Idiopathic hypertrophic subaortic stenosis.

نویسندگان

E Braunwald

E D Wigle

چکیده

ONE of the most characteristic clinical features of idiopathic hypertrophic subaortic stenosis (IHSS) is the striking variability in the intensity of the symptoms which accompany this disease. It has become clear recently that the severity of obstruction to left ventricular outflow is variable in IHSS and may be altered by a variety of physiological and pharmacological stimuli.' Alterations in the volume of the left ventricle, in the pressure which distends the outflow tract during systole, and in the contractile state of the myocardium all tend to modify the dimensions of the outflow tract and thereby to influence the severity of the obstruction. Syncope, near syncope, dizziness, and angina pectoris are noted most commonly in patients with IHSS when they are in the erect position, and these symptoms also tend to occur during or immediately following exertion. Since ventricular volume is reduced and sympathetic stimulation of the heart is increased during exercise and when shifting from the supine to the upright position,2 the possibility was considered that alterations in body position alone might exert an important influence on the severity of obstruction in patients with IHSS and offer an explanation for the intensification of symptoms which frequently accompanies assumption of the erect position. Accordingly, the present study examines the hemodynamic effects of changing body position by means of a tilt table in a group of patients with IHSS having varying degrees of obstruction to left ventricular outflow. Group Studied and Methods

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