Ventricular Septal Bulge
VSB
is an isolated hypertrophy of the basal segment of the interventricular septum protruding into the outflow tract of the left ventricle (LV),
- common in elderly
- 4% to 8% in individuals ?60 years of age a
- 10% in the eighth decade of life
Hypertension
and often difficult to distinguish from genetic hypertrophic cardiomyopathy
HCM is diagnosed less frequently than VSB at older ages, with a reversed female predominance. Most patients diagnosed with HCM at older ages suffer from hypertension, similar to those with VSB.
- Criteria
- isolated basal septal hypertrophy and a wall thickness >12?13 mm;
- sometimes a proximal-to-mid/distal septal wall thickness ratio ?1.3?1.5 is used as an additional criterion,
- the presence of left ventricular outflow tract obstruction as an exclusion criterion, because considered diagnostic for HCM.
- Most patients with VSB
- Have a hx of hypertension
- between 50% and 80%
- Usually asymptomatic
- EKG
- usually no LVH
- maximal septal thickness is <15mm
- posterior wall thickness <11mm
- no mitral valve abnormalities
- Rarely have SAM and LVOT obstruction
- No LGE
- Have a hx of hypertension
Links and References
Canepa, M et al Distinguishing ventricular septal bulge versus hypertrophic cardiomyopathy in the elderly Heart. 2016 Jul 15; 102(14): 1087?1094.