Cardiac Catheterization in a Patient with Obstructive Hypertrophic Cardiomyopathy and Syncope

Figure 1 – Panel A, extrinsic compression of the diagonal branch and septal branches (white arrows). Panel B, ventriculography of the right ventricle (RV) and left ventricle (LV), showing significant interventricular septal (IVS) hypertrophy during diastole and Panel C, LV outflow tract obstruction during end-systole. A 35-year-old man sought medical care for recurrent syncope episodes related to moderate exertion in the past 2 months. Upon physical examination, the presence of a rude systolic murmur on the left sternal border was identified. The echocardiogram disclosed a moderate increase in the left atrium and significant hypertrophy of the interventricular septum with an estimated maximum diastolic diameter of 31 mmHg and a maximum left ventricular outflow tract gradient of 56 mmHg. The 24-hour Holter assessment showed the presence of frequent ventricular extrasystoles and an episode of nonsustained ventricular tachycardia. He was prescribed metoprolol 50 mg daily and, based on the high risk of sudden death, received an implantable cardioverter-defibrillator.