Diagnostic value of simultaneous non-invasive continuous, ambulatory finger blood pressure and electrocardiogram monitoring in a patient with hypertrophic obstructive cardiomyopathy.
BACKGROUND
The pathophysiology of hypertrophic obstructive cardiomyopathy (HOCM) is complex and heterogeneous, and it may be difficult to disentangle the various pathophysiologic properties leading to complaints.


OBJECTIVE
To elucidate the sequence of acute pathophysiologic changes leading to complaints in a patient with HOCM.


METHODS
Cardiopres measurements [the combination of non-invasive, continuous finger artery blood pressure monitoring, and three-lead electrocardiogram (ECG) recordings] were performed during physiologic, supine exercise--before and after replacement of metoprolol by verapamil. Within 24 h of the Cardiopres measurement standard Doppler echocardiography was performed. Finger artery pressure wave was analysed using Beatscope software (BMI-TNO, Amsterdam, The Netherlands), ST analysis was performed with H-Scribe (Mortara Instrument, Bilt, The Netherlands).


RESULTS
Exercise under metoprolol: finger BP decreased from 130/65 mmHg to 90/60 mmHg, heart rate increased from 65 bpm to 100 bpm and ST analysis revealed significant ST depression in all leads. The occurrence of ST depression preceded the hypotension. Echocardiography showed a dynamic gradient of 70 mmHg. Exercise under verapamil: the patient had less complaints, BP increased from 125/60 mmHg to 165/65 mmHg, heart rate increased from 75 bpm to 107 bpm and ST analysis showed no ST depression > 1 mm. Echocardiography showed no change.


CONCLUSIONS
The use of the Cardiopres during a physiological stimulus showed improvement in exercise capacity in a patient with HOCM, while the standard test, stress-echocardiography, showed no correlation with clinical status. The Cardiopres is a useful diagnostic and research tool, allowing non-invasive, ambulatory monitoring of blood pressure and ECG changes.
Boon
Diederik
D
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. d.boon@amc.uva/nl
van Goudoever
Jeroen
J
Huijskes
Raymond
R
Piek
Jan J
JJ
van Montfrans
Gert A
GA
D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory / Q000592:standards*; D015444:Exercise; D005260:Female; D005385:Fingers; D006439:Hemodynamics; D006801:Humans; D008790:Metoprolol / Q000494:pharmacology; D008875:Middle Aged; D014700:Verapamil / Q000494:pharmacology
D000889:Anti-Arrhythmia Agents; D014700:Verapamil; D008790:Metoprolol