A Patient with a Sigmoid-Shaped Septum who Complained of Chest Pain with Latent Left Ventricular Outflow Tract Obstruction and was Diagnosed by Dobutamine Stress Echocardiography

Abstract

A 56-year-old man was admitted to the hospital with episodes of shortness of breath and chest pain on effort immediately after standing. Physical examination revealed a systolic murmur at the left sternal border in the fourth intercostal space. Transthoracic cross-sectional echocardiography showed a sigmoid-shaped septum protruding markedly into the left ventricle. Treadmill exercise testing revealed no ischemic ST-T changes. Dobutamine stress echocardiography (DSE) resulted in left ventricular outflow tract obstruction (LVOTO) accompanying the chest symptoms. Latent LVOTO occurs rarely in cases of sigmoid-shaped septum, which are considered normal during the aging process. We conclude that we should pay attention to latent LVOTO among the causes of unexplained chest pain in patients with sigmoid-shaped septum, and that DSE is necessary to make the diagnosis of latent LVOTO.