The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index; none of the 13 sources its claims cite is checked for support yet.
Management of Hypertrophic Obstructive Cardiomyopathy with Concurrent Hypertension and Intracerebral Haemorrhage: A Case Report
Open accessAbstract
Hypertrophic Obstructive Cardiomyopathy (HOCM) is primarily a hereditary genetic disorder that presents difficulties in managing hypertension using a wide range of antihypertensive medications. It is crucial to steer clear of any substance that reduces preload or afterload in this situation, making beta-adrenergic receptor antagonists the ideal option. Hereby is a case of a 41-year-old who reported to the Medicine Outpatient Department (OPD) with complaints of weakness in the right upper and lower limbs for two days and altered sensorium. The patient was recently diagnosed with hypertension, and a Computed Tomography (CT) scan showed a left gangliocapsular bleed with a 3 mm midline shift. Echocardiography revealed HOCM. The patient was started on antioedema drugs and metoprolol. A repeat CT scan showed a decrease in the size of the bleed and surrounding oedema. The patient’s consciousness improved, and blood pressure came under control. He was discharged with antihypertensives for regular follow-ups. Overall, this case underscores the complex interplay between HOCM and hypertension, the challenges in managing hypertension in HOCM patients, and the critical role of beta-adrenergic receptor antagonists in this setting. It highlights the need for a tailored approach to hypertension management and the importance of early recognition and appropriate intervention in patients with HOCM presenting with complications such as intracranial haemorrhage.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
A single case report describes a 41-year-old man with newly detected hypertension who presented with right-sided weakness and altered sensorium, found to have a left gangliocapsular intracerebral haemorrhage alongside echocardiographically diagnosed hypertrophic obstructive cardiomyopathy (HOCM). He was managed with mannitol, levetiracetam, and metoprolol, with radiological and clinical improvement, illustrating the difficulty of treating hypertension when preload- and afterload-reducing drugs are contraindicated.
Key findings
- On presentation: pulse 74 beats per minute, blood pressure 180/100 mmHg, Glasgow Coma Score E2V2M4, 0/5 power in the right upper and lower limbs with exaggerated right-sided reflexes, and fundus examination showing early papilloedema.
- CT brain showed a well-defined hyperdense area (HU: 60–68) measuring approximately 36×50×27 mm (CC×AP×TR) in the left gangliocapsular region, thalamus, and corona radiata, with perilesional oedema, sulcal/Sylvian fissure/left lateral ventricle effacement, and a 3 mm midline shift to the right.
- Echocardiography revealed moderate concentric left ventricular hypertrophy with HOCM; ECG showed sinus tachycardia, an LVH pattern, and deep Q-wave and T-wave inversions in all leads.
- After treatment with injections of mannitol, levetiracetam, and metoprolol, a repeat CT showed the bleed decreased to 21×18×20 mm (CC×AP×TR) with reduced surrounding oedema; consciousness and right-sided limb power improved over two weeks, and the patient was discharged on antihypertensives for follow-up.
- The discussion cites literature that hypertension is found in 30 to 50% of patients with HOCM, that HOCM prevalence ranges from 0.02 to 0.2% in Western and Asian countries, and that ACE inhibitors and nitrates should be avoided because they worsen LVOT obstruction by reducing afterload.
Methods
- Design: single case report from the Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
- Data: clinical history and examination, routine blood investigations, ECG, CT brain (initial and repeat), and echocardiography in one 41-year-old male patient.
- Analysis: descriptive narrative of the clinical course, with the discussion contextualising the case against cited literature on HOCM and concurrent hypertension; no formal statistical analysis was performed.
Limitations
- The paper states no explicit limitations section.
- Evident from the text: this is a single case report with no control or comparison group, so no causal or generalisable conclusions can be drawn; the follow-up described is short (two weeks, with the patient "now on regular follow-up").
- Evident from the text: the discussion cites Wang Z et al. as describing a right-sided gangliocapsular bleed in patients with HOCM, whereas the index patient's bleed was left-sided, an inconsistency in the paper's own framing.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
0 of 13 cited sources checked · 0 supported · 0 flagged
- Findingown data§ Abstract
On examination the patient's blood pressure was 180/100 mmHg.
“his blood pressure was 180/100 mmHg”
Quote in the paperNot a substantial claim - Findingown data§ Abstract
Echocardiography of the patient revealed moderate concentric left ventricular hypertrophy with hypertrophic obstructive cardiomyopathy.
“Echocardiography revealed moderate concentric Left Ventricular Hypertrophy (LVH) with Hypertrophic Obstructive Cardiomyopathy (HOCM)”
Quote in the paperSubstantial claim - Premisecitation§ Discussion
A significant consequence of hypertension is a cerebral accident, leading to a gangliocapsular bleed in patients with HOCM.
“In a study by Wang Z et al., it was found that another significant consequence of hypertension is a cerebral accident, leading to a gangliocapsular bleed on the right-side in patients with HOCM, as seen in index patient (12).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] 12. Wang Z, Zheng Y, Ruan H, Li L, Zhang M, Duan L, et al. The impact of hypertension on the prognosis of patients with hypertrophic cardiomyopathy: A single-centre retrospective study. Peer J. 2023;11:e14614. [crossref][PubMed] Tables and Figures [Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4] [Table / Fig - 5] DOI and Others DOI: 10.7860/JCDR/2024/72561.19555 Date of Submission: Apr 30, 2024 Date of Peer Review: May 14, 2024 Date of Acceptance: May 22, 2024 Date of Publishing: Jun 01, 2024 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was inform
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Conclusion
Timely identification and intervention improve the overall prognosis of patients with HOCM.
“Timely identification and intervention play a crucial role in improving the overall prognosis of these patients.”
Quote in the paperSubstantial claim
- It may state two separate claims as one. 12
- Probably not a substantial claim. 17
It may state two separate claims as one.
Findingown data§ AbstractA repeat CT scan of the patient showed a decrease in the size of the bleed to 21*18*20 mm and a decrease in surrounding oedema.
“A repeat CT scan showed a decrease in the size of the bleed to 21*18*20 mm (CC*AP*TR) and surrounding oedema”
- Also stated in: § Abstract · plain
“A repeat CT scan showed a decrease in the size of the bleed and surrounding oedema.”
Quote in the paperNot a substantial claim- Also stated in: § Abstract · plain
It may state two separate claims as one.
Findingown data§ AbstractCT brain of the patient showed a well-defined hyperdense area measuring approximately 36*50*27 mm in the left gangliocapsular region, thalamus and corona radiata, suggestive of intraparenchymal haemorrhage, with perilesional oedema, mass effect and a 3 mm midline shift to the right.
“The CT brain showed a well-defined hyperdense area (HU: 60-68) measuring approximately 36*50*27 mm Craniocaudal (CC) Anteroposterior (AP) Transverse (TR) in the left gangliocapsular region, thalamus, and corona radiata, suggestive of intraparenchymal haemorrhage”
- Also stated in: § Abstract · plain
“a midline shift of 3 mm to the right”
Quote in the paperSubstantial claim- Also stated in: § Abstract · plain
It may state two separate claims as one.
Findingown data§ AbstractA 41-year-old male presented to the Medicine Outpatient Department with rapid onset weakness of the right upper and lower limbs that started two days earlier, accompanied by altered sensorium.
“A 41-year-old male presented to the Medicine Outpatient Department (OPD) with a rapid onset of weakness in the right upper and lower limbs that started two days ago, accompanied by altered sensorium.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown data§ AbstractThe patient demonstrated gradual improvement in consciousness and in the power of the right upper and lower limbs over two weeks.
“The patient demonstrated gradual improvement in consciousness, and the power of the right upper and lower limbs improved over two weeks.”
- Also stated in: § Abstract · plain
“The patient’s consciousness improved, and blood pressure came under control.”
Quote in the paperNot a substantial claim- Also stated in: § Abstract · plain
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Premisecitation§ DiscussionPatients with HOCM and a history of hypertension had fewer syncopal episodes and a lower prevalence of sudden cardiac death in the family compared with those with HOCM without hypertension.
“In a study by Luo Q et al., it was concluded that patients with HOCM and a history of hypertension had fewer syncopal episodes and a lower prevalence of sudden cardiac death in the family compared to those with HOCM without hypertension.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] 10. Luo Q, Chen J, Zhang T, Tang X, Yu B. Retrospective analysis of clinical phenotype and prognosis of hypertrophic cardiomyopathy complicated with hypertension. Sci Rep. 2020;10(1):349. [crossref][PubMed] source
Checked before — its earlier verdict is held back until a new check runs.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionThe prevalence of HOCM ranges from 0.02 to 0.2% in Western and Asian countries.
“The prevalence of HOCM ranges from 0.02 to 0.2% in Western and Asian countries (2).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] 2. Basit H, Brito D, Rout P, Alahmadi MH, Sharma S. Hypertrophic cardiomyopathy. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 28613539.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionHypertension is commonly found in 30 to 50% of patients with HOCM.
“Hypertension is commonly found in 30 to 50% of patients with HOCM.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] 7. Wang A. Hypertension and hypertrophic cardiomyopathy. Hypertrophic Cardiomyopathy. 2019:221-30. [crossref]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Premisecitation§ DiscussionThere is no difference in the presence of left ventricular outflow tract obstruction between HOCM patients with and without hypertension, but the prevalence of left ventricular outflow tract obstruction is significantly higher in patients with hypertension.
“Previous studies have shown no difference in the presence of LVOT obstruction between HOCM patients with and without hypertension, but the prevalence of LVOT obstruction was significantly higher in patients with hypertension (10),(11).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [10] 10. Luo Q, Chen J, Zhang T, Tang X, Yu B. Retrospective analysis of clinical phenotype and prognosis of hypertrophic cardiomyopathy complicated with hypertension. Sci Rep. 2020;10(1):349. [crossref][PubMed] source
Checked before — its earlier verdict is held back until a new check runs.
- cites [11] 11. Deng T, Ou B, Zhu T, Xu D. The effect of hypertension on cardiac structure and function in different types of hypertrophic cardiomyopathy: A single-centre retrospective study. Clin Exp Hypertens. 2019;41(4):359-65. Doi: 10.1080/ 10641963.2018.1489543. Epub 2018 Jul 9. PMID: 29985667. [crossref][PubMed] source
Probably not a substantial claim.
Premisecitation§ DiscussionAngiotensin converting enzyme inhibitors and nitrates should be avoided in HOCM because they can worsen left ventricular outflow tract obstruction by reducing afterload.
“Angiotensin Converting Enzyme (ACE) inhibitors and nitrates should be avoided as these medications can worsen Left Ventricular Outflow Tract (LVOT) obstruction by reducing afterload (1).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] 1. Raj MA, Ranka S, Goyal A. Hypertrophic obstructive cardiomyopathy. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 28613570.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
Premisenone given§ DiscussionBeta-blockers and verapamil/diltiazem are the initial recommended medications for treating HOCM and hypertension, because they alleviate heart obstruction while regulating blood pressure.
“Beta-blockers and verapamil/diltiazem are the initial recommended medications for treating HOCM and hypertension. These medications help alleviate heart obstruction while regulating blood pressure.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionHOCM is a genetically predisposed heart condition in which the septal wall of the myocardium thickens, leading to left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve.
“The HOCM is a genetically predisposed heart condition where the septal wall of the myocardium thickens, leading to Left Ventricular Outflow Tract (LVOT) obstruction due to systolic anterior motion of the mitral valve (1).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] 1. Raj MA, Ranka S, Goyal A. Hypertrophic obstructive cardiomyopathy. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 28613570.
Probably not a substantial claim. It may state two separate claims as one.
Interpretationreasoning§ AbstractThis case underscores the complex interplay between HOCM and hypertension, the challenges in managing hypertension in HOCM patients, and the critical role of beta-adrenergic receptor antagonists in this setting.
“Overall, this case underscores the complex interplay between HOCM and hypertension, the challenges in managing hypertension in HOCM patients, and the critical role of beta-adrenergic receptor antagonists in this setting.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Premisecitation§ DiscussionIn the past 20 years, advanced treatment options have significantly improved outcomes in HOCM, allowing many patients to lead normal or extended lives with better quality of life and reduced mortality.
“However, in the past 20 years, advanced treatment options have significantly improved outcomes, allowing many patients to lead normal or extended lives with a better quality of life and reduced mortality rates associated with HOCM (5).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] 5. Maron BJ, Maron MS, Rowin EJ. Perspectives on the overall risks of living with hypertrophic cardiomyopathy. Circulation. 2017;135(24):2317-19. [crossref][PubMed] source
Probably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionThere were no significant differences in clinical outcomes, such as five year survival rates or cardiac death, among individuals with HOCM.
“There were no significant differences in clinical outcomes, such as five year survival rates or cardiac death, among individuals with HOCM (9).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] 9. Bai Y, Zheng JP, Lu F, Zhang XL, Sun CP, Guo WH, et al. Prevalence, incidence and mortality of hypertrophic cardiomyopathy based on a population cohort of 21.9 million in China. Sci Rep. 2022;12(1):18799. [crossref][PubMed] source
Checked before — its earlier verdict is held back until a new check runs.
Probably not a substantial claim. The paper may give no reason why it holds.
Interpretationnone given§ ConclusionThe course of HOCM can be further complicated by cerebrovascular accidents, often in the form of intracerebral bleeding.
“Furthermore, the course of the disease can be further complicated by cerebrovascular accidents, often in the form of intracerebral bleeding.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionHistorically, HOCM was associated with a poor prognosis, including cardiac failure, thromboembolic events, malignant arrhythmias and death.
“Historically, HOCM was associated with a poor prognosis, including cardiac failure, thromboembolic events, malignant arrhythmias, and death [3,4].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [3] 3. Maron BJ. Hypertrophic cardiomyopathy: A systematic review. JAMA. 2002;287(10):1308-20. Doi: 10.1001/jama.287.10.1308. PMID: 11886323. [crossref] source
- cites [4] 4. Maron BJ, Olivotto I, Spirito P, Casey SA, Bellone P, Gohman TE, et al. Epidemiology of hypertrophic cardiomyopathy-Related death: Revisited in a large non-referral-based patient population. Circulation. 2000;102(8):858-64. Doi: 10.1161/01.cir.102.8.858. PMID: 10952953. [crossref][PubMed] source
Probably not a substantial claim. The paper may give no reason why it holds.
Interpretationnone given§ ConclusionFavourable outcomes can be achieved in patients with HOCM if they adhere to prescribed antihypertensive medications.
“It is crucial to note that favourable outcomes can be achieved in patients with HOCM if they adhere to prescribed antihypertensive medications.”
Quote in the paperNot a substantial claimProbably not a substantial claim. It may state two separate claims as one.
Interpretationreasoning§ AbstractBeta-adrenergic receptor antagonists are the ideal option for managing hypertension in patients with HOCM, because substances that reduce preload or afterload should be avoided.
“It is crucial to steer clear of any substance that reduces preload or afterload in this situation, making beta-adrenergic receptor antagonists the ideal option.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it.
Premisecitation§ DiscussionIndividuals with co-morbidities may experience a more significant impact on their survival than the effect of HOCM alone.
“A recent study suggests that individuals with co-morbidities may experience a more significant impact on their survival than the effect of HOCM alone (6).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] 6. Wasserstrum Y, Barriales-Villa R, Fernández-Fernández X, Adler Y, Lotan D, Peled Y, et al. The impact of diabetes mellitus on the clinical phenotype of hypertrophic cardiomyopathy. Eur Heart J. 2019;40(21):1671-77. [crossref][PubMed] source
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
Premisenone given§ DiscussionHypertension can lead to left ventricular hypertrophy due to increased strain on the heart, resulting in concentric or eccentric enlargement, increased left ventricular contraction and impaired diastolic function.
“Hypertension can lead to LVH due to increased strain on the heart, resulting in either concentric or eccentric enlargement, increased left ventricular contraction, and impaired diastolic function.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
Interpretationnone given§ ConclusionIndividuals diagnosed with HOCM may initially show no symptoms, although the first clinical signs may present as atrial or ventricular arrhythmias.
“Individuals diagnosed with HOCM may initially show no symptoms, although the first clinical signs may present as atrial or ventricular arrhythmias.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
There have been no major randomised trials for the treatment of HOCM.
“Unfortunately, there have been no major randomised trials for the treatment of HOCM, and the consensus is to treat symptomatic patients only.”
The paper relies on this without support.
The five year survival rate in individuals with HOCM and hypertension is generally poor.
“The five year survival rate in individuals with HOCM and hypertension is generally poor.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting claims about LVOT obstruction prevalence
MinorThe discussion first says LVOT obstruction did not differ between patients with and without hypertension, then says its prevalence was significantly higher in patients with hypertension.
“Previous studies have shown no difference in the presence of LVOT obstruction between HOCM patients with and without hypertension”
“the prevalence of LVOT obstruction was significantly higher in patients with hypertension”
Bleed reported on opposite sides
MinorThe discussion says the index patient had a right-sided gangliocapsular bleed, but the CT description places the bleed on the left.
“a gangliocapsular bleed on the right-side in patients with HOCM, as seen in index patient”
“in the left gangliocapsular region, thalamus, and corona radiata, suggestive of intraparenchymal haemorrhage”
Citations
Cites
The publisher hasn’t deposited this paper’s reference list.
Research works printed but not linked: 4
- [1]1. Raj MA, Ranka S, Goyal A. Hypertrophic obstructive cardiomyopathy. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 28613570.
- [2]2. Basit H, Brito D, Rout P, Alahmadi MH, Sharma S. Hypertrophic cardiomyopathy. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 28613539.
- [7]7. Wang A. Hypertension and hypertrophic cardiomyopathy. Hypertrophic Cardiomyopathy. 2019:221-30. [crossref]
- [12]12. Wang Z, Zheng Y, Ruan H, Li L, Zhang M, Duan L, et al. The impact of hypertension on the prognosis of patients with hypertrophic cardiomyopathy: A single-centre retrospective study. Peer J. 2023;11:e14614. [crossref][PubMed] Tables and Figures [Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4] [Table / Fig - 5] DOI and Others DOI: 10.7860/JCDR/2024/72561.19555 Date of Submission: Apr 30, 2024 Date of Peer Review: May 14, 2024 Date of Acceptance: May 22, 2024 Date of Publishing: Jun 01, 2024 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: May 01, 2024 • Manual Googling: May 16, 2024 • iThenticate Software: May 21, 2024 (11%) ETYMOLOGY: Author Origin EMENDATIONS: 6 JCDR is now Monthly and more widely Indexed . Emerging Sources Citation Index (Web of Science, thomsonreuters) Index Copernicus ICV 2017: 134.54 Academic Search Complete Database Directory of Open Access Journals (DOAJ) Embase EBSCOhost Google Scholar HINARI Access to Research in Health Programme Indian Science Abstracts (ISA) Journal seek Database Google Popline (reproductive health literature) www.omnimedicalsearch.com Sitemap | Login | Register | Feedback | Contact | Advertisers | Copyright & Disclaimer | Important Notice Affiliated websites : JCDR Prepublishing | Neonatal Database | Neonatal Database download center Premchand Shantidevi Research Foundation (PSRF, India) © Copyright 2007-2026, Journal of Clinical and Diagnostic Research, India.
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Metadata
- Authors
- Mangudkar, S., lingineni, V., Gokhale, V. S., Yadav, P. M., & Shokeen, A.
- Venue
- JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
- Publisher
- JCDR Research and Publications
- Published
- 2024
- ISSN
- 0973-709X (ISSN-L)
- 2249-782X
- OpenAlex
- W4399864504
- Semantic Scholar
- 7889635cc5a0fa5940c35fb24e7c92bf6107dbcb
- Cited by
- 0
- References
- 0
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- hypertrophic obstructive cardiomyopathy, hypertension, intracerebral hemorrhage, beta-blockers, metoprolol, antihypertensive therapy, cerebral edema, altered sensorium
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