1. Case for UK CPN
R.A.
NHS Lothian

2. 65 year-old man
PMH of sleep apnoea
2017 – investigated for possible TIA; no significant carotid stenosis but diagnosed with hypertension
ECHO at this stage also showed ‘marked left ventricular apical hypertrophy, moderate septal and anteroseptal hypertrophy, and mild hypertrophy in other regions’

3. No specific recent illnesses or complaints
Was reportedly well when he went to bed but found dead there the following morning (due to sleep apnoea, wife slept separately so no witness to actual circumstances surrounding death)

4. PM
BMI of 23 (190cm, 83kg)
670g heart; concentric LVH 22mm (RV 6mm); patchy left ventricular fibrosis in all regions; severe atheroma proximal LAD, otherwise patchy mild-to-moderate atheroma; valves no significant disease
Kidneys (R200g, L210g) granular cortices
Lungs (each 900g) widely oedematous
Other main organs showed no specific abnormalities

5. Histo
Mid-ventricular slice plus conduction system sampled
Areas of established fibrosis and myocyte misalignment in all blocks from the left ventricle (including away from the septum), with single focus of similar in one right ventricular section
Mild thickening of some intramyocardial arterioles

6. Question
Are the changes consistent with HCM, or could such changes be attributable to his diagnosed hypertension (including the extensive disarray)?
My view is that his cardiac enlargement may be due to both!
Many thanks!

7. 1. Free anterior LV sections

8. 2. Lateral left ventricle sections

9. 3. Free posterior LV section

10. 4. Anterior and posterior septal sections

11. 5. Right ventricle section