Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1975 Mar;37(3):305–312. doi: 10.1136/hrt.37.3.305

Pathological features of hypertrophic obstructive cardiomyopathy (HOCM) in the elderly.

A Pomerance, M J Davies
PMCID: PMC483970  PMID: 1169958

Abstract

The pathological findings and available clinical data in 15 necropsy cases of HOCM, aged over 61 years, are reported. Three patients were in the eighth decade and 4 in the ninth; 8 were women. Five presented as sudden death, 2 died in congestive cardiac failure, and 7 died of unrelated conditions and HOCM was an apparently incidental postmortem finding. Compared with cases under 60 years, the hearts of the elderly patients were heavier and less likely to show typical asymmetrical hypertrophy, the free wall of the left ventricle also being thickened in two-thirds of the cases over 60 years. Most of the elderly cases showed a distinctive band of fibrous thickening over the upper part of the interventricular septum. This lesion had a "mirror image" relation to the lower part of the aortic surface of the anterior mitral cusp, with the histological features of a friction lesion. It appears to be a morphological expression of the systolic contact of anterior mitral cusp and interventricular septum seen on cineangiography and thus diagnostic of HOCM. Once formed, the fibrous band appears to persist even if the obstructive element disappears. It is, therefore, a valuable diagnostic feature indicating a diagnosis of HOCM in an age group where the morphology is usually not the classical asymmetrical form and in which this diagnosis is usually not considered.

Full text

PDF
305

Images in this article

306Image
on p.306
306Image
on p.306
307Image
on p.307
310Image
on p.310
310Image
on p.310
311Image
on p.311

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alday L. E., Moreyra E., Amuchástegui L. M., Madoery R. J. Recognizing and treating muscular subaortic stenosis. Geriatrics. 1973 Jul;28(7):74–76. [PubMed] [Google Scholar]
  2. BRACHFELD N., GORLIN R. Subaortic stenosis: a revised concept of the disease. Medicine (Baltimore) 1959 Dec;38:415–433. [PubMed] [Google Scholar]
  3. Davies M. J., Pomerance A., Teare R. D. Pathological features of hypertrophic obstructive cardiomyopathy. J Clin Pathol. 1974 Jul;27(7):529–535. doi: 10.1136/jcp.27.7.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. EDWARDS J. E., BURCHELL H. B. Endocardial and intimal lesions (jet impact) as possible sites of origin of murmurs. Circulation. 1958 Nov;18(5):946–960. doi: 10.1161/01.cir.18.5.946. [DOI] [PubMed] [Google Scholar]
  5. EDWARDS J. E. PATHOLOGY OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION. Circulation. 1965 Apr;31:586–599. doi: 10.1161/01.cir.31.4.586. [DOI] [PubMed] [Google Scholar]
  6. Frank S., Braunwald E. Idiopathic hypertrophic subaortic stenosis. Clinical analysis of 126 patients with emphasis on the natural history. Circulation. 1968 May;37(5):759–788. doi: 10.1161/01.cir.37.5.759. [DOI] [PubMed] [Google Scholar]
  7. Goodwin J. F. Hypertrophic diseases of the myocardium. Prog Cardiovasc Dis. 1973 Sep-Oct;16(2):199–238. doi: 10.1016/s0033-0620(73)80014-3. [DOI] [PubMed] [Google Scholar]
  8. Hardarson T., De la Calzada C. S., Curiel R., Goodwin J. F. Prognosis and mortality of hypertrophic obstructive cardiomyopathy. Lancet. 1973 Dec 29;2(7844):1462–1467. doi: 10.1016/s0140-6736(73)92730-x. [DOI] [PubMed] [Google Scholar]
  9. Henry W. L., Clark C. E., Epstein S. E. Asymmetric septal hypertrophy (ASH): the unifying link in the IHSS disease spectrum. Observations regarding its pathogenesis, pathophysiology, and course. Circulation. 1973 Apr;47(4):827–832. doi: 10.1161/01.cir.47.4.827. [DOI] [PubMed] [Google Scholar]
  10. MENGES H., Jr, BRANDENBURG R. O., BROWN A. L., Jr The clinical, hemodynamic, and pathologic diagnosis of muscular subvalvular aortic stenosis. Circulation. 1961 Nov;24:1126–1136. doi: 10.1161/01.cir.24.5.1126. [DOI] [PubMed] [Google Scholar]
  11. Olsen E. G. Pathology of primary cardiomyopathies. Postgrad Med J. 1972 Dec;48(566):732–737. doi: 10.1136/pgmj.48.566.732. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. PARE J. A., FRASER R. G., PIROZYNSKI W. J., SHANKS J. A., STUBINGTON D. Hereditary cardiovascular dysplasia. A form of familial cardiomyopathy. Am J Med. 1961 Jul;31:37–62. doi: 10.1016/0002-9343(61)90222-4. [DOI] [PubMed] [Google Scholar]
  13. Parker B. M. The course in idiopathic hypertrophic muscular subaortic stenosis. Ann Intern Med. 1969 May;70(5):903–911. doi: 10.7326/0003-4819-70-5-903. [DOI] [PubMed] [Google Scholar]
  14. Penther P., Cousteau J. P., Gay J., Maurice P., Lenègre J. Quelques aspects particuliers de la cardiomyopathie obstructive des sumets de plus de cinquante-cinq ans (à propos de 14 observations) Arch Mal Coeur Vaiss. 1970 Sep;63(9):1230–1246. [PubMed] [Google Scholar]
  15. Salazar A. E., Edwards J. E. Friction lesions of ventricular endocardium. Relation to chordae tendineae of mitral valve. Arch Pathol. 1970 Oct;90(4):364–376. [PubMed] [Google Scholar]
  16. Simon A. L., Ross J., Jr, Gault J. H. Angiographic anatomy of the left ventricle and mitral valve in idiopathic hypertrophic subaortic stenosis. Circulation. 1967 Dec;36(6):852–867. doi: 10.1161/01.cir.36.6.852. [DOI] [PubMed] [Google Scholar]
  17. Tajik A. J., Assad-Morell J. L., Giuliani E. R. Hypertrophic obstructive cardiomyopathy in the elderly. Am Heart J. 1973 Apr;85(4):574–574. doi: 10.1016/0002-8703(73)90508-5. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES