Hypercontractile cardiac state mimicking hypertrophic subaortic stenosis

Idiopathic hypertrophic subaortic stenosis (IHSS) is a disease manifested as a spectrum of various clinical and laboratory findings. We present the case of a patient with classical clinical and hemodynamic findings of IHSS who lacked all of the typical echocardiographic features of the disease. The case emphasizes the need for diligent use of bedside physical examination and vasoactive manipulation of systolic murmurs whenever functional left ventricular outflow tract obstruction is suspected, since it can occasionally be missed by echocardiography.