[Apical hypertrophic myocardiopathy with mid-ventricular obstruction and apical necrosis].
In a 41-year old man hospitalized for investigation of a systolic ejection murmur, echocardiography revealed an apical (17 mm) and, chiefly, a mid ventricular (38 mm) myocardial hypertrophy resulting in a true stricture at that level. During systole the mid ventricular area became obstructed, dividing the left ventricule into an apical akinetic chamber and a proximal hyperkinetic chamber. Left ventriculography confirmed this abnormality and catheterization showed a left intraventricular pressure gradient of 60 mmHg. Although left coronary arteriography proved normal, myocardial radionuclide scanning at exercise displayed apical necrosis which resulted in a peculiar haemodynamic behaviour well demonstrated by doppler ultrasound. The apex of the left ventricle was filled in two stages: first, during atrial contraction, giving at doppler (mid ventricular sample) a positive flow with a speed of 1m/sec during 120 ms; then, during the isovolumetric period, giving a positive flow with a speed of 1m/sec during 60 ms. The apex drained during systole and protodiastole, giving a negative mid ventricular obstruction flow with a speed of 4 m/sec with protosystolic and mesodiastolic reinforcement.
Slama
M A
MA
Service de cardiologie, hôpital de Beauvais.
Tribouilloy
C
C
Bickert
P
P
Caze
F
F
Jobic
Y
Y
Darras
B
B
Lesbre
J P
JP
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
Myocardiopathie hypertrophique apicale avec obstruction médio-ventriculaire et nécrose apicale.