Hypertrophic cardiomyopathy may cause congestive heart failure. Failure to recognise its predominant pathophysiologic mechanism may have adverse consequences. A 75 year old women was admitted for progressive dyspnoea and new onset atrial fibrillation. Propafenone was unsuccessful in restoring sinus rhythm. Digoxin and diuretics were started without clinical improvement, and captopril was added. A two dimensional (cross sectional) …