Congestive heart failure in hypertensive patients with normal systolic function and dynamic left ventricular outflow obstruction.
BACKGROUND
Hypertensive patients with left ventricular hypertrophy and normal systolic function can develop congestive heart failure refractory to conventional drug therapy with digoxin, diuretic, and vasodilators.


METHODS
We studied 8 patients with a history of systemic hypertension (6 females and 2 males, mean age 69+/-6 years), affected by New York Heart Association (NYHA) class IV congestive heart failure notwithstanding conventional drug therapy with digoxin, diuretic, and vasodilators. After clinical history and physical examination, blood chemistry including cardiac enzymes, arterial blood gases, chest roentgenogram, standard 12-lead ECG, and complete echocardiographic study were performed in all patients.


RESULTS
In all cases, a left ventricle with increased wall thickness, normal cavity size, and normal or supernormal systolic function was shown. All patients had left ventricular systolic dynamic obstruction, with peak gradient between 36 and 130 mmHg (mean 83+/-31). After having stopped treatment with nitrates, digoxin, and diuretics, drug therapy with calcium channel antagonists or beta-blockers was started, and rapid clinical improvement with disappearance of left ventricular outflow obstruction was observed.


CONCLUSIONS
Sometimes, a distinction between several forms of heart failure is clinically impossible. However, when conventional therapy is not effective in patients with longstanding history of systemic hypertension and ECG signs of left ventricular hypertrophy, diastolic heart failure and/or dynamic left ventricular obstruction should be suspected. Thus, an early echocardiographic study should be performed.
Sgreccia
A
A
Istituto di I Clinica Medica, Università La Sapienza, Viale del Policlinico--00161 Rome, Italy.
Morabito
G
G
Gurgo Di Castelmenardo
A
A
Bernardo
M L
ML
Petrilli
A C
AC
De Leva
R
R
De Marzio
P
P
Nuccio
F
F
Morelli
S
S
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D013599:Systole; D014694:Ventricular Outflow Obstruction / Q000150:complications* / Q000503:physiopathology