Hypertrophic obstructive cardiomyopathy presenting with profound hypotension. Role of two-dimensional and Doppler echocardiography in diagnosis and management.

Five patients, all women, age ranges 59 to 84 years, with underlying hypertrophic obstructive cardiomyopathy (HOCM) presented with profound hypotension. Initial clinical and hemodynamic evaluation suggested cardiogenic shock in two cases, acute myocardial ischemia in two cases, and hypovolemia in one case. The two patients thought to be in cardiogenic shock were given inotropes without improvement. One patient in whom myocardial ischemia was suspected received nitroglycerin, followed by a marked fall in blood pressure. All five patients remained hypotensive until two-dimensional and Doppler echocardiography were performed, identifying HOCM as the cause of the hypotension, thereby allowing for corrective therapeutic measures.