CASE REPORT

A patient with obstructive hypertrophic cardiomyopathy: a case report

Starry Homenta Rampengan , Fery Budiman Santoso

Starry Homenta Rampengan
Department of Cardiology and Vascular Medicine, Universitas Sam Ratulangi, Manado, Indonesia. Email: starry88888@yahoo.com

Fery Budiman Santoso
Department of Cardiology and Vascular Medicine, Universitas Sam Ratulangi, Manado, Indonesia
Online First: August 31, 2021 | Cite this Article
Rampengan, S., Santoso, F. 2021. A patient with obstructive hypertrophic cardiomyopathy: a case report. Bali Medical Journal 10(2): 891-898. DOI:10.15562/bmj.v10i2.2562


Background: Hypertrophic cardiomyopathy (HCM) is a left ventricle hypertrophic condition related to genetic disorders involving the gene encoding protein from the cardiac sarcomere apparatus. The prevalence of this disease is relatively low, but various clinical presentations make underrecognized and underdiagnosed. We reported obstructive hypertrophy cardiomyopathy patients with an episode of unexplained syncope and malignant arrhythmia.

Case Report: A 44 years old man came with the chief complaint of shortness of breathing. The patient felt the chief complaint since two years ago with getting worse during mild physical activity. The symptom got better during rest or slept with one pillow without complaining of dyspnea. One year ago, the patient started to feel palpitation disappear and arise with shortness of breathing. The patient got syncope two weeks ago during mild activities after a short period of breathlessness. For the vital sign, blood pressure was at 90/60 mmHg, blood pulse was 67 bpm irregular, breath frequency was 17x/min, and oxygen saturation was 99% room air. The electrocardiogram (ECG) showed atrial fibrillation with regular ventricular rate and left bundle branch block morphology of the QRS complex with Q wave at anterior precordial. The patient also checked for electrocardiography and ambulatory ECG monitoring using Holter. The patient was diagnosed with obstructive hypertrophy cardiomyopathy (OHCM), atrial fibrillation with regular ventricular rate and given Dabigatran 110 mg twice daily, metoprolol XL 12,5 mg once daily, and furosemide 10mg once daily for his medication.

Conclusion: Theoretically, myectomy is the best option for this case; however, due to limited high-volume hospitals in Indonesia doing myectomy for hypertrophic obstructive cardiomyopathy, alcohol septal ablation may be an alternative option if the medication was no longer adequate to improve symptoms.

References

Gersh B, Maron B, Bonow R, Dearani J, Fifer M, Link M, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(24). Available from: https://pubmed.ncbi.nlm.nih.gov/22068434/

Lilly LS, Johnson P. The Cardiomyopathies. In: Lilly LS, editor. Pathophysiology of Heart Disease: An Introduction to Cardiovascular Medicine. Philadelphia: Lippincott Williams & Wilkins; 2020. Available from: https://books.google.co.id/books?id=XxBpswEACAAJ

Maron B, Rowin E, Maron M. Global Burden of Hypertrophic Cardiomyopathy. JACC Heart Fail. 2018;6(5):376–8. Available from: https://pubmed.ncbi.nlm.nih.gov/29724362/

Elliott P, Anastasakis A, Borger M, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733–79. Available from: https://pubmed.ncbi.nlm.nih.gov/25173338/

Woo A. Hypertrophic Cardiomyopathy: Echocardiography in Diagnosis and Management of Patients. In: Otto CM, editor. The Practice of Clinical Echocardiography. 5th ed. New York: Elsevier/Saunders; 2012. (ClinicalKey 2012). Available from: https://books.google.co.id/books?id=glNJKXiC_loC

Maron B, Ommen S, Semsarian C, Spirito P, Olivotto I, Maron M. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol. 2014;64(1):83–99. Available from: https://pubmed.ncbi.nlm.nih.gov/24998133/

Maron B. Clinical Course and Management of Hypertrophic Cardiomyopathy. N Engl J Med. 2018;379(20):1976–7. Available from: https://pubmed.ncbi.nlm.nih.gov/30428294/

Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick T. Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging. Eur Heart J. 2009;30(1):98–106. Available from: https://pubmed.ncbi.nlm.nih.gov/18997179/

Maron B, Maron M, Olivotto I. Hypertrophic Cardiomyopathy. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. New York: Elsevier; 2018. (Braunwald's Heart Disease). Available from: https://books.google.co.id/books?id=6-MctAEACAAJ

McLeod C, Ackerman M, Nishimura R, Tajik A, Gersh B, Ommen S. Outcome of patients with hypertrophic cardiomyopathy and a normal electrocardiogram. J Am Coll Cardiol. 2009;54(3):229–33. Available from: https://pubmed.ncbi.nlm.nih.gov/19589435/

Guttmann O, Rahman M, O'Mahony C, Anastasakis A, Elliott P. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart. 2014;100(6):465–72. Available from: https://pubmed.ncbi.nlm.nih.gov/24014282/

Klues H, Schiffers A, Maron B. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26(7):1699–708. Available from: https://pubmed.ncbi.nlm.nih.gov/7594106/

Bos J, Towbin J, Ackerman M. Diagnostic, prognostic, and therapeutic implications of genetic testing for hypertrophic cardiomyopathy. J Am Coll Cardiol. 2009;54(3):201–11. Available from: https://pubmed.ncbi.nlm.nih.gov/19589432/

Olivotto I, Cecchi F, Casey S, Dolara A, Traverse J, Maron B. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. 2001;104(21):2517–24. Available from: https://pubmed.ncbi.nlm.nih.gov/11714644/

Panaich S, Badheka A, Chothani A, Mehta K, Patel N, Deshmukh A, et al. Results of ventricular septal myectomy and hypertrophic cardiomyopathy (from Nationwide Inpatient Sample [1998-2010]). Am J Cardiol. 2014;114(9):1390–5. Available from: https://pubmed.ncbi.nlm.nih.gov/25205630/

Sorajja P. Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: A Word of Balance. J Am Coll Cardiol. 2017;70(4):489–94. Available from: https://pubmed.ncbi.nlm.nih.gov/28728695/

Fifer M, Palacios I, Sanborn D, Sigwart U. Textbook of Catheter-Based Cardiovascular Interventions: A Knowledge-Based Approach [Internet]. Lanzer P, editor. Swtzerland: Springer International Publishing; 2018. Available from: https://books.google.co.id/books?id=UCRZDwAAQBAJ

Spirito P, Rossi J, Maron B. Alcohol septal ablation: in which patients and why? Ann Cardiothorac Surg. 2017;6(4):369–75. Available from: https://pubmed.ncbi.nlm.nih.gov/28944178/

Afanasyev A, Bogachev-Prokophiev A, Kashtanov M, Astapov D, Zalesov A, Budagaev S, et al. Myectomy versus alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. Interact Cardiovasc Thorac Surg. 2020;31(2):158–65. Available from: https://pubmed.ncbi.nlm.nih.gov/32386304/


Article Views      : 0
PDF Downloads : 0