Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach
Hypertrophic cardiomyopathy (HCM) with mid-cavitary obstruction (MCO) is an uncommon condition affecting approximately 10% of HCM patients which is associated with serious outcomes, including sudden cardiac death and heart failure. We present the case of a 43-year-old male with type 2 diabetes mell...
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| Language: | English |
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Vilnius University Press
2025-04-01
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| Series: | Acta Medica Lituanica |
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| Online Access: | https://www.journals.vu.lt/AML/article/view/38008 |
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| author | Rajeev Bharadwaj Deb Boruah Bhupen Barman Suman Kalita |
| author_facet | Rajeev Bharadwaj Deb Boruah Bhupen Barman Suman Kalita |
| author_sort | Rajeev Bharadwaj |
| collection | DOAJ |
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Hypertrophic cardiomyopathy (HCM) with mid-cavitary obstruction (MCO) is an uncommon condition affecting approximately 10% of HCM patients which is associated with serious outcomes, including sudden cardiac death and heart failure. We present the case of a 43-year-old male with type 2 diabetes mellitus who experienced worsening dyspnea and palpitations, leading to the diagnosis of HCM with MCO without outlet obstruction. Cardiac MRI with gadolinium contrast reveals significant mid-cavitary obstruction without left ventricular outflow tract obstruction with a scar burden of 27% and the absence of other high-risk factors such as apical aneurysm and NSVT runs on Holter monitoring. The patient was treated conservatively with the oral beta-blocker therapy, resulting in symptomatic improvement. Given the high risk of an adverse outcome, it is crucial to recognise MCO early and provide the appropriate treatment. This case report discusses the presentation, diagnosis, and management of a patient with HCM and mid-cavitary obstruction, highlighting the unique treatment considerations associated with this condition.Take home message1. Mid-cavitary obstruction (MCO) in hypertrophic cardiomyopathy (HCM) is associated with high-risk outcomes of sudden cardiac death and heart failure.2. While beta-blockers can improve symptoms in many MCO patients, treatment should be personalized based on the symptom severity and risk factors.3. Patients with MCO are at risk of complications like apical aneurysms, thromboembolism, and arrhythmias.
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| format | Article |
| id | doaj-art-c72ddb64d8ec44e9b27a62d37d68e196 |
| institution | OA Journals |
| issn | 1392-0138 2029-4174 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Vilnius University Press |
| record_format | Article |
| series | Acta Medica Lituanica |
| spelling | doaj-art-c72ddb64d8ec44e9b27a62d37d68e1962025-08-20T02:13:26ZengVilnius University PressActa Medica Lituanica1392-01382029-41742025-04-0132110.15388/Amed.2025.32.1.16Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management ApproachRajeev Bharadwaj0https://orcid.org/0000-0003-2445-4181Deb Boruah1https://orcid.org/0000-0003-3831-135XBhupen Barman2https://orcid.org/0000-0002-5433-1310Suman Kalita3https://orcid.org/0009-0004-1164-9849All India Institute of Medical Sciences GuwahatiAll India Institute of Medical Sciences GuwahatiAll India Institute of Medical Sciences GuwahatiAll India Institute of Medical Sciences Guwahati Hypertrophic cardiomyopathy (HCM) with mid-cavitary obstruction (MCO) is an uncommon condition affecting approximately 10% of HCM patients which is associated with serious outcomes, including sudden cardiac death and heart failure. We present the case of a 43-year-old male with type 2 diabetes mellitus who experienced worsening dyspnea and palpitations, leading to the diagnosis of HCM with MCO without outlet obstruction. Cardiac MRI with gadolinium contrast reveals significant mid-cavitary obstruction without left ventricular outflow tract obstruction with a scar burden of 27% and the absence of other high-risk factors such as apical aneurysm and NSVT runs on Holter monitoring. The patient was treated conservatively with the oral beta-blocker therapy, resulting in symptomatic improvement. Given the high risk of an adverse outcome, it is crucial to recognise MCO early and provide the appropriate treatment. This case report discusses the presentation, diagnosis, and management of a patient with HCM and mid-cavitary obstruction, highlighting the unique treatment considerations associated with this condition.Take home message1. Mid-cavitary obstruction (MCO) in hypertrophic cardiomyopathy (HCM) is associated with high-risk outcomes of sudden cardiac death and heart failure.2. While beta-blockers can improve symptoms in many MCO patients, treatment should be personalized based on the symptom severity and risk factors.3. Patients with MCO are at risk of complications like apical aneurysms, thromboembolism, and arrhythmias. https://www.journals.vu.lt/AML/article/view/38008hypertrophic cardiomyopathyleft ventricle outflow tract obstructionmid-cavitary obstructionheart failurebeta-blocker therapyconservative management |
| spellingShingle | Rajeev Bharadwaj Deb Boruah Bhupen Barman Suman Kalita Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach Acta Medica Lituanica hypertrophic cardiomyopathy left ventricle outflow tract obstruction mid-cavitary obstruction heart failure beta-blocker therapy conservative management |
| title | Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach |
| title_full | Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach |
| title_fullStr | Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach |
| title_full_unstemmed | Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach |
| title_short | Mid-Cavitary Obstruction in Hypertrophic Cardiomyopathy (HCM): A Rare Case Report and Management Approach |
| title_sort | mid cavitary obstruction in hypertrophic cardiomyopathy hcm a rare case report and management approach |
| topic | hypertrophic cardiomyopathy left ventricle outflow tract obstruction mid-cavitary obstruction heart failure beta-blocker therapy conservative management |
| url | https://www.journals.vu.lt/AML/article/view/38008 |
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