Hypertrophic cardiomyopathy: obstruction flushed out with exercise echocardiography.

Received 20 August 2014; revision accepted for publication 25 November 2014. We describe the case of a 17-year-old girl with a recent diagnosis of hypertrophic cardiomyopathy. Her main symptom was post-exercise dizziness without loss of consciousness. Two-dimensional transthoracic echocardiography revealed marked hypertrophy of the basal segment of the interventricular septum (27 mm) (figure 1, panel A) with no subaortic gradient at rest and during a Valsalva manoeuvre performed in the supine position (figure 1, panel B). The additional investigations did not reveal sustained or non-sustained ventricular tachycardia on 48-hour Holter monitoring nor hypotension during bicycle exercise testing. The patient underwent exercise echocardiography in a semi-supine position on a tilting exercise table. Echocardiographic imaging was continuous during exercise and recovery and did not reveal left ventricular outflow tract obstruction (LVOTO) (figure 1, Hypertrophic cardiomyopathy: obstruction fl ushed out with exercise echocardiography