Continuous apex to left ventricle blood flow pattern in hypertrophic cardiomyopathy with apical aneurysm and midventricular obstruction

Abstract

A 42-year-old female presented with chest pain, noted to have systolic and diastolic murmurs on physical examination and left ventricular hypertrophy on the electrocardiogram. Echocardiography with contrast enhancement revealed hypertrophic cardiomyopathy (HCM) with apical aneurysm and mid left ventricular cavity obstruction. Doppler interrogation showed continuous systolic and diastolic flow from the apex to left ventricle (LV) with a transient deceleration giving rise to a notched pattern. Myocardial ischemia of the apex was demonstrated on adenosine nuclear scintigraphy without epicardial coronary obstruction on angiography. This case demonstrates a novel Doppler pattern with continuous apex to LV flow in HCM in the setting of apical ischemia that may account for the formation of the aneurysm. (Echocardiography 2012;29:E131-E133) A 42-year-old female presented with chest pain, incidentally noted to have hypertrophic cardiomyopathy (HCM) with apical aneurysm and mid left ventricular cavity obstruction on echocardiography with contrast enhancement. A peculiar continuous systolic and diastolic flow pattern traveling from the apex to left ventricle was demonstrated on continuous-wave Doppler interrogation. Concomitant apical myocardial ischemia may provide a clue to the underlying mechanism of aneurysm formation. © 2012, Wiley Periodicals, Inc.