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The most challenging scenario occurs when the hallmark features of hypertrophic cardiomyopathies are absent, and when left ventricular wall thickness lies within the "gray zone" of 13-15 mm. Echocardiography within the clinical context is central to making the distinction. The distinction can have significant implications for further patient management (Table 13).

hypertensive cardiomyopathy admission. His echocardiography images and videos appear in Figs. 29-31.

Hypertension is the most prevalent cardiovascular disease, and hypertensive heart disease including LVH is far more prevalent than the other cardiomyopathies combined. LVH is a strong independent risk factor for cardiovascular morbidity and mortality in population studies, in primary and secondary hypertension, and in patients with heart disease. Echocardiographically derived LVH is a better measure (more sensitive) and a stronger predictor of outcomes than electrocardiographic LVH.

A summary of echocardiographic findings in hypertensive cardiomyopathy is shown in Table 14. Echocardiographic findings in hypertension generally present less dramatically than in our case presentation, but concentric LVH remains the hallmark echocardiographic finding. This manifests as increased left ventricular wall thickness with no increase in cavity size. Remodeling can occur in response to ischemic injury or heart failure.

case presentation

A 34-yr-old male Haitian immigrant with no reported past medical history suddenly reported feeling unwell while playing with sister's children. He vomited, fell to floor unresponsive, and was taken to hospital where his blood pressure measured 320/220 mmHg. Head computed tomography showed scan showed subarachoid hemorrhage.

Appropriated management was instituted, but his blood pressure proved extremely difficult to control. He was extubated, but expired 10 d following

Table 13

Parameters for Differentiating Athelete's Heart Vs Hypertrophic Cardiomyopathy Within "Gray Zone"

"Gray zone" of LV wall thickness 13-15 mm Athlete's heart Hypertrophic cardiomyopathy

Table 13

Parameters for Differentiating Athelete's Heart Vs Hypertrophic Cardiomyopathy Within "Gray Zone"

"Gray zone" of LV wall thickness 13-15 mm Athlete's heart Hypertrophic cardiomyopathy

Clinical presentation

Asymptomatic; ECG signs of LVH

Most asymptomatic; but also syncope,

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