Go Hiasa, MD; Mareomi Hamada, MD; Koji Kodama, MD; Sanae Watanabe, MD; Tomoaki Ohtsuka, MD; Shuntaro Ikeda, MD; Hidetoshi Hashida, MD; Taishi Kuwahara, MD; Yuji Hara, MD; Yuji Shigematsu, MD; Kunio Hiwada, MD

Abstract
A 58-year-old male patient had apical hypertrophic cardiomyopathy (HCM) associated with a life-threatening tachycardia due to atrial flutter. Following palpitation and dyspnea for 2-3h, he became unconscious because of circulatory catastrophe, but was fully resuscitated. An electrocardiogram recorded just before the loss of consciousness revealed atrial flutter at a rate of 260beats/min with a 2:1 ventricular response. He was diagnosed as having apical HCM based on the echocardiographic and left ventriculographic findings. Atrial stimulation at a rate of 150pacings/min for 1min caused a marked drop in systemic systolic blood pressure from 170 to 120 mmHg. The patient was treated with 150mg of cibenzoline per day to prevent supraventricular tachyarrhythmias and to improve left ventricular diastolic function. At the time of the recent follow-up at 2 and a half years, he felt quite well.
(Jpn Circ J 2000; 64: 225- 228)

Key Words: Apical hypertrophic cardiomyopathy; Cardiopulmonary arrest; Tachycardiac atrial flutter

Mailing address: Mareomi Hamada, MD, The Second Department of Internal Medicine, Ehime University School of Medicine, Shigenobu, Onsen-gun, Ehime 791-0295, Japan