Exercise-induced diastolic paradoxical jet flow in a patient with hypertrophic cardiomyopathy
Mayumi Takeoka1, Michiyo Yamano2, Tatsuya Kawasaki2
1Central Clinical Laboratory, Matsushita Memorial Hospital, Sotojima 5-55, Moriguchi, Osaka 570-8540, Japan.
Abstract:
Early diastolic flow from the apex toward the base of the left ventricle - diastolic paradoxical jet flow - may be observed at rest in patients with hypertrophic cardiomyopathy (HCM). We herein report a case of HCM with exercise-induced diastolic paradoxical jet flow, accompanied by an apical myocardial perfusion abnormality of the left ventricle. A 56-year-old man was referred for the further evaluation of abnormal electrocardiography at a medical check-up. Echocardiography showed myocardial hypertrophy predominantly in the apex of the left ventricle with a maximum wall thickness of 27 mm without an apical aneurysm. Paradoxical jet flow was not detected at rest, but developed after treadmill exercise and lasted for approximately six minutes. Exercise scintigraphy with thallium-201 showed reduced tracer uptake in the left ventricular apex with complete redistribution, findings consistent with myocardial ischemia of the left ventricular apex.
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