Uniquely abnormal intracavitary flow during late systole and relaxation in hypertrophic obstructive cardiomyopathy with midventricular obstruction

We describe a patient with hypertrophic cardiomyopathy who had a uniquely abnormal jet from the base to the apex during late systole and the relaxation period. This 48-year-old woman was admitted with exertional dyspnea and palpitations. Two dimensional echocardiography revealed asymmetric septal hypertrophy and a left midventricular obstruction at the level of the papillary muscles. A high-velocity ejectional jet (peak velocity 4.8 m/s) directed toward the base during systole and an abnormal jet (peak velocity 2.2 m/s) directed toward the apex during late systole and the relaxation period were demonstrated through the midventricular obstruction site using Doppler echocardiography. The peak systolic pressure gradient between the apical and the basal chamber was 91 mmHg, and the peak systolic pressure was higher in the apical chamber than in the basal chamber. However, a reverse pressure gradient was revealed between the two chambers during late systole and the relaxation period when the abnormal jet was demonstrated.