Mid-systolic flow reversal in a patient with mid-ventricular obstructive hypertrophic cardiomyopathy.

Abstract

An 80-year-old man with palpitations presented to our hospital. A 12-lead electrocardiogram showed atrial fibrillation, complete right bundle branch block (CRBBB), right axis deviation, and negative T waves in leads II, III, aVF, and V1–V4. A chest radiograph showed a cardiothoracic ratio of 58 %. A 2D transthoracic echocardiography showed LV hypertrophy (the interventricular septum was 14 mm thick and the LV posterior wall was 9 mm thick), mid-ventricular obstruction, and apical aneurysm. A pulsed Doppler echocardiogram showed systolic mid-ventricular obstruction and paradoxical jet flow typical for MVOCM [2]. Moreover, additional mid-systolic flow reversal was intermittently observed at the obstruction. This flow was observed between the systolic flow and paradoxical jet flow (Figs. 1, 2a). The patient underwent cardiac catheterization to enable visualization of the mechanism of this flow reversal and to examine whether the apical aneurysm was caused by myocardial infarction. Simultaneous LV pressure recordings showed that the basal pressure intermittently surpassed the apical pressure in mid-systole, which corroborated the echocardiographic data (Fig. 2b). Coronary arteriography yielded normal results. The patient was discharged with beta-blocker, calcium channel blocker, and anticoagulation.