SHM Converge Scientific Abstract ePoster Gallery-Transesophageal Echocardiography to Distinguish Pathological Versus Physiological Cardiac Hypertrophy

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This case highlights the importance of evaluating young patients with exertional dyspnea, chest pain, and near-syncope for hypertrophic cardiomyopathy (HCM), even when symptoms are initially attributed to exercise-induced asthma. HCM is a common inherited cardiac disorder, and many patients have left ventricular outflow tract obstruction (HOCM), which can increase the risk of serious cardiac events, including sudden death.<br /><br />A 29-year-old man with a history of presumed exercise-induced asthma presented with two weeks of chest pain, exertional dyspnea, and recurrent near-syncope. Initial emergency department workup was negative for myocardial infarction, with normal chest X-ray, non-ischemic EKG, and negative serial troponins. Transthoracic echocardiography showed bifid papillary muscles, prompting cardiology consultation.<br /><br />Advanced transesophageal echocardiography (TEE) demonstrated a high left ventricular outflow tract gradient of 122 mmHg. However, the gradient did not change with amyl nitrite, suggesting the findings were more consistent with physiological hypertrophy, likely worsened by dehydration, rather than true obstructive HCM. This case underscores how advanced imaging, including TEE and provocative testing, can help distinguish pathological HCM from non-pathological cardiac hypertrophy.<br /><br />The patient was discharged on metoprolol with counseling on hydration and diet, and an ambulatory monitor was provided to evaluate for arrhythmias. Key lessons include maintaining suspicion for HCM in young symptomatic patients, avoiding anchoring on alternative diagnoses such as asthma, and using echocardiography, cardiology consultation, and advanced imaging when the diagnosis is unclear.

Asset Subtitle

Lubika J. Nkashama

Meta Tag

Author List Heather N. Hofmann, Lubika J. Nkashama

Category Clinical Vignettes

Concept Hypertrophic Cardiomyopathy

Concept Transthoracic Echocardiography

Concept Left Ventricular Outflow Tract Obstruction

Concept Ventricular Hypertrophy

Concept Sickle Cell Disease

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Lerner College of Medicine of CWRU

Presenting Author Lubika J. Nkashama

Track Adult

Keywords

hypertrophic cardiomyopathy

left ventricular outflow tract obstruction

exertional dyspnea

near-syncope

chest pain

exercise-induced asthma

transesophageal echocardiography

bifid papillary muscles

physiological hypertrophy

sudden cardiac death

Hypertrophic Cardiomyopathy

Transthoracic Echocardiography

Left Ventricular Outflow Tract Obstruction

Ventricular Hypertrophy

Sickle Cell Disease