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European Journal of Echocardiography 2004 5(1):79-81; doi:10.1016/S1525-2167(03)00045-3
© 2004 by European Society of Cardiology
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Copyright © 2003, The European Society of Cardiology

Diastolic gradient in hypertrophic cardiomyopathy of the apical type

M.A Ioannides*, P Konis, G Georgiou and E Nicolaides

Cardiology Department, Larnaca General Hospital, Larnaca, Cyprus

Received 7 May 2003; received in revised form 8 May 2003; accepted after revision 8 May 2003.

* Corresponding author. Onisilou 9A, Aglantzia, 2121 Nicosia, Cyprus. Tel.: +357-248-00-500; fax: +357-243-04-205. ioannidism{at}cytanet.com.cy


   Abstract
Top
 Abstract
1. Case presentation
 2. Discussion
 Further reading
 
Diastolic intracavitary gradient in the left ventricle is a common finding in patients with apical hypertrophy. We report the case of a patient with hypertrophic cardiomyopathy and midventricular obstruction. The paradoxical jet flow in this patient, during diastole, was directed towards the base away from the apex.

Keywords: diastolic paradoxical gradient; hypertrophic cardiomyopathy


   1. Case presentation
Top
 Abstract
 1. Case presentation
2. Discussion
 Further reading
 
A 60-year-old male underwent cardiac evaluation in our department because of surface ECG abnormalities (Fig. 1).


Figure 1
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  		Figure 1 Surface ECG abnormalities.

 
His general history is unremarkable. On auscultation he had a systolic ejection murmur. A transthoracic echocardiogram revealed hypertrophy of the apex (both septal and lateral walls). Pulse doppler, in left ventricular cavity, detected an intracavitary gradient during systole with maximum velocity of 2.2 m/s and an early diastolic forward gradient with maximum velocity of 1.3 m/s (Figs. 2 and 3Go).


Figure 2
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  		Figure 2 Intracavitary gradient during systole with maximum velocity 2.2 m/s.

 


Figure 3
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  		Figure 3 Early diastolic forward gradient with maximum velocity 1.3 m/s.

 

   2. Discussion
Top
 Abstract
 1. Case presentation
 2. Discussion
Further reading
 
Systolic intraventricular obstruction is described in patients with apical hypertrophic cardiomyopathy. Diastolic gradient has been reported and indicates impaired diastolic performance. It seems to be due to the delay of diastole at the apical level and transiently higher pressure at the apex. Identification of these gradients is important as they have been related to embolic events and ventricular arrhythmias.


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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
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Right arrow Articles by Ioannides, M.A
Right arrow Articles by Nicolaides, E
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Right arrow Articles by Ioannides, M.A
Right arrow Articles by Nicolaides, E
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