apical hypertrophic cardiomyopathy presenting as peripheral cyanosis on exertion and paroxysmal nocturnal dyspnea: an atypical case report

Introduction: hypertrophic cardiomyopathy (hcm) is defined by the presence of significant left ventricular hypertrophy (lvh) in the absence of secondary factors like systemic hypertension, aortic stenosis, and athlete's heart syndrome. case presentation: a 67-year-old woman, with a complaint of severe fatigue, peripheral cyanosis on normal daily activity life, and paroxysmal nocturnal dyspnea, was admitted to cardiac care unit, razavi hospital, mashhad, iran. in the primary physical examination, cardiac auscultation revealed pathologic s4 sound. clinical investigations such as electrocardiography, chest x-ray, and echocardiography approved apical hypertrophic cardiomyopathy (ahcm). only administration of metoprolol succinate with a short-term follow-up showed completely relieved pathologic presentation of this case. conclusion: in this case report, the management of a patient with peripheral cyanosis on normal activity, paroxysmal nocturnal dyspnea, and ahcm was emphasized. this case showed that early diagnosis followed by medication and supportive care, can control the patient's symptoms and postpone the progression of heart failure symptoms.