An Unusual Case of Shock in an Octogenarian

Overview

Journal Ann Geriatr Med Res

Specialty Geriatrics

Date 2021 May 19

PMID 34010990

Authors

Michael A Chen

Affiliations

Soon will be listed here.

Abstract

An octogenarian presented to our hospital in shock after being "found down" at home. She was dehydrated, hypernatremic, and suffering from a urinary tract infection. Findings of a murmur and those on electrocardiography led to the performance of echocardiography, with all findings consistent with a diagnosis of hypertrophic obstructive cardiomyopathy. The patient was volume resuscitated and administered antibiotics; after stabilization, she was started on a low-dose beta-blocker. Hypertrophic cardiomyopathy is a common genetic disorder that is usually diagnosed in the second to fifth decades of life. It is an uncommon cause or contributor to shock and is unusually initially diagnosed at an advanced age. We briefly review the diagnosis and management of hypertrophic cardiomyopathy in older adults, particularly in the setting of shock.

References

Chen-Tournoux A, Fifer M, Picard M, Hung J . Use of tissue Doppler to distinguish discrete upper ventricular septal hypertrophy from obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2008; 101(10):1498-503. DOI: 10.1016/j.amjcard.2008.01.027. View

Maron B, Olivotto I, Spirito P, Casey S, BELLONE P, Gohman T . Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000; 102(8):858-64. DOI: 10.1161/01.cir.102.8.858. View

Ommen S, Mital S, Burke M, Day S, Deswal A, Elliott P . 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 142(25):e558-e631. DOI: 10.1161/CIR.0000000000000937. View

Fay W, Taliercio C, Ilstrup D, Tajik A, Gersh B . Natural history of hypertrophic cardiomyopathy in the elderly. J Am Coll Cardiol. 1990; 16(4):821-6. DOI: 10.1016/s0735-1097(10)80328-6. View

Alashi A, Smedira N, Popovic Z, Fava A, Thamilarasan M, Kapadia S . Characteristics and Outcomes of Elderly Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc. 2021; 10(3):e018527. PMC: 7955450. DOI: 10.1161/JAHA.120.018527. View

Maron B, Rowin E, Casey S, Haas T, Chan R, Udelson J . Risk stratification and outcome of patients with hypertrophic cardiomyopathy >=60 years of age. Circulation. 2013; 127(5):585-93. DOI: 10.1161/CIRCULATIONAHA.112.136085. View

Maron B, Rowin E, Casey S, Link M, Lesser J, Chan R . Hypertrophic Cardiomyopathy in Adulthood Associated With Low Cardiovascular Mortality With Contemporary Management Strategies. J Am Coll Cardiol. 2015; 65(18):1915-28. DOI: 10.1016/j.jacc.2015.02.061. View

Elliott P, Anastasakis A, Borger M, Borggrefe M, Cecchi F, Charron P . 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(39):2733-79. DOI: 10.1093/eurheartj/ehu284. View

Lever H, Karam R, Currie P, Healy B . Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape. Circulation. 1989; 79(3):580-9. DOI: 10.1161/01.cir.79.3.580. View

10.

Morita H, Larson M, Barr S, Vasan R, ODonnell C, Hirschhorn J . Single-gene mutations and increased left ventricular wall thickness in the community: the Framingham Heart Study. Circulation. 2006; 113(23):2697-705. DOI: 10.1161/CIRCULATIONAHA.105.593558. View

11.

Niimura H, Patton K, McKenna W, Soults J, Maron B, Seidman J . Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation. 2002; 105(4):446-51. DOI: 10.1161/hc0402.102990. View

12.

Diaz T, Pencina M, Benjamin E, Aragam J, Fuller D, Pencina K . Prevalence, clinical correlates, and prognosis of discrete upper septal thickening on echocardiography: the Framingham Heart Study. Echocardiography. 2009; 26(3):247-53. PMC: 2657181. DOI: 10.1111/j.1540-8175.2008.00806.x. View

13.

Maron B, Ommen S, Semsarian C, Spirito P, Olivotto I, Maron M . Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol. 2014; 64(1):83-99. DOI: 10.1016/j.jacc.2014.05.003. View

14.

Lewis J, Maron B . Elderly patients with hypertrophic cardiomyopathy: a subset with distinctive left ventricular morphology and progressive clinical course late in life. J Am Coll Cardiol. 1989; 13(1):36-45. DOI: 10.1016/0735-1097(89)90545-7. View