Severe concentric LVH w/ 'spade-shaped' LV

[tomsgal]

My husband was diagnosed with hypertrophic cardiomyopathy just this past May when he was hospitalized because of his 'extraordinary' EKG. They did 2 EKG's, echo and heart cath. I quote the impressions of those two tests as follows:

Echo - 1.Severe concentric left ventricular hypertophy with hyperdynamic left ventricle; ejection fraction 65%. Findings consistent with hypertrophic cardiomyopathy, as the patient does not have a history of hypertension. (2) Evidence of diastolic dysfunction. (3) Mild tricuspid regurgitation. (4) Mild pulmonic regurgitation. (Note: left atrium measures 3.8 cm)  

Cath - Left ventriculogram performed in the RAO 30 position revealed severe concentric left ventricular hypertroophy with spade shaped left ventricle. No mitral regugitation was noted.
Normal coronary arteries. LV gram and hemodynamic findings consistent with hypertrophic cardiomyopathy with mild obstruction.

He does have symptoms regularly of chest pain, extreme fatigue and a chronic cough. He currently takes an aspirin daily, and 50mg of Metoprolol. His blood pressure is consistently on the low side. He hasn't seen any improvement on this medication.

From what I have read on the subject, most hypertrophy cases deal with thickening of the septum and his septum measurement is 1.4 cm - which is in the normal range. Are we perhaps looking at dilated cardiomyopathy here? Would he be a candidate for any type of surgery? Just how 'severe' is his hypertrophy?
I would appreciate your insight....by the way, this forum is wonderful!
Thank you
Karl

[CCF-M.D.-KE]

Cardiomyopathy:

It sounds as if your husband could possibly have hypertrophic cardiomyopathy. I don't think that what you describe is consistent with dilated cardiomyopathy. Hypertrophic cardiomyopathy is condition where the heart muscle is thicker than normal. This can result in rhythm problems and obstruction to blood flow out of the heart. People with this condition should avoid strenuous activity, isometric exercise and becoming dehydrated.

I would recommend that your husband see a specialist in this area
who will  obtain more critical information regarding his medical history. This person could also further examine his echocardiogram. Here at the Cleveland Clinic we have doctors (Dr. Lever) who specialize in patients with hypertrophic cardiomyopathy. I would strongly encourage consultation with a physician here or in your area.


Thanks for your question,


CCF-MD-KE

[tomsgal]

Thanks for your input...yes, from what I have learned his septal measurement is borderline for hypertrophy. What is confusing is that the septal measurement is borderline normal, yet the LV hypertrophy is referred to as 'severe" (spade-shaped).....it doesn't seem to follow along the 'normal' guidelines. Have heard of a surgical procedure and the alcohol abalation that you mentioned. I believe there are certain guidelines for such procedures; and don't know if hubby would be a candidate -my knowledge is limited, but here again most of those procedures seem to deal with a thickened septum and not LV hypertrophy. I appreciate your comments...thanks!