Background: A 47-year-old woman with obstructive hypertrophic cardiomyopathy presented with chest pain that had persisted despite treatment with verapamil and alpha-receptor antagonists. The patient had no other significant cardiac symptoms, no history of hypertension, and no familial predisposition to hypertrophic cardiomyopathy or sudden cardiac death. A loud (grade III/VI), dynamic, systolic ejection murmur was noted that could be heard diffusely over the precordium.
Investigations: Radionuclide perfusion imaging, coronary angiography, intracoronary Doppler flow measurements, and ambulatory electrocardiographic monitoring.
Diagnosis: Obstructive hypertrophic cardiomyopathy, myocardial ischemia and sudden cardiac arrest.
Management: Surgical myectomy and cardioverter-defibrillator implantation.