Case of Hypertrophic Cardiomyopathy with Clinical Progression to Restrictive Physiology

Hypertrophic cardiomyopathy (HCM) is defined as an unexplained left ventricular (LV) hypertrophy ≥15 mm (13 mm if family history present) occurring in the absence of identifiable factor that may account for LV wall thickening, including pressure overload and infiltrative or storage disorder. Restrictive physiology is a pattern of ventricular filling with increased myocardial stiffness leading to elevation of ventricular pressure, causing diastolic dysfunction. A 60-year-old man was brought to the hospital with progressive worsening breathlessness for 2 days and bilateral lower limb swelling. The patient was a known case of HCM, ischemic heart disease (IHD) with single-vessel disease – ostial D1 70% stenosis, atrial fibrillation (AF), status post radiofrequency ablation, moderate LV systolic dysfunction (ejection fraction [EF] – 30%), with recurrent admission due to heart failure. The patient presented with hypotension and bilateral lower limb swelling, and systemic examination showed bilateral crepitations. The patient was diagnosed with acute decompensated heart failure, heart failure with reduced EF, HCM, old IHD, and AF with controlled ventricular rate. Serial two-dimensional echocardiography showed the progression of HCM to restrictive physiology. The patient deteriorated and was planned for a heart transplant with bridging LV assist device therapy. The transition is not usually reported, and literature related to this is scarce; hence, this case is being reported.