204) A 16 year old boy presents for pre-participation examination prior to athletic training in his college campus. He denies any history of dizziness or palpitations or shortness of breath upon exertion. He denies any syncopal episodes. His father died of cardiac arrest during a marathon at the age of 32 years. Physical examination reveals a systolic murmur that increases with valsalva maneuver. Electrocardiogram reveals changes consistent with left ventricular hypertrophy. An echocardiogram reveals asymmetric septal hypertrophy and Systolic Anterior Motion (SAM) of the Anterior Mitral Leaflet. Which of the following is an indication for Implantable Cardioverter-Defibrillator in this patient?
A) Left Ventricular Thickness of 22mm
B) Increase in blood pressure upon exercise
C) His age
D) Systolic Anterior Motion of Mitral leaflet
E) Decrease in blood pressure during exercise
d
An implantable-cardioverter defibrillator (ICD) may be needed to prevent sudden death. ICDs are used in high-risk patients. High risks include:
• Drop in blood pressure during exercise
• Family history of cardiac arrest
• History of cardiac arrest or ventricular tachycardia
• History of unexplained fainting
• Life-threatening heart rhythms on a Holter monitor
• Severe heart muscle thickness(,septum thickness more than 30 mm)
Ans E.