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[Hypertrophic cardiomyopathy with progressive left ventricular hypertrophy: a case report]
Journal of Cardiography
|March 1, 1985
Summary
This case study highlights the progression of left ventricular hypertrophy (LVH) to include asymmetric septal hypertrophy (ASH) and systolic anterior movement (SAM) in a hypertensive patient over time.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- A 64-year-old male with a history of hypertension since age 48 presented with recurrent dyspnea and palpitations.
- Initial diagnosis of hypertension was well-controlled with propranolol.
Observation:
- At age 59, the patient experienced his first episode of dyspnea and palpitations, with ECG showing left ventricular hypertrophy (LVH) and abnormal Q waves.
- Initial echocardiogram revealed mild LVH without asymmetric septal hypertrophy (ASH) or systolic anterior movement (SAM).
- On subsequent admission, physical examination revealed a grade III systolic murmur, and ECG showed diminished left precordial voltage and increased Q wave depth.
Findings:
- Echocardiography demonstrated prominent septal hypertrophy (IVST: 20 mm) with ASH (IVST/PWT = 2.0), SAM, an enlarged left atrium, and a diminished left ventricular (LV) cavity.
- Left ventricular catheterization identified a significant pressure gradient (90 mmHg) between the LV apex and outflow tract.
- Endomyocardial biopsy revealed markedly hypertrophied myocardial fibers with disarray and bizarre nuclei.
Implications:
- This case illustrates the potential progression of LVH to include ASH and SAM over a follow-up period.
- The findings underscore the importance of serial cardiac evaluations in patients with evolving hypertensive heart disease.
- Histological evidence supports significant myocardial remodeling and disarray in this patient's condition.