A Case Series on Hypertrophic Cardiomyopathy with Midventricular Obstruction and Apical Aneurysm

Midventricular obstruction (MVO) is a rare phenotypic subvariant of hypertrophic cardiomyopathy (HCM). It occurs in 1-10% of patients and due to its rarity, its clinical progression and natural history has not yet been extensively studied. However, the available data has shown it to have worse clinical outcomes and prognosis. While reports on hypertrophic cardiomyopathy has been published in the Philippines, there has been no data on this particular variant in the local literature. We identified 3 cases of hypertrophic cardiomyopathy with midventricular obstruction. 2 cases were initially managed as a case of ischemic heart disease who were ruled out after undergoing cardiac magnetic resonance. One case was initially admitted due to a stroke however, an incidental finding on 2D Echo noted the presence of HCM. He also underwent cardiac magnetic resonance which revealed the full extent of his disease. All 3 patients were also found to have apical aneurysms due to ischemia from the pressure coming from the obstruction. Hypertrophic cardiomyopathy is the most common genetic cardiovascular disease but its subvariants are rare and difficult to diagnose. Apical aneurysms are also often missed on 2D Echo. However, cardiac magnetic resonance provides increased detection of the disease with better detailing of the extent and severity. It could also provide information regarding prognostication with regards to arrhythmias and sudden cardiac death. More data however is needed so new avenues for research are open on its application.