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Loss of mid-cavity gradient in hypertrophic cardiomyopathy following myocardial infarction: blessing in disguise
  1. P Kadermuneer,
  2. K T Sajeer,
  3. C G Sajeev,
  4. M P Ranjith
  1. Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
  1. Correspondence to Dr P Kadermuneer, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India; drkm66{at}

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Hypertrophic cardiomyopathy (HCM) is characterised by a heterogeneous clinical expression, unique pathophysiology and diverse natural history. Longstanding left ventricular (LV) outflow tract obstruction is a strong determinant of HCM-related progressive heart failure and cardiovascular death. Here we report the clinical features and natural history of a young female with HCM and mid-cavity obstruction who became symptomatically better after apical myocardial infarction which resulted in the loss of mid-cavity obstruction.

A 40-year-old woman presented with a history of progressive worsening of dyspnoea on exertion over the previous 6 months. She had been diagnosed with hypertrophic obstructive cardiomyopathy at the age of 28 years when she had recurrent episodes of syncope. Most of the syncopal episodes were exertional and started 3 years prior to the diagnosis. Her ECG at that time showed LV hypertrophy with T …

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