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1. HCM WITH "CHERRY ON TOP" SIGN IN
ECHOCARDIOGRAPHY

2. Case report
Male, 53 Yrs, Admission because of dyspnea
MH: Left ventricular outflow tract stenosis for 5 years without
treatment
Examination
Patient is alert, HR: 74 beats/min, BP: 110/70mmHg, Heart sound:
systolic murmur in aortic valves 3/6 grade, Lungs are normal, Abdomen
is soft

3. ECG, XRay

4. Echo
Left ventricular outflow tract obstruction in hypertrophic
cardiomyopathy with “cherry on top” pattern.
EF BP 62%, Reduce GLS: - 18.6%
Moderate aortic regurgitation, Mild mitral regurgitation
#Dx: Amyloidosis

5. Test for Diagnosis
Complete blood test:
- WBC: 7.29 G/L; Hgb: 151 g/L; PLT: 133 G/L
- Creatinin: 94 mcmol/L ; Ure: 5.1 mmol/L
- Na: 140 mmol/L; K: 3,7 mmol/L
- Tn Ihs: 10 ng/L
- NT Pro BNP: 325 ng/L
Blood cell examination and Bone marrow biopsy: Normal
Urine Test: Pro (-), RBC (-)

6. Test for Diagnosis
- ANA (-).
- Anti Ds DNA (-).
- Serum free light chain assay: Free Kappa/ Lambda: 13.5/20.9
- Monoclonal protein: IgG, IgA, IgM normal
- Serum protein electrophoresis (SPEP) and immunofixation (IFE), urine
protein electrophoresis (UPEP) and immunofixation: Normal, Kappla,
Lambda light chains: not detect

7. MRI
HCM with LVOT Obstruction
Two atria are dilated, two ventricles are not dilated, two ventricular
systolic function is normal