Idiopathic Hypertrophic Subaortic Stenosis in the Elderly

Thirty-two per cent (14 of 44) of patients with idiopathic hypertrophic subaortic stenosis catheterized at the Massachusetts General Hospital were over the age of 60; in only five (36 per cent) of these patients was the diagnosis considered before catheterization. Comparison of these (median age, 65) with younger patients (median age, 39) revealed striking similarity in symptomatology, physical findings and routine laboratory data. However, three of the older patients (21 per cent) exhibited diastolic blowing murmurs (p less than 0.01), and two (14 per cent) had aortic-valve calcification on x-ray study (p less than 0.05); both were absent in younger patients. All older patients had resting left ventricular outflow-tract gradients (53 ± 9 mm mean ± S.E.M., of mercury) whereas 23 per cent of the younger patients had absent resting gradients (32 ± 5 mm mean ± S.E.M. of mercury) (p less than 0.05). Thus, a substantial number of patients with idiopathic hypertrophic subaortic stenosis are elderly. The diagnosis in such cases is obscured, however, not only by age but also by certain features that suggest coronary or valvular disease.