Severe, reversible global left ventricular dysfunction in the setting of long-standing poorly controlled hypertension may represent a global variant of stress cardiomyopathy that resolves with medical therapy and blood pressure control.
May support BP optimization in hypertensive LV dysfunction; hypothesis-generating for a global stress cardiomyopathy variant.
An adult man with long-standing poorly controlled cardiac risk factors presented with acute decompensated heart failure (ADHF). Echocardiogram, cardiac MRI and catheterisation suggested idiopathic dilated cardiomyopathy, severe systolic dysfunction, ejection fraction 25% with global left ventricular (LV) dilation and apical thrombus. He responded well to diuretics and gradual uptitration of lisinopril and carvedilol. Follow-up echocardiogram in 2 months demonstrated complete recovery of systolic function, normalisation of LV size and shape with severe LV hypertrophy. This presentation is potentially a global variant of stress cardiomyopathy with recovery of LV function, highlighting the importance of appropriate imaging, catheterisation and clinical monitoring in patients with ADHF.
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Chockalingam et al. (2018) studied this question.
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