case_images: PMC4677590_01
case_images: (a) EKG on admission. Notice the isolated ST-T segment elevation in V2. (b) Patient's baseline normal EKG obtained a few months prior to admission. (c) Left ventriculogram-end diastole. (d) Left ventriculogram-end systole. Notice the severe hypokinesia to akinesia in the anteroapical area and balloon-like dilation of the LV apex during systole.
case_images: JCHIMP-5-29419-g001.jpg
case_images: PMC4677590_01_JCHIMP-5-29419-g001.jpg
case_images: F0001
case_images: A 12-lead electrocardiogram (EKG) showed isolated ST-T segment elevation in lead V2 (Fig. 1a) from baseline (Fig. 1b). Of concern was the left ventriculogram, which showed severe hypokinesis, bordering on akinesis, in the anteroapical area and a balloon-like dilation of the LV apex during systole (Fig. 1c and d).
case_images: (a) Pressure tracing during pull back from left ventricle to LVOT. Notice the progressive drop of pressure. (b) Pressure tracing from LVOT to aorta. (c) TEE with color Doppler during systole. Notice the severe MR jet from LV to LA. (d) Systolic anterior motion (SAM) of the anterior mitral valve leaflet. Positions of both leaflets during systole are outlined. Arrow pointing to the anterior leaflet.
case_images: JCHIMP-5-29419-g002.jpg
case_images: PMC4677590_01_JCHIMP-5-29419-g002.jpg
case_images: F0002
case_images: LVOT, indicative of LVOT obstruction. Lack of this pressure drop from the LVOT to the aorta essentially ruled out presence of aortic stenosis (Fig. 2b). MR (Fig. 2c), but found no definite prolapse, flail mitral valve leaflet, or papillary muscle rupture. More significantly, the TEE revealed obvious SAM of the anterior mitral valve leaflet (Fig. 2d). SAM is associated with elevated velocities in the LVOT, consistent with LVOT obstruction.