AJM onlineClinical communication to the editorRecurrent Syncope: An Unusual Complication of Hypertensive Heart Disease
Section snippets
Case Report
A 62-year-old hypertensive woman presented with a syncopal episode of 15 minutes duration after voiding on the toilet. The patient denied any presyncopal symptoms, postictal confusion, urinary, or bowel incontinence but reported several previous episodes of syncope. On examination, she had a grade III/VI systolic murmur and appeared hypovolemic with flat neck veins and orthostatic hypotension. Relevant laboratory results revealed hyponatremia, acute kidney injury, hypomagnesemia, elevated
Discussion
Syncope accompanied by a systolic murmur generally suggests a fixed mechanical obstruction. However, outflow tract obstruction may be dynamic, for example, after exercise or during Valsalva maneuvers.6 Predictors of hemodynamically significant outflow tract obstruction include chordal systolic anterior motion at peak, small hyperdynamic left ventricles, increased septal wall thickness, and younger age.7
Conclusions
This case is notable because hypertensive heart disease rarely is implicated as the sole cause of left ventricular outflow tract obstruction. Our case also highlights 2 therapeutic challenges in managing outflow tract obstruction: (1) maintaining adequate preload while also (2) decreasing afterload with antihypertensive therapy targeted toward reverse ventricular remodeling.8
References (8)
- et al.
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J Am Coll Cardiol
(2011) - et al.
Hypertension and hypertrophic subaortic stenosis
Am J Med
(1971) - et al.
Symptomatic exercise-induced left ventricular outflow tract obstruction without left ventricular hypertrophy
J Am Soc Echocardiogr
(2013) Functional obstruction of the left ventricle (acquired aortic subvalvular stenosis)
Guys Hosp Rep
(1957)
Cited by (1)
The prognostic value of circulating microRNA⁃29b in left ventricular hypertrophy in patients with hypertension
2019, Chinese Journal of Internal Medicine/Zhonghua Neike Zazhi
Funding: None.
Conflict of Interest: None.
Authorship: Both authors had access to the data and played a role in writing this manuscript.