Exercise Testing to Unmask Latent LVOT Obstruction in a Highly Symptomatic Patient with Hypertrophic Cardiomyopathy (JACC July 2024-2)-Article: Exercise Testing to Unmask Latent LVOT Obstruction in a Highly Symptomatic Patient with Hypertrophic Cardiomyopathy

Article: Exercise Testing to Unmask Latent LVOT Obstruction in a Highly Symptomatic Patient with Hypertrophic Cardiomyopathy

Back to course

Pdf Summary

A 30-year-old man with hypertension presented symptoms of palpitations, shortness of breath, and dizziness. Initial resting echocardiogram indicated hypertrophic cardiomyopathy (HCM) with a potentially obstructed left ventricular outflow tract (LVOT). Exercise stress testing was recommended to unmask latent LVOT obstruction and assess overall exercise tolerance, as per the 2024 HCM guidelines. The exercise test revealed a severe dynamic LVOT obstruction, leading to a diagnosis of obstructive HCM as a significant contributor to the patient's symptoms. Management options included beta-blockers and calcium-channel blockers as first-line therapy, with further interventions like septal reduction or myosin inhibitors for persistent symptoms. Shared decision-making was emphasized for personalized care. Accurate measurement of LVOT gradients was crucial for therapeutic decisions. Exercise stress testing helped differentiate obstructive from non-obstructive HCM, guiding appropriate management. Additionally, the importance of accurate gradient measurements and differentiating LVOT obstruction from other conditions like SAM-related MR were highlighted. The case underscores the value of exercise testing, accurate gradient measurement, and shared decision-making for optimizing care in symptomatic HCM patients. Follow-up indicated ongoing consideration of additional therapeutic options based on the patient's response to initial treatment.

Keywords

hypertension

palpitations

shortness of breath

dizziness

hypertrophic cardiomyopathy

LVOT obstruction

exercise stress testing

beta-blockers

calcium-channel blockers

shared decision-making