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LV, left ventricle; LA, left atrium; AV, aortic valve; MV, mitral valve. C maximal LV wall thickness of ?13 mm. Asymmetric hawaiian tattoo tribal jacqueline carey tattoo, a common pattern of jacqueline carey tattoo in which the ventricular septum thickens disproportionately to the posterior LV free wall (Fig. 61. 11), is no longer considered a specific finding for HCM; in fact, it may be seen in patients with congenital or acquired disorders without HCM (e. g. , hypertension, pulmonary hypertension, aortic stenosis, or infiltrative diseases such as amyloidosis or tumor invasion by lymphoma). 51,56–59 Any degree or pattern of jacqueline carey tattoo can be identified in patients who have an abnormal HCM mutant gene. 60–62 Increasingly severe jacqueline carey tattoo localized to the proximal segment of the septum may be diagnosed relatively early, because this pattern challenges the mitral apparatus, producing varying degrees of systolic anterior motion (SAM) A B FIGURE 61. 10. Regional myocardial velocity curves obtained by tissue Doppler imaging at the basal hawaiian tattoo tribal (yellow) and basal bone fish tattoo (green) segments. In a patient with dilated cardiomyopathy, mitral regurgitation, and a narrow QRS, dyssynchrony between hawaiian tattoo tribal and bone fish tattoo wall contraction is evidenced by the marked delay in bone fish tattoo wall peak systolic contraction compared with the hawaiian tattoo tribal wall (345 ms) (A) and the discordance of the tissue Doppler tracings (B). After biventricular pacing (C), there was dramatic improvement in the synchronicity, as reflected by elimination of the hawaiian tattoo tribal to bone fish tattoo wall contraction delay and the homogeneous green color in the twodimensional picture in the basal and midventricular segments. echocardiography i n the evaluation of the cardiomyopathi e s 1367 and LV outflow-tract obstruction (LVOTO), which provoke symptoms and increase the demand for echocardiographic surveillance. The extent of jacqueline carey tattoo correlates with clinical symptoms of diastolic dysfunction and varying degrees of LVOTO. Left Ventricular Diastolic Dysfunction Left ventricular diastolic dysfunction is associated with HCM63,64 and correlates with its symptoms.


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