title: Diagnostic value of simultaneous non-invasive continuous, ambulatory finger blood pressure and electrocardiogram monitoring in a patient with hypertrophic obstructive cardiomyopathy.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. d.boon@amc.uva/nl
authors.forename: Diederik
authors.initials: D
authors.lastname: Boon
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Goudoever
authors.forename: Raymond
authors.initials: R
authors.lastname: Huijskes
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Gert A
authors.initials: GA
authors.lastname: van Montfrans
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents; D014700:Verapamil; D008790:Metoprolol