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[A case of hypertrophic cardiomyopathy with right ventricular outflow obstruction manifested during three-year
Insights
A rare case of hypertrophic cardiomyopathy developed right ventricular outflow obstruction over three years, without affecting the left ventricle. This highlights unusual disease progression in cardiac patients.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Case Study
Background:
- Idiopathic hypertrophic cardiomyopathy (IHC) typically affects the left ventricle.
- Outflow obstruction in IHC commonly occurs in the left ventricular outflow tract.
Observation:
- A 55-year-old female presented with non-obstructive IHC initially.
- Over three years, she developed right ventricular outflow obstruction with septal protrusion.
- Left ventricular outflow tract remained unaffected.
Findings:
- Echocardiography and cardiac catheterization confirmed right ventricular outflow obstruction (20 mmHg gradient).
- Hemodynamic changes progressed from non-obstructive to obstructive IHC.
- Development of obstruction was isolated to the right ventricle.
Implications:
- This case demonstrates a rare presentation of IHC with isolated right ventricular outflow obstruction.
- Highlights the potential for evolving hemodynamic characteristics in hypertrophic cardiomyopathy.
- Suggests the need for careful monitoring of ventricular involvement in IHC patients.
Abstract:
A case is reported of a 55-year-old female with idiopathic hypertrophic cardiomyopathy, which was accompanied with outflow obstruction in the right ventricle developed during the previous 3 years without lesion of the left ventricle. In 1984, she was admitted to our hospital to be examined for cardiac murmurs and abnormal electrocardiogram including ST depression and inverted T. The findings of echocardiography and cardiac catheterization revealed non-obstructive hypertrophic cardiomyopathy. She had been treated with sympathetic beta-blockade and calcium antagonist for 3 years until she complained of dyspnea on exertion, and she was readmitted to our hospital in 1987. Echocardiographic findings showed protrusion of the ventricular septum toward the right ventricle and systolic turbulent flow along the right ventricular outflow tract (by pulsed Doppler technique). A pressure gradient of 20 mmHg across the protrusion was detected by the examination of the cardiac catheter. However, neither protrusion nor pressure gradient was observed in the left ventricular outflow tract as well as that in 1984. Idiopathic hypertrophic cardiomyopathy has been described as involving both ventricles, and outflow obstruction is the usual hemodynamic finding in the left ventricle. However, right ventricular outflow obstruction is the usual hemodynamic finding in the left ventricle. However, right ventricular outflow obstruction with the left ventricular outflow tract intact has been very rare. In addition, in this case, the change of hemodynamic characteristics from non-obstructive to obstructive hypertrophic cardiomyopathy, and the development of these changes only in the right ventricle were observed during the last 3 years.