Our Patient

Our patient's diagnosis is severe hypertrophic obstructive cardiomyopathy. Based on his history, physical examination and initial laboratory results, he was advised to stop all strenuous and competitive athletic activity.

Further risk stratification for hypertrophic cardiomyopathy is necessary to determine the optimal treatment. Major risk factors for sudden death include: a personal history of cardiac arrest, a family history of premature sudden death, particularly at a young age, a personal history of unexplained syncope, falling blood pressure on exercise tolerance testing, the presence of ventricular tachycardia on ambulatory electrocardiographic monitoring and left ventricular wall thickness equal to or greater than three centimeters. The more adverse risks the patient has, the higher the risk of sudden death.

Because our patient had a personal history of syncope and a family history of sudden death, he underwent further evaluation with exercise tolerance testing and 24-hour electrocardiographic monitoring.

Our patient's treadmill exercise tolerance test demonstrated a normal rise in systolic blood pressure with exercise. The results of the 24-hour ambulatory electrocardiographic monitoring showed frequent premature atrial and ventricular complexes, the latter including several couplets. There was no evidence of ventricular tachycardia or prolongation of the Q-T interval.