Unsuccessful treatment the end stage of hypertrophic cardiomyopathy with cardiac resynchronization therapy: A case report

Introduction and importance: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by left ventricular hypertrophy (LVH) and myocardial infarction. Less than 5% of HCM patients develop left ventricular cytological dysfunction and severe heart failure. These patients are usually treated with after-drug-lowering drugs such as angiotensin converting enzyme inhibitors, digitalis, diuretics, and beta-blockers, but many are candidates for heart transplantation. Case presentation: A 41-year-old woman with a known case of hypertrophic obstructive cardiomyopathy (HOCM) who first referred to our emergency room in 1998 due to shortness of breath and fatigue. Echocardiography showed HOCM. In 1982, he presented with a complaint of syncope and palpitations, and an ICD was implanted. From 1983 to 1988, he was admitted and treated for several episodes of inappropriate shock. In 2010, due to the End of Life, the generator was changed for the patient. Between 1995 and 1996, he was hospitalized several times with complaints of orthopenia, functional dysfunction of class III, II, nocturnal attack shortness of breath, weakness and lethargy and fatigue, nocturnal sputum, weight gain, edema and ascites, and despite drug treatment, Discharge fraction decreased to 10% and left ventricular dilatation increased. Clinical discussion: Due to the nature of the disease and the echocardiogram data, the patient underwent an upgrade of the ventricular lead implant defibrillator into a three-cavity intracardiac pacemaker (CRT-D) in which a polar ion implant was placed in the coronary sinus. At the last visit, the 5% EF was measured and the patient was included in the heart transplant list. Conclusions: Due to early diagnosis of this disease is difficult, so the clinical signs and history of the patient at the time of referral will be very helpful.