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Reappearance of the left ventricular pressure gradient in a patient with hypertrophic obstructive cardiomyopathy

Yusuke Ochiumi1, Shuntaro Ikeda, Mareomi Hamada

  • 1Department of Cardiology, Uwajima City Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|April 3, 2015
PubMed

Insights

This study reports a rare case of Takotsubo cardiomyopathy in an 84-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM). The patient experienced chest pain, and the left ventricular outflow pressure gradient reappeared after initial disappearance.

Area of Science:

  • Cardiology
  • Cardiovascular Diseases
  • Internal Medicine

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is a condition characterized by a dynamic left ventricular outflow tract obstruction.
  • Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, typically presents with symptoms mimicking myocardial infarction.

Observation:

  • An 84-year-old female patient with diagnosed HOCM presented with chest pain and elevated troponin T.
  • Administration of cibenzoline initially abolished the left ventricular outflow pressure gradient (LVPG).
  • Subsequent left ventricular pressure pullback revealed a reappearance of the LVPG, accompanied by left ventriculography showing apical ballooning and basal hypercontraction.

Findings:

  • The patient was diagnosed with coexisting HOCM and Takotsubo cardiomyopathy.
  • The reappearance of LVPG was attributed to the hyperdynamic basal contractions characteristic of TCM.
  • This case highlights a complex interplay between HOCM and TCM.

Implications:

  • Understanding the dynamic nature of LVPG in the presence of both HOCM and TCM is crucial for accurate diagnosis and management.
  • This case underscores the importance of considering atypical presentations in cardiovascular medicine.
  • Further research may elucidate the mechanisms underlying the interaction between these two conditions.

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