[SCD-FORUM] 88E RE: HCM in 49-year-old man. Dr. Rigopoulos

[SCD INFO]

Dear Dr. de la Torre,

This is really an interesting case. After excluding coronary artery 
disease in this patient, an option before any intervention would be to 
change his medication to verapamil or add disopyramide to the 
propranolol. If the patient still remains symptomatic, he should either 
have myectomy or a septal ablation procedure, based mainly on the 
morphologic appearance of the septum. Palpitations should, however, be 
further clarified. Has the patient had any Holter recording? It would be 
very heplful to know if he has VT bursts or only supraventricular runs.

Dr. Angelos Rigopoulos
2nd Department of Cardiology
University of Athens Medical School
Athens, Greece

> First of all, greetings. Congratulations for such an interesting event.
> I have a case I would like to share. It is a young man (49 years old) 
> with hypertrophic cardiomyopathy diagnosed years ago.
> Now he is very symptomatic, with angina in rest and crises of 
> palpitations accompanied by dizziness, and we could not document which 
> type they are. In echocardiogram I have found besides septal 
> hypertrophy of 23 mm, double gradient, one in LVOT, peak of 68 mmHg, 
> and another intraventricular, of 145 mmHg. He is being treated with 
> propranolol 40 mgs per 8 hours.
> My question is: would he benefit with a dual chamber pacemaker? Would 
> it be essential to implant ICD? Which of the options is more 
> appropriate (pacemaker, myectomy, or septal ablation)?
> Once again, congratulations,
> Dr. Rafael S. León de la Torre
> Cardiólogo-Ecocardiografista
> Centro de atención cardiovascular de Camaguey
> Cuba
--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee