022H Asymmetric Hypertrophic Obstructive Cardiomyopathy

ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

37-year-old female with a history of hypertrophic cardiomyopathy presented to the ER with pleuritic chest pain
CXR showed cardiomegaly with evidence of left ventricular enlargement and left atrial enlargement.

CTA showed no evidence of PE but confirmed the presence of LAE and LVH with asymmetric septal thickening and relative sparing of the apex.

LVH –
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

LAE, ASYMMETRIC LVH
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

APICAL SPARING
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

A pyrophosphate scan was negative for amyloidosis

PYROPHOSPHATE SCAN – NEG FOR AMYLOID
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

An echocardiogram confirmed the presence of an obstructive cardiomyopathy with systolic anterior motion of the mitral valve and late systolic mitral regurgitation. The left atrium was enlarged and the right atrium was mildly enlarged. The ejection fraction was normal and estimated to be between 64%. There was a resting gradient across the outflow tract of 40-68 mmHg. LV mass index was 156g/sq m

ASH and SAM
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Image a and b are in systole and show systolic anterior motion of the mitral valve into the LVOT (green arrowhead). In diastole the anterior leaflet is open (d green arrowhead)
Note also the relative thickness of the septal wall (red line) compared to the free wall (white line).
Ashley Davidoff MD

SAM resulting in MITRAL REGURGITATION ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
An echocardiogram confirmed the presence of an obstructive cardiomyopathy with systolic anterior motion of the mitral valve and late systolic mitral regurgitation. The left atrium was enlarged and the right atrium was mildly enlarged. The ejection fraction was normal and estimated to be between 64%. There was a resting gradient across the outflow tract of 40-68 mmHg. LV mass index was 156g/sq
Ashley Davidoff MD

MRI confirmed the findings of the echo showing asymmetric septal hypertrophy, systolic anterior motion of the mitral valve with mitral regurgitation. The LA was 5.2cms, septal wall in diastole was 27.6mms and free wall was 16.8 mms. LV cavity size in diastole was normal. RA and RV were normal. EF was 70% and LV mass was 130g/ sq. m

SHORT AXIS IN SYSTOLE
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

LAE, ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY , ENLARGED MPA
Ashley Davidoff MD

SAM (red arrow) and MR (yellow arrow)
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD

SYSTOLE AND DIASTOLE
RELATIVE SPARING OF THE APEX
ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
37-year-old female with a history of hypertrophic cardiomyopathy presented to the ER with pleuritic chest pain
CXR showed cardiomegaly with evidence of left ventricular enlargement and left atrial enlargement.
CTA showed no evidence of PE but confirmed the presence of LAE and LVH with asymmetric septal thickening and relative sparing of the apex.
A pyrophosphate scan was negative for amyloidosis
An echocardiogram confirmed the presence of an obstructive cardiomyopathy with systolic anterior motion of the mitral valve and late systolic mitral regurgitation. The left atrium was enlarged and the right atrium was mildly enlarged. The ejection fraction was normal and estimated to be between 64%. There was a resting gradient across the outflow tract of 40-68 mmHg. LV mass index was 156g/sq m
MRI confirmed the findings of the echo showing asymmetric septal hypertrophy, systolic anterior motion of the mitral valve with mitral regurgitation. The LA was 5.2cms, septal wall in diastole was 27.6mms and free wall was 16.8 mms. LV cavity size in diastole was normal. RA and RV were normal. EF was 70% and LV mass was 130g/ sq. m
Nodular LGE was noted in the mid myocardium in the inferoseptal region at the hinge points and at the antero-apical regions
Ashley Davidoff MD

Nodular LGE was noted in the mid myocardium in the inferoseptal region at the hinge points and at the antero-apical regions

The Common Vein

TCV