Background: Hypertrophic cardiomyopathy (HCM) is a left ventricle hypertrophic condition related to genetic disorders involving the gene encoding protein from the cardiac sarcomere apparatus. The prevalence of this disease is relatively low, but various clinical presentations make underrecognized and underdiagnosed. We reported obstructive hypertrophy cardiomyopathy patients with an episode of unexplained syncope and malignant arrhythmia.
Case Report: A 44 years old man came with the chief complaint of shortness of breathing. The patient felt the chief complaint since two years ago with getting worse during mild physical activity. The symptom got better during rest or slept with one pillow without complaining of dyspnea. One year ago, the patient started to feel palpitation disappear and arise with shortness of breathing. The patient got syncope two weeks ago during mild activities after a short period of breathlessness. For the vital sign, blood pressure was at 90/60 mmHg, blood pulse was 67 bpm irregular, breath frequency was 17x/min, and oxygen saturation was 99% room air. The electrocardiogram (ECG) showed atrial fibrillation with regular ventricular rate and left bundle branch block morphology of the QRS complex with Q wave at anterior precordial. The patient also checked for electrocardiography and ambulatory ECG monitoring using Holter. The patient was diagnosed with obstructive hypertrophy cardiomyopathy (OHCM), atrial fibrillation with regular ventricular rate and given Dabigatran 110 mg twice daily, metoprolol XL 12,5 mg once daily, and furosemide 10mg once daily for his medication.
Conclusion: Theoretically, myectomy is the best option for this case; however, due to limited high-volume hospitals in Indonesia doing myectomy for hypertrophic obstructive cardiomyopathy, alcohol septal ablation may be an alternative option if the medication was no longer adequate to improve symptoms.