A Marked Heart
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The lungs and liver showed alterations secondary to chronic passive congestion. A bilateral pleural effusion composed of clear yellow liquid 1, mL was detected and also cerebral edema. Diagnoses - Coarctation of the aortic arch, concentric left ventricular hypertrophy, bicuspid aortic valve. This is a case of marked concentric and symmetric hypertrophy of the left ventricle due to coarctation of the aortic arch, whose clinical diagnosis was hypertrophic cardiomyopathy.
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This clinical diagnosis could not be morphologically confirmed because the myocardial hypertrophy observed in hypertrophic cardiomyopathy is, by definition, primary, and it cannot be attributed to ventricular overload resulting from pressure or volume Coarctation of the aortic arch, particularly when associated with marked stenosis of the aortic lumen, as in the present case, obviously causes left ventricular overload. The marked ventricular hypertrophy resulted in heart failure, probably diastolic due to absence of ventricular dilation, with consequent chronic passive congestion of the lungs and liver.
Ventricular arrhythmia, which might have been the terminal cause of the patient's death, may be related to intense myocardial hypertrophy and the presence of small foci of ventricular fibrosis cardiomyosclerosis.
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A congenital alteration frequently associated with coarctation of the aortic arch with a closed ductus arteriosus, present in this case, is the bicuspid aortic valve We should stress, however, that in this case no morphological evidence of dysfunction of this valve existed. Sudden death in hypertrophic cardiomiopaty: A profile of 78 patientes. Circulation ; Coexistence of suddden cardiac death and end-stage heart failure in familial hypertrophic cardiomiopathy.
J Am Coll Cardiol ; Detection of arrhythmia in hipertrofic cardiomiopathy:prospective study. Sudden death in hypertrophic cardiomiopathy - assesment of patients at high risk. Prognostic significance of hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study.
Am J Cardiol ; 48; Hypertrophic cardiomiopaty and sudden death. N Engl J Med ; ; Sudden death during empiric amiodarone therapy in symptomatic hypertrophic cardiomyopathy. Am J Cardiol ; Management of arrhythmias in hypertrophic cardiomyopathy. Cardiovasc Drugs Ther ; 8: Eur Heart J ; Histopathology ; Anomalies associated with coarctation of aorta. Particular reference to infancy. He was also the most stubborn jackass she had ever met. She was an infuriating pain in the ass, and he'd be damned straight to hell if he had to spend even one day without her by his side.
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