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Hypertrophic cardiomyopathy is a clinically heterogeneous disease with common findings of ventricular hypertrophy, left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, and diastolic dysfunction. Sometimes, the condition can lead to catastrophic cardiac events. Pregnancy can pose a larger challenge, due to medication restrictions associated with pregnancy. We report a case of a 43-year-old pregnant woman presenting with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). As her pregnancy progressed, her HOCM worsened both symptomatically and by objective echocardiographic data. These changes continued despite optimized medical therapy. After an in-depth discussion with both the patient and family, we proceeded with alcohol septal ablation, which was successful in both reducing her LVOT gradient and her symptoms. Her pregnancy was overall uneventful, and both she and her child are doing well more than 4 years from the date of the procedure.

Natural history of mitral valve prolapse (MVP) in the community is widely heterogeneous [(1)][1]. Prognosis in MVP ranges from normal life expectancy to subsets with high morbidity/excess mortality, including sudden cardiac death [(2)][2]. Although MVP is identified in a significant number of

Little is known of the importance of echocardiographic measures of resting systemic vascular resistance (SVR), cardiac output, and diastolic function in the development of a hypertensive response during dobutamine stress echocardiography. We performed a retrospective review of 325 subjects who underwent stress echocardiography and a resting echocardiogram on the same day. Logistical regressions were performed to determine associations between hypertensive response to each type of stress test and clinical and hemodynamic measurements obtained by transthoracic echocardiography. Patients with a hypertensive response to dobutamine or exercise stress modalities had Stage 1 hypertension. Those with a hypertensive response to dobutamine had a significantly elevated SVR and a lower cardiac output compared to those with a hypertensive response to exercise or a nonhypertensive response to dobutamine. An SVR ≥2000 dynes × sec/cm 5 showed excellent discrimination between patients who did and did not have a hypertensive response to dobutamine (c = 0.80). A hypertensive response to both stress modalities showed an association with measures of diastolic dysfunction. The hemodynamic and echocardiographic phenotypes of individuals with a hypertensive response to exercise differ from those with a hypertensive response to dobutamine. Further work is necessary to understand and guide antihypertensive therapy when a hypertensive response to stress testing is discovered and to inform choice of stress modality when resting hypertension is present.

A 34-year-old man came to our adult congenital heart disease centre after duplicate superior vena cava (SVC) was incidentally found on chest computed tomography performed for testicular leiomyosarcoma staging. He was asymptomatic. Examination revealed a grade 1/6 ejection murmur at the left upper sternal border. Electrocardiogram and chest X-ray were normal. Transthoracic echocardiography revealed a dilated right atrium (area …

Hypertrophic cardiomyopathy (HCM) is a clinically heterogeneous disease with common findings of ventricular hypertrophy and diastolic dysfunction. Sometimes the condition can lead to catastrophic cardiac events. Pregnancy poses a larger challenge, given medication restrictions and increased