Left Ventricular Hypertrophy in a Runner
Things Are Not Always What They Seem
A 63-year-old male runner presented for outpatient cardiology evaluation of decreased exercise tolerance and increased left ventricular (LV) wall thickness noted on an echocardiogram obtained by his primary care provider. The patient had been an avid runner since a young age; however, over the previous months he had noted decreased exercise tolerance prompting evaluation by his primary physician. His medical history was only significant for hypertension that had been well controlled with a single medication. ECG revealed sinus bradycardia with markedly elevated voltage in the anterolateral precordial leads (Figure 1). Echocardiography with strain imaging demonstrated increased LV wall thickness measuring 1.8 cm at the basal septum and 1.7 cm at the basal inferolateral wall (Figure 2A). Ejection fraction was noted to be normal; however, longitudinal strain imaging was markedly abnormal throughout the septum, extending into adjacent regions of the anterior and inferior walls and normalizing in the lateral wall and apex (Figure 2B and 2C).