ablation: percutaneous infarction of septum to reduce

outflow tract obstruction; heart block major complication

➣Surgical myectomy: large center surgical mortality about 3%

■Restrictive: As per underlying etiology (i.e. primary amyloidosis: con-

sider alkylating agents; some centers use autologous stem cell trans-

plantation)

follow-up

During Treatment & Routine

■Repeat assessment of LV function 6 months after treatment or with

deterioration of clinical course

complications and prognosis

■Highly variable and dependent on underlying etiology

OTHER CLOTTING FACTOR DEFICIENCIES

MARGARET V. RAGNI, MD, MPH

history & physical

History

■easy bruising, epistaxis postoperative or traumatic bleeding

■GI, GU, or soft tissue bleeding

■menorrhagia in women

■family history of bleeding, consanguinity

■intracranial bleeding at birth (F VII, XIII deficiency)

■splenic rupture (F I deficiency)

■umbilical bleeding, spontaneous abortion (F I, XIII deficiency)

■poor wound healing (F I, XIII deficiency)