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a,b,c: Transthoracic two dimensional echocardiography (2D, 1a) and transesophageal echocardiography (2D/3D, 1b and 1 c) in patient 1 with advanced disease, moderate mitral regurgitation and dilated left atrium. SAM systolic anterior movement.
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F1
The long duration of HCM and the systolic anterior movement with moderate mitral regurgitation lead to a dilated LA (Figure 1).
a,b: 2a. In patient 1, cardiac catheterization with levocardiogram shows midventricular obstruction. 2b: From the top to the bottom surface ECG leads I, II, III. Red Curve: Left ventricular (LV) Pressure, yellow curve: Aortic pressure. The tracings demonstrate the Brockenbrough-Braunwald-Morrow sign in HOCM patients as the LV-pressure increases significantly in the post extrasystole period.
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F2
Figure 2 shows pressure tracings demonstrating the Brockenbrough-Braunwald-Morrow sign during cardiac catheterization.
Clearly elevated LA pressure in patient 1, yellow curve, red: aortic curve. From the top to the bottom surface ECG leads I, II, III. Red Curve: AO, Aortic pressure (range 0-200 mmHg). Yellow curve: LA, Left atrial pressure (range 0-100 mmHg).
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F3
Even in sinus rhythm the patient suffered from clearly elevated LA pressure as seen in Figure 3.
PMC5027184_02
Inappropriate ICD shock therapy in patient 2 after detection of "VF" (ventricular fibrillation) due to AF with rapid ventricular response. From the top to the bottom: Upper line, A: Atrial channel with atrial sensing and atrial cycle length. V: Ventricular channel with alteration marking from VS=Ventricular sense to VT=Ventricular Tachycardia and VF=Ventricular Fibrillation. Lower line A/V: Atrial and Ventricular intra-cardiac electrogram.
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F4
Actually, he experienced several inappropriate ICD shocks because of AF with rapid ventricular response (Figure 4).
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