Symptoms

•  complaining of dyspnea on exertion, fatigue,
• decreased exercise tolerance.
• 7 years ago.
  • s/p DES x 2 to LCX
• echocardiographic evidence of HCM associated with
  • chordal SAM and significant
  • LVOT gradient.  137 mmHg;
  • peak velocity of his MR is 8.4 m/s,
  • corresponding to at least a LV systolic pressure of 283 mmHg.
• MRI 4 years ago
  • 1.The LV is normal in size.
  • symmetrical LV hypertrophy with
  • slightly more prominent thickening at the base antero-septal wall.

  • 

    

    • maximal wall thickness is 16 mm
    • normal left ventricle
    • LVEF: 67 %.
• SAM
  • • • flow acceleration through LVOT in systole with
      • systolic anterior motion of the anterior mitral valve leaflet
      • mild to moderate MR.

  • 

    

    

  • LGE  diffuse intermediate intensity signal of late gadolinium
    enhancement
    • sub-endocardium and mid-endocardium layer
      • basal anterior wall,
      • basal lateral wall and
      • basal inferior wall with
      • scattered high intensity foci in the base anterior wall
        • suggestive of fibrosis
        • consistent with hypertrophic cardiomyopathy.

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• s/p recent coronary angiography in 3years ago
  • clean coronaries with
  • patent stent as well as
  • anomalous RCA arising from his LMCA.
• s/p CTA 3 years ago
  • non-obstructive CAD and
  • anomalous origin of RCA with acute angle at takeoff
  • interarterial course.
  • preserved global systolic LV function.
  •