A case of a 77-year-old woman with a history of hypertrophic cardiomyopathy (HCM) presented with intermittent episodes of exertional dyspnea and chest discomfort. Her coronary angiogram revealed normal coronary arteries but with hypertrophic obstructive cardiomyopathy with an increasing left ventricular-aortic gradient on isoproterenol provocation. Likewise, an intensified gradient was observed after a premature ventricular contraction (PVC) that is distinguished as the Brockenbrough-Braunwald-Morrow sign substantiating confirmation of left ventricular outflow tract (LVOT) obstruction.
Objectives: This study examines the intrapatient variability in peak instantaneous left ventricular outflow tract (LVOT) gradients and aortic pulse pressures during rest, exercise, and after ventricular ectopy.
Background: Although the variability in LVOT gradients in patients with hypertrophic cardiomyopathy (HCM) is well known, the predictors of such variation are not. We hypothesized that quantitative invasive analysis of gradient variation could identify useful predictors of maximal gradients.
A case of a 77-year-old woman with a history of hypertrophic cardiomyopathy (HCM) presented with intermittent episodes of exertional dyspnea and chest discomfort. Her coronary angiogram revealed normal coronary arteries but with hypertrophic obstructive cardiomyopathy with an increasing left ventricular-aortic gradient on isoproterenol provocation. Likewise, an intensified gradient was observed after a premature ventricular contraction (PVC) that is distinguished as the Brockenbrough-Braunwald-Morrow sign substantiating confirmation of left ventricular outflow tract (LVOT) obstruction.
: A 55-year-old gentleman with hypertrophic obstructive cardiomyopathy and heart failure symptoms underwent cardiac catheterization, which confirmed a significant pressure drop (60 mmHg) across the left ventricular outflow tract, a double-peaked pulse (pulsus bisferiens) and an absent postextrasystolic potentiation (Brockenbrough-Braunwald-Morrow sign) in the left ventricular outflow tract and the aorta. He was treated with medical therapy optimization and intracardiac defibrillator implantation. Cardiac catheterization may provide characteristic clues not only to diagnose obstructive hypertrophic cardiomyopathy, but also to understand its pathophysiological correlates.
