An 80-year-old female with a history of coronary artery disease and post cardiac bypass surgery was admitted with increasing shortness of breath and fatigue. Electrocardiogram showed left ventricular hypertrophy with marked nonspecific ST-T changes. Transthoracic echocardiography demonstrated normal systolic function with asymmetric septal hypertrophy (25 mm) and increased left ventricular outflow velocity indicating a gradient up to 144 mmHg ( Fig. 1 ). Coronary angiography demonstrated patent grafts. Hemodynamics demonstrated the classic Brockenbrough–Braunwald phenomenon: a resting gradient of 62 mmHg in left ventricular outflow tract increased the post ventricular premature beat to 160 mmHg; diminution in arterial pressure; and the appearance of a developing spike-and-dome pulse-wave configuration ( Fig. 2 ).
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