Hypertrophic cardiomyopathy with mid-cavity obstruction and

apical aneurysm

56 yo AAM with PMH of HTN who presented to Washington Hospital Center after an abnormal stress test.

History of Present Illness

• Patient’s medical history begins in 1999 when he presented to Southern Maryland with nausea and vomiting. – Patient underwent a full cardiac workup

including an echocardiogram that was significant for LVH and a cardiac catheterization that was reportedly normal.

– He was discharged with a diagnosis of vertigo.

History of Present Illness

• For the next eleven years the patient was followed by a private cardiologist.– He reports that he underwent yearly echocardiograms

during this time period.– Upon questioning, the patient denies chest pain, but

does report feeling occasionally lightheaded.

• This year his private cardiologist passed away and a new cardiologist that took over his care.– On an initial visit his ekg was found to be abnormal.

This prompted a stress test.

History of Present Illness

• During the exercise stress test the patient developed VT. On the stress test, the patient was able to exercise for 8 min and reached a max HR 142 bpm. Nuclear images found a fixed apical wall defect w/ small inferior wall ischemia. Patient was found to have a dyskinetic apex consistent with aneurysm.

History of Present Illness

• Patient had echo was found to have LVEF 68% with an apical aneurysm.

History

• PMH: as above

• Medications: Verapamil 240 mg daily, Atenolol 100 mg daily, ASA 81, Nexium

• Family History: Brother CAD, Mother CAD with defibrillator

• Social History: +smoker (quit 3 weeks prior to current admission), social drinker, works as chemical engineer

Admission Exam and Labs

Physical Exam

Gen: pleasant, NAD

36.9 118/77 56 18 98% RA

HEENT: MMM

Neck: -JVD

Chest: RRR –m, -g

Lungs: CTAB

Abd: soft

Ext: edema

Labs:

139 104 15

3.6 24 1.6109

6.613.2

39.2220