Provokable left ventricular outflow tract obstruction in a patient without hypertrophy.
BACKGROUND
A 61-year-old man presented with shortness of breath and chest pain on exertion. He had been diagnosed as having hiatus hernia 2 years previously and was taking proton-pump inhibitors as necessary. He had a family history of ischemic heart disease and subarachnoid hemorrhage.


METHODS
Physical examination, electrocardiography, echocardiography, cardiopulmonary exercise testing, coronary angiography, transoesophageal echocardiography, stress echocardiography.


METHODS
Provokable left ventricular outflow tract obstruction without electrocardiographic abnormalities or left ventricular hypertrophy on echocardiography.


RESULTS
Pharmacological therapy (atenolol 50 mg daily, disopyramide 250 mg twice daily), dual-chamber pacemaker implantation.
Pasquale
Ferdinando
F
The Heart Hospital, London, UK.
Tomé-Esteban
Maria Teresa
MT
Morgagni
Riccardo
R
Elliott
Perry
P
D000787:Angina Pectoris / Q000209:etiology; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001262:Atenolol / Q000008:administration & dosage / Q000009:adverse effects; D002304:Cardiac Pacing, Artificial; D003952:Diagnostic Imaging; D004206:Disopyramide / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000209:etiology; D006334:Heart Function Tests; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D001262:Atenolol; D004206:Disopyramide