Hypertrophic Obstructive Cardiomyopathy in Young Adults
Hypertrophic Obstructive Cardiomyopathy in Young Adults
A 17-year-old youth was found unconscious in a ditch, lying on his left side, apparently having fallen off his bicycle. The ambulance crew initially attending treated him for a head injury with possible cervical spine injury, and left upper abdominal tenderness raising the possibility of splenic injury. On the basis of putative head, spinal and abdominal injury, air ambulance attendance and transport was requested. On arrival the aircrew found that the patient was fully conscious, and packaged in cervical collar and on a long board. His Glasgow Coma Scale score was 15 and he appeared fully orientated, although he had amnesia of the event. However, he did recall feeling dizzy before the accident. There were no other relevant symptoms, and at the scene he reported no chest pain or shortness of breath. There was no history of alcohol or drug consumption. The airway was self-maintained, breathing was normal and unimpaired and there was no evidence of external haemorrhage. His blood pressure was 138/81 mm Hg. Abdominal examination disclosed slight tenderness in the left upper quadrant but no other abnormality. There was slight tenderness over the left hip, but no signs suggestive of pelvic or limb injury. The patient was transferred to hospital by air, where he gave a history of chest pain preceding the episode of syncope. Subsequent investigation included a 12-lead ECG which demonstrated left ventricular hypertrophy and a chest x-ray examination which showed abnormality of the cardiac shadow, highly suggestive of hypertrophic obstructive cardiomyopathy (HOCM) (figure 1).
(Enlarge Image)
Figure 1.
Chest x-ray of patient.
Case Report
A 17-year-old youth was found unconscious in a ditch, lying on his left side, apparently having fallen off his bicycle. The ambulance crew initially attending treated him for a head injury with possible cervical spine injury, and left upper abdominal tenderness raising the possibility of splenic injury. On the basis of putative head, spinal and abdominal injury, air ambulance attendance and transport was requested. On arrival the aircrew found that the patient was fully conscious, and packaged in cervical collar and on a long board. His Glasgow Coma Scale score was 15 and he appeared fully orientated, although he had amnesia of the event. However, he did recall feeling dizzy before the accident. There were no other relevant symptoms, and at the scene he reported no chest pain or shortness of breath. There was no history of alcohol or drug consumption. The airway was self-maintained, breathing was normal and unimpaired and there was no evidence of external haemorrhage. His blood pressure was 138/81 mm Hg. Abdominal examination disclosed slight tenderness in the left upper quadrant but no other abnormality. There was slight tenderness over the left hip, but no signs suggestive of pelvic or limb injury. The patient was transferred to hospital by air, where he gave a history of chest pain preceding the episode of syncope. Subsequent investigation included a 12-lead ECG which demonstrated left ventricular hypertrophy and a chest x-ray examination which showed abnormality of the cardiac shadow, highly suggestive of hypertrophic obstructive cardiomyopathy (HOCM) (figure 1).
(Enlarge Image)
Figure 1.
Chest x-ray of patient.
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