Pathology - Hypertrophic Obstructive Cardiomyopathy Pathophysiology Myosin heavy chains, which are sarcomere proteins, are impacted by this autosomal dominant disease. The outcome, known as "myocardial disarray," is sarcomere unit enlargement that disrupts normal heart muscle alignment at the microscopic level. This disorder affects 0.2% to 0.5% of the general population and is present in all racial groupings. The most typical symptoms include syncope, palpitations, dyspnea, chest discomfort, and, in certain cases, abrupt cardiac death. Up to 25% of people may experience outflow obstruction from the left ventricle during rest due to a hypertrophic cardiac septum, however this condition typically manifests itself dynamically (ventricular volume dependently) with an increase in cardiac output during exercise. Ventricular outflow obstruction resulting from asymmetric septal hypertrophy impairs the systolic anterior motion of larger mitral valve leaflets during periods of decreased ventricular fullness. When the arterial pressure is initially high, obstructive mitral valve position suppresses the pulse, and outflow forces ultimately overcome it, a bifid carotid pulse can be observed. The murmur's increased loudness during the Valsalva maneuver is a highly distinctive feature that reveals the obstruction's dynamic nature. Optimizing cardiac function can be achieved through medical therapy and awareness of the disease; for most people, avoiding dynamic outflow blockage (such as intense exercise) is advised.
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