No abstract

A 51-year-old male patient developed rapidly progressive shortness of breath on exertion and prelung oedema. His past history was notable for right kidney agenesis, but negative for arterial hypertension. Also, the family history was negative for sudden cardiac deaths. The ECG on admission is shown in figure 1. (1.) What is your diagnosis: hypertrophic car-diomyopathy, hypertensive cardiomyopathy or something else? (2.) Which examination will help to establish the diagnosis? Explanatory answers (1.) The 12-lead-ECG is highly suggestive for left ventricular hypertrophy (LVH) with a typical strain pattern as well as signs of left atrial hypertrophy. However, there is no left axis deviation as one would expect in a case of severe LVH. PQ and QTc intervals are within normal limits (fig. 1). Transthoracic echocar-diography revealed severe left ventricular thickening of the interventricular septum (19 mm) with involvement of the apex and the posterior wall (12 mm) without LVOT obstruction. Systolic left ventricular function was preserved , but diastolic dysfunction was present. There was a tendency towards hypertrophy of