Dual Left Ventricular Outflow Tract Obstruction Presenting in Old Age

Hypertrophic obstructive cardiomyopathy with Rheumatic heart disease, severe aortic stenosis and severe mitral stenosis is an uncommon presentation. Diagnosis ofdual left ventricular outflow tract obstructive physiology, caused by severe symptomatic obstructive hypertrophic cardiomyopathy and concomitant moderate or severe aortic stenosis is of paramount importance for management. (myectomy and aortic valve replacement). Our case, is a 67 years old hypertensive male presented with complain of chest pain, diffuse, radiating to left arm, associated with sweating and also with history of loss of consciousness.