Hypertrophic cardiomyopathy

SUMMARY A patient with hypertrophic cardiomyopathy, syncope, and frequent ventricular tachycardia was monitored during a syncopal episode. An unrecordable blood pressure and the loss of a left ventricular outflow tract murmur without evidence of arrhythmia suggested a primary haemodynamic mechanism such as reduction in left ventricular volume. Death is often sudden in hypertrophic car-diomyopathyl and is associated with syncope2 and serious ventricular arrhythimia.3 Though asystole,4 complete heart block,5 rapid atrioventricular conduc-tion precipitating ventricular fibrillation,6 and mas-sive myocardial infarction7 have been documented, the cause of death remains uncertain in the majority of patients who die suddenly. Acute haemodynamic. deterioration with increased left ventricular outflow tract gradient or tachycardia with decreased stroke volume have been proposed but never documented a