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Provokable left ventricular outflow tract obstruction in a patient without hypertrophy
Ferdinando Pasquale1, Maria Teresa Tomé-Esteban, Riccardo Morgagni
1The Heart Hospital, London, UK.
Background:
A 61-year-old man presented with shortness of breath and chest pain on exertion. He had been diagnosed as having hiatus hernia 2 years previously and was taking proton-pump inhibitors as necessary. He had a family history of ischemic heart disease and subarachnoid hemorrhage.
Investigations:
Physical examination, electrocardiography, echocardiography, cardiopulmonary exercise testing, coronary angiography, transoesophageal echocardiography, stress echocardiography.
Diagnosis:
Provokable left ventricular outflow tract obstruction without electrocardiographic abnormalities or left ventricular hypertrophy on echocardiography.
Management:
Pharmacological therapy (atenolol 50 mg daily, disopyramide 250 mg twice daily), dual-chamber pacemaker implantation.
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