<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><P style="margin: 0.0px 0.0px 12.0px 0.0px">I write to you to introduce a clinical case. This patient is a 30 year old woman, with a family history of non obstructive HCM with genetic study that found a mutation in the Troponin T gene (TNT) located in chromosome 1. The mutation is Arg92Gln. Four cousins under 20 have suffered sudden death and one 45 year old aunt has also suffered sudden death. Her mother and 3 other cousins have a CDI because of the family history and evident HCM in Echo. Another aunt and one cousin also have a CDI because syncope and evident HCM.</P><P style="margin: 0.0px 0.0px 12.0px 0.0px">Currently this patient has not presented symptoms and the EKG shows a negative T wave in V1-V3 ( not present years ago), and the previously normal Echo has changed, and now shows a mild enlargement of left atrium and mild mid septum thickening of 12- 13 mm, with no abnormal aspect and no obstruction. MRI is similar to the Echo, and shows normal aspect of septum but thickness is 13mm. No arrhythmias during 24 hrs Holter nor exercise testing.</P><P style="margin: 0.0px 0.0px 12.0px 0.0px">She is on atenolol but we would like to have your input in this case on whether this justifies a CDI now.</P><P style="margin: 0.0px 0.0px 12.0px 0.0px">Besides, we would like to know your opinion about young members of this family. There are children and young persons with apparently normal Echo but they have one or two brothers with sudden death or syncope. ¿Do you think they also need a CDI? Finally, what about the adult and older members of this family? Probably most have an evident HCM in Echo. Would it be enough with atenolol or with amiodarore alone, or do they also need a CDI?. </P><P style="margin: 0.0px 0.0px 12.0px 0.0px">We appreciate and thank you for your time and suggestions. </P><P style="margin: 0.0px 0.0px 12.0px 0.0px">Most Sincerely </P><P style="margin: 0.0px 0.0px 12.0px 0.0px">Rene Asenjo <<A href="mailto:reneasenjo@vtr.net">reneasenjo@vtr.net</A>></P><BR><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR></BODY></HTML>