Typical SAM of the mitral valve was detected by echocardiography in a 71-year-old patient with acute myocardial infarction. The patient showed auscultation signs of IHSS and was digitalized and hypovolemic secondary to diarrhea. Following rehydration and digitalis being discontinued, SAM was no longer seen. There were no signs of IHSS at post-mortem examination. This case demonstrates that obstruction of left ventricular outflow tract together with echocardiographical findings of SAM and the typical clinical signs of IHSSS may be observed without the presence of asymmetric septal hypertrophy. This supports the hypothesis that ejection dynamics in a small and asynergically contracting left ventricle may contribute substantially to the appearance of SAM. On the other hand echocardiographic findings of SAM without asymmetric septal hypertrophy may not exclude symptoms of IHSS.
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