Pasquale F, Tomé-Esteban MT, Morgagni R, Elliott P
Provokable left ventricular outflow tract obstruction in a patient without hypertrophy. [Journal Article]
Nat Rev Cardiol 2009 Apr; 6(4):313-6.
BACKGROUND: A 61-year-old man presented with shortness of breath and chest pain on exertion. He had been diagnosed as having hiatus hernia 2 years previously and was taking proton-pump inhibitors as necessary. He had a family history of ischemic heart disease and subarachnoid hemorrhage.
INVESTIGATIONS: Physical examination, electrocardiography, echocardiography, cardiopulmonary exercise testing, coronary angiography, transoesophageal echocardiography, stress echocardiography.
DIAGNOSIS: Provokable left ventricular outflow tract obstruction without electrocardiographic abnormalities or left ventricular hypertrophy on echocardiography.
MANAGEMENT: Pharmacological therapy (atenolol 50 mg daily, disopyramide 250 mg twice daily), dual-chamber pacemaker implantation.
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