Asymmetric septal hypertrophic cardiomyopathy - systolic anterior motion of mitral leaflet

Case contributed by Palak Thakrar


Chest pain and palpitations since 3 days.

Patient Data

Age: 60 years
Gender: Male

Asymmetrical septal hypertrophy involving the basal septum including the basal anteroseptal and anterior segments, maximum thickness at the basal interventricular septum measures 19mm.

Evidence of chordal SAM (systolic anterior motion of mitral leaflet) with visible flow acceleration in the LVOT (left ventricular outflow tract) likely suggestive of left ventricular outflow tract obstruction (LVOTO)

On delayed post-contrast imaging: mild patchy mid-wall enhancement of the hypertrophied segment suggestive of fibrosis. Enhancement along the RV/LV (right ventricle/left ventricle) insertion point. 

Case Discussion

Hypertrophic cardiomyopathy (HCM) is a diffuse or segmental left ventricular hypertrophy in the absence of systemic or cardiac disease. Asymmetric involvement of the interventricular septum is the most common HCM. The criteria for diagnosing is septal thickness greater than or equal to 15 mm (normal wall thickness is 12 mm or less, measured during diastole) or ratio of septal thickness to the thickness of the left ventricular inferior wall at the mid-ventricular level is greater than 1.5.

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