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A 49-year-old woman with a history of idiopathic hypertrophic subaortic stenosis diagnosed in 1982 presented with progressive dyspnea on exertion, paroxysmal nocturnal dyspnea, and palpitations. A physical examination revealed a heart rate of 74 bpm, blood pressure of 106/65 mm Hg, room air saturation of 87%, mild jugular venous distension, and a III/VI systolic ejection murmur at the left lower sternal border that was accentuated by the Valsalva maneuver. A baseline ECG was obtained (Figure 1), and an echocardiogram revealed severe left ventricular hypertrophy with an interventricular septum …

Acute ST Depressions in a Patient With Idiopathic Hypertrophic Subaortic Stenosis and Normal Coronary Arteries