Mammoth Ventricular Hypertrophy

A 23-year-old man was referred to the cardiology clinic because of an abnormal ECG and a murmur. He was asymptomatic from the cardiac perspective, and there was no significant family history of cardiac disease or sudden death. He was physically active but was not an athlete and did not exercise regularly. On physical examination, he had a blood pressure of 140/70 mm Hg in both arms with a normal jugular venous pressure of 8 cm water. Cardiac auscultation revealed a soft crescendo-decrescendo systolic murmur heard loudest over the lower left sternal edge. The rest of the physical examination was normal.His ECG showed sinus rhythm with markedly increased voltages suggestive of left ventricular hypertrophy (Figure 1).Figure 1. A 12-lead ECG showing sinus rhythm with markedly increased voltages suggestive of left ventricular hypertrophy.His echocardiogram was of very limited quality as a result of poor acoustic windows but was suggestive of left ventricular hypertrophy. Cardiac magnetic resonance cine imaging showed striking mammoth asymmetrical left …