0:01

This next patient is a 58-year-old female

0:03

who also has a diagnosis of hypertrophic cardiomyopathy.

0:07

She presented with presyncope as well as nonsustained ventricular tachycardia on a holter

0:12

monitor, which eventually led to echocardiography and MRI.

0:17

On this cine image, we see that the patient has the typical pattern of septal hypertrophy

0:23

that we often see in hypertrophic cardiomyopathy.

0:25

This is the most common pattern of hypertrophic cardiomyopathy.

0:29

What you see that's different from the previous case is

0:32

that you don't see the same degree of regurgitation through the mitral valve.

0:36

There is some left atrial enlargement, but you don't see that regurgitant jet.

0:40

When we go ahead to the other cine images, we're confirming this basal anterior wall hypertrophy.

0:48

Again, no regurgitation.

0:50

And then on the three chamber,

0:52

or LVOT view, you can see that the anterior

0:56

and posterior leaflet to the mitral valve, here and here, are coapting nicely.

1:01

You don't see any regurgitation.

1:03

There's no systolic anterior motion of the anterior leaflet to the mitral valve.

1:07

Let me just show that right here.

1:08

So this is the slice where you would see that hockey stick appearance,

1:12

like on that last case, from systolic anterior motion on the mitral valve.

1:16

In this case, it's absent.

1:17

So it is possible to have asymmetric

1:20

septal hypertrophy without systolic anterior motion, as you see in this case.

1:25

Just skipping ahead to the late gadolinium enhancement images,

1:29

we'll see that this patient has some mild late gadolinium enhancement

1:32

at the inferior right ventricular insertion point.

1:36

Let me move ahead to the higher resolution short access images,

1:40

and you can see that there's this little bit of enhancement here.

1:44

Maybe a little bit of patchy enhancement and some other foci, perhaps right here.

1:49

Overall, I would say this is mild late

1:52

gadolinium enhancement in a patient with hypertrophy of the anterior wall

1:57

and the septum and no systolic anterior motion of the mitral valve leaflet.