Cardiology Follow-Up

Background:

• Non-obstructive hypertrophic cardiomyopathy (HCM)
• Unobstructed coronary arteries on CTCA (12/05/2023)
• Paroxysmal atrial fibrillation (PAF) and prior cardioembolic right MCA TIA (2022)
• Hypertension, hyperlipidaemia, and ex-smoker (15 pack-years)

Medication: Bisoprolol 5 mg PO OD, apixaban (Eliquis®) 5 mg PO BD, ramipril 5 mg PO OD, atorvastatin 20 mg PO ON, and magnesium citrate 200 mg PO OD.

It was a pleasure reviewing Arthur Pendelton in the cardiomyopathy clinic today.

Symptoms

Reports increased fatigue over the last month and two recent presyncopal episodes on standing quickly. No recurrent TIA symptoms or focal neurological deficits.

Symptoms

He reports stable NYHA Class II dyspnoea on exertion. He experiences occasional brief palpitations lasting a few seconds, but denies chest pain, orthopnoea, PND, ankle swelling, or syncopal episodes.

Exercise: Walks dog 2 miles daily on flat ground; limited by breathlessness on steep inclines.

Examination

BP 128/76 mmHg, HR 62 bpm (regular), SpO2 98 % on room air, Weight 82.4 kg. JVP not elevated. Heart sounds normal (S1, S2) with no murmurs. Chest clear to auscultation bilaterally. No peripheral oedema.

Investigations

• ECG: Sinus rhythm, 62 bpm, LVH by voltage criteria with deep anterolateral T-wave inversion (unchanged).
• Echocardiogram: Asymmetrical septal hypertrophy (MWT 18 mm), LVEF 60 %, no LVOT obstruction at rest or with Valsalva, mild LA dilatation (14/02/2025).
• Bloods: Hb 142 g/L, eGFR > 90 mL/min/1.73m², K+ 4.4 mmol/L, NT-proBNP 410 ng/L.
• Cardiac MRI: Confirmed septal HCM with mild patchy mid-wall late gadolinium enhancement (LGE < 5 % of LV mass) (10/11/2023).
• 48-hour Holter monitor: Sinus rhythm throughout, rare isolated VEs, no NSVT or AF captured, HCM SCD 5-year risk score low at 2.1 % (20/03/2025).

Impression and Plan

Clinically stable non-obstructive HCM and PAF. Presyncopal episodes appear orthostatic in nature rather than cardiogenic. We will continue current medical therapy with bisoprolol 5 mg PO OD and apixaban 5 mg PO BD for stroke prophylaxis, and I have advised him on conservative measures for postural symptoms including adequate hydration.

Routine review in the cardiomyopathy clinic in 12 months with a repeat echocardiogram, 12-lead ECG, and 24-hour Holter monitor prior to the appointment.