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This case report describes how the use of metabolic exercise testing in a 28 year old woman with morphologically and haemodynamically mild hypertrophic cardiomyopathy and severe exercise limitation led to the diagnosis of an alternative cause for the patient\u2019s symptoms, namely a primary disturbance of the mitochondrial respiratory chain probably caused by a nuclear encoded gene defect.<\/jats:p>","DOI":"10.1136\/hrt.81.4.441","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"441-443","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Diagnostic utility of metabolic exercise testing in a patient with cardiovascular disease"],"prefix":"10.1136","volume":"81","author":[{"given":"P M","family":"Elliott","sequence":"first","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK, \n\nbInstitute of Neurology, The National Hospital, Queen Square, London, WC1N 3BG, UK, \n\ncDivision of Human and Exercise Science, School of Applied Science, South Bank University, London, SE1 0AA, UK, \n\ndDepartment of Neurology, The Medical School, Framlington Place, University of Newcastle upon Tyne, NR2 4HB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M G","family":"Hanna","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK, \n\nbInstitute of Neurology, The National Hospital, Queen Square, London, WC1N 3BG, UK, \n\ncDivision of Human and Exercise Science, School of Applied Science, South Bank University, London, SE1 0AA, UK, \n\ndDepartment of Neurology, The Medical School, Framlington Place, University of Newcastle upon Tyne, NR2 4HB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S 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