Middle age man with high blood pressure, moderate symmetrical left ventricular hypertrophy
Brazil
Case presentation
- Male patient, with 41 years of age, with history of chest pain and exhaustion in strain.
- He mentions systemic hypertension without treatment currently. He doesn’t smoke or have diabetes.
- His father died with 77 years of age due to AMI? His brother died suddenly when he was 37 y.o. in his sleep.
- Cardiac auscultation: regular heart rhythm; HR=68 bpm + fourth heart sound without murmur
- Normal pulmonary artery and limbs
- BP=140/100 mmHg
- After the ECG was made (annex) we suggested performing Echo to rule out apical hypertrophic cardiomyopathy.
- Supplementary tests
- Several ECGs with the same morphology. See the next slide.
Echo: LV end diastolic diameter: 49 mm. LV end systolic diameter: 26 mm. Septal diastolic thickness: 14 mm. LV posterior wall diastolic diameter: 14 mm. Aorta: 29 mm; LA: 40 mm EF=78% Mass: 355 g
Conclusion: moderate LV concentric hypertrophy. Moderate LV diastolic dysfunction. Heart valves with normal morphological aspect. Absence of gradient in the LVOT. Mild mitral reflux.
Holter monitoring:
Sinus rhythm predominates
Asymptomatic isolated ventricular ectopic beats (210) Absence of NSVT
Left heart catheterization:
Presence of myocardial bridge in the proximal 1/3 of the LAD
LV with asymmetrical hypertrophy with apical predominance (ventriculography shows spade-like morphology) Normal coronary arteries
Any comments?
Apresentaçao do caso
Masc.,41 anos com história de pontadas no peito e cansaço aos esforços.
Relata H.A.S. sem tratamento atualmente.Nega fumo e diabetes.
Pai faleceu aos 77 anos de IAM?Irmão faleceu súbitamente aos 37 anos enquanto dormia.
AC:Ritmo cardíaco regular FC=68 bpm+ quarta bulha sem sopro
A.pulmonar e extremidades normais
PA=140/100mmHg
Após realização do ECG (anexo) sugerimos realizar ECO para afastar cardiomiopatia hipertrófica apical.Vários ECGs com a mesma morfologia
ECO: Diametro diastólico final do VE:49mm Diametro sistólico final do VE:26mm.Espessura diast. do septo:14mm. Diametro diastolico da parede posterior do VE:14mm. Aorta: 29mm;AE:40mm.FE=78% Massa:355g Conclusão: Hipertrofia moderada concêntrica do VE; Disfunção diastólica moderada do VE.; Valvas cardíacas com aspecto morfologico normal.Ausência de gradiente na via de saída do VE. Refluxo mitral leve.
HOLTER:
Predomina ritmo sinusal
Ectopias ventriculares isoladas(210) assintomáticas
Ausência de de TVNS
CATE:
Presença de ponte miocárdica no 1/3 proximal da DA
VE com hipertrofia assimétrica com predomínio apical (ventriculografia mostra morfologia “spade-like” “Coronárias normais”
