Circulation, Vol 79, 580-589, Copyright © 1989 by American Heart Association
HM Lever, RF Karam, PJ Currie and BP Healy
The striking clinical and pathologic features of hypertrophic
cardiomyopathy have been defined almost exclusively in the young. Little is
known about this condition in the elderly, although it is assumed to be
part of a single disease. Accordingly, we studied 28 patients who were 65
years of age and older (mean age, 72 +/- 6.4 years) who were diagnosed as
having hypertrophic cardiomyopathy by M- mode, two-dimensional, and Doppler
echocardiography and compared them with a group of 28 consecutive patients
with this disease who were younger than 40 years of age (mean age, 26 +/-
9.5 years). No clinically detectable differences existed between the two
groups, except for an increased incidence of mild hypertension in the
elderly. Echocardiography in both groups showed hypertrophy with a small
left ventricular cavity, and Doppler outflow tract velocity or cardiac
catheterization in most patients showed systolic anterior motion of the
mitral valve or a systolic outflow tract gradient or both. Significant
differences existed between both groups, however, concerning left
ventricular size and shape. The elderly group had a predominantly ovoid
cavity contour with normal septal curvature. In contrast, in the young
group, a markedly abnormal cardiac shape predominated (p less than 0.0001)
with a crescent-shaped left ventricular cavity and a reversed curvature of
the interventricular septum. The right ventricular free wall was prominent
by echocardiography in the young compared with the elderly group (p less
than 0.001). Apart from a more frequent history of mild hypertension in the
elderly, likely related to age, these findings show that hypertrophic
cardiomyopathy, when present in the elderly, has similar clinical features
to that in the young.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5210.
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