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Case Reports
. 2025 Jul 1:57:102250.
doi: 10.1016/j.rmcr.2025.102250. eCollection 2025.

Reverse Bernheim Phenomenon - A True Enigma

Evan Wasserman  1 , Luis Wulff  1 , Debabrata Bandyopadhyay  1 , Ricardo Restrepo-Jaramillo  1 , Raheel Qureshi  1 , Jose Herazo-Maya  1 , Monirul Islam  1
Affiliations
Case Reports

Reverse Bernheim Phenomenon - A True Enigma

Evan Wasserman et al. Respir Med Case Rep. .

Abstract

A 70-year-old man was admitted with progressive dyspnea and exercise-induced syncopal episodes. His past medical history was significant for heart failure with preserved ejection fraction (HFpEF) and pulmonary arterial hypertension (PAH). He was treated with ambrisentan, sildenafil and selexipag. Due to progressive symptoms, he underwent right heart catheterization (RHC). Compared to his prior, this showed improvement in mean pulmonary arterial pressure (mPAP) but worsened pulmonary capillary wedge pressure (PCWP). He was therefore titrated off selexipag and continued on other medications. Despite this his symptoms continued to worsen. Resting echocardiography demonstrated normal left ventricular (LV) systolic function with right ventricle (RV) dilatation and dysfunction; no shunt across the interatrial septum was detected. During a stress echocardiogram he had an episode of syncope with associated hypotension and oxygen desaturation. The images confirmed dramatic RV dilatation at peak exercise along with leftward bulging of the septum leading to compression of the left ventricular outflow tract (LVOT) - "the reverse Bernheim phenomenon". The RV size and function recovered rapidly at rest. The patient's PAH therapy was subsequently escalated with addition of intravenous treprostinil, which led to improvement of exercise capacity and resolution of syncopal episodes. A repeat stress echocardiogram revealed resolution of the acute exercise-induced RV dilatation and septal bulging without compressing the LVOT.

Keywords: Bernheim syndrome; Diastolic dysfunction; Interventricular septum; LVOT obstruction; PAH specific treatment; Pulmonary arterial hypertension; RV dysfunction; Reverse bernheim syndrome; Ventricular interdependence.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Leftward ventricular septal shift during exercise. Panels A and B show baseline echocardiographic four chamber views in diastole and systole, respectively. Panels C and D are the same views during exercise, highlighting RV dilation and a reduction in LV volume.
See this image and copyright information in PMC

References

    1. Alpert J.S. The effect of right ventricular dysfunction on left ventricular form and function. Chest. 2001 Jun;119(6):1632–1633. - PubMed
    1. Bernheim H. Venous asystole in hypertrophy of the left heart with associated stenosis of the right ventricle. Rev De Med. 1910;30:785–801.
    1. Chung M.S., Ko J.M., Chamogeorgakis T., Hall S.A., Roberts W.C. The myth of the bernheim syndrome. SAVE Proc. 2013 Oct;26(4):401–404. - PMC - PubMed
    1. Russek H.I., Zohman B.L. The syndrome of bernheim as a clinical entity. Circulation. 1950;1:759–765.
    1. Atlas D.H., Eisenberg H.L., Gaberman P. Bernheim's syndrome: report of a case. Circulation. 1950;1:753–758.

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