Hypertrophic Cardiomyopathy with Lymphoma

A 71-year-old woman presents 2 years after successful alcohol septal ablation for hypertrophic cardiomyopathy. She was recently diagnosed with lymphoma and has subsequently developed new onset congestive heart failure (CHF).

Figure 63-1. Transthoracic echocardiogram (TTE): Apical four-chamber view.

Figure 63-2.

QUESTION 1. Based on the parasternal long-axis and apical views (Fig. 63-1 and Video 63-1), which of the following is most likely correct?

A. Patient has developed heart failure due to lymphoma infiltrating the myocardium

B. CHF is associated with left ventricular dysfunction from chemotherapy

C. Patient has had a recurrence of hypertrophic cardiomyopathy physiology with systolic anterior motion of the mitral valve (SAM), mitral regurgitation (MR), and left ventricular outflow tract (LVOT) gradient

D. Heart failure due to a ventricular septal defect after alcohol septal ablation

View Answer

ANSWER 1: C. Patient has had a recurrence of hypertrophic cardiomyopathy physiology with SAM, MR, and LVOT gradient.

QUESTION 2. Which of the following is not demonstrated on the motion (M)-mode echocardiogram (Fig. 63-2)?

A. Asymmetric septal hypertrophy

B. SAM

C. Mitral annular calcification (MAC)

D. Mitral stenosis

View Answer

ANSWER 2: D. Septum measures 2 cm, and the inferolateral wall measures 1 cm.

In Figure 63-7, the yellow arrow identifies SAM, and the blue arrow identifies MAC.