Abstract

MENDOZA-GONZALEZ, Celso; ROLDAN, Francisco Javier  and  GARCIA LOPEZ, Zaira. Obstructive hypertrophic cardiomyopathy. Arch. Cardiol. Méx. [online]. 2008, vol.78, n.2, pp.229-231. ISSN 1665-1731.

Hypertrophic cardiomyopathy (HCM) was first described more than a century ago; the characteristic finding is an inappropriate myocardial hypertrophy, occurring in the absence of an obvious cause.¹² Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract, in asymmetric septal hypertrophy, establishes which is the best treatment strategy. Forty-one-year-old man with a history of recurrent palpitations without any other symptomatology. The initial electrocardiogram (EKG) showed sinus rhythm with evidence of ventricular left hypertrophy and unspecific changes in ventricular repolarization. The trans-thoracic echocardiogram showed HCM and mitral regurgitation. The electrophysiological study, under treatment with amiodarone, did not induce ventricular arrhythmias. The 10-years evolution of the EKG showed changes of variable degrees associated with the hypertrophy and systolic overload of the left ventricle. The echocardiographic three-dimensional reconstruction in the long axis revealed the dynamic obstruction of the left ventricular outflow tract. In the hemodynamic study, the existence of a sub-aortic gradient confirmed the diagnosis and showed an increase of the gradient at the post-extrasystolic beat (Brockenbrough-Braunwald phenomenon). The echocardiographic three-dimensional reconstruction defines more accurately the exact site of the septal hypertrophy and its hemodynamic consequences.

Keywords : Obstructive hypertrophic cardiomyopathy; Three-dimensional reconstruction; Asymmetric ventricular hypertrophy.

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