Volume 4, Issue 1, March 2020, Page: 22-26
Acute Coronary Syndrome and Myocardial Ischemia in Hypertrophic Cardiomyopathy
Ambreen Gul, Department of Cardiology, Faculty of Medicine, Southend University Hospital, Southend, UK
Ali Gohar Lodro, Department of Cardiology, Faculty of Medicine, Southend University Hospital, Southend, UK
Received: Nov. 7, 2019;       Accepted: Jan. 29, 2020;       Published: Mar. 18, 2020
DOI: 10.11648/j.ccr.20200401.15      View  152      Downloads  84
Abstract
47 years old male smoker with no co morbidities, presented with history of chest pain in the retrosternal area for the 3 days. The Pain was described as sharp, non-exertional and intermittent. Patient did not have any family history of known cardiac disease or sudden cardiac death. A Clinical examination failed to reveal any abnormalities. An ECG revealed deep T wave inversion in the anterolateral chest leads with left ventricular hypertrophy (LVH). Bloods analysis showed normal Complete blood count, liver function and mildly increased cardiac troponins. The Patient was admitted to the CoronaryCare Unit with a diagnosis of acute coronary syndrome. Patient was initiated dual antiplatelets, fondaparinux and high intensity atorvastatin. Following this, an echocardiogram revealed severe Left ventricular hypertrophy and reduced LV (left ventricular) cavity dimensions. Good LV systolic function with grade 3 diastolic dysfunction was noted. Coronary angiogram showed a normal right and left coronary system. Patient was diagnosed with hypertrophic cardiomyopathy. Cardiac MRI Showed severe Left ventricular hypertrophy with interventricular septum thickness 3.7 cm with rest of the walls hypertrophied. There was evidence of severe fibrosis of the septum, anterior and lateral wall. On the basis of severe left ventricular hypertrophy (especially septal thickness >3.5 cm) and myocardial fibrosis, Patient was started on beta blockers and ICD was inserted for primary prevention of arrhythmias.
Keywords
Hypertrophic Cardiomyopathy, Acute Coronary Syndrome, Myocardial Fibrosis
To cite this article
Ambreen Gul, Ali Gohar Lodro, Acute Coronary Syndrome and Myocardial Ischemia in Hypertrophic Cardiomyopathy, Cardiology and Cardiovascular Research. Vol. 4, No. 1, 2020, pp. 22-26. doi: 10.11648/j.ccr.20200401.15
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Maron BJ, Spirito P, Roman MJ, et al. Prevalence of hypertrophic cardiomyopathy in a population based sample of American Indian aged 51 to 77 years. Am J Cardiolo 2004; 93: 81510.
[2]
Zou Y, Song L, Wang Z, et all. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults. J Am Coll Cardiol 1999; 33: 1590.
[3]
Maron BJ, Gardin JM, Flack JM, et al. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation 1995; 92: 785.
[4]
Veselka J, Anavekar NS, Charron P, Hypertrophic obstructive cardiomyopathy. Lancet 2017; 389: 1253.
[5]
Semsarian J, Ingles J, Maron MS, et al. New perspective on the prevalence of hypertrophic cardiomyopathy. J of American College of Cardiology 2015; 65: 1249.
[6]
Elliot PM, Kaski JC, Prasad K, et all. Chest pain during daily life in patients with hypertrophic cardiomyopathy: an ambulatory electrocardiographic study. Eur Heart J 1996; 17: 1056.
[7]
McLeod CJ, Ackerman MJ, Nishimura RA, et all. Outcome of patients with hypertrophic cardiomyopathy and a normal electrocardiogram. J AM Coll Cardiolo. 2009; 54: 229.
[8]
Rowin EJ, Maron BJ, Applebaum E, et al. Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiology 2012; 110: 1027.
[9]
Claire E Raphael, Robert Cooper, Kim H Parker et al. Mechanism of Myocardial Ischemia in Hypertrophic Cardiomyopathy. J AM Coll cardiol VOL. 68, NO. 15, 2016.
[10]
GuptaT, Harkrishnan P, Kolte d, et al. Outcomes of acute myocardial infarction in patients with hypertrophic cardiomyopathy: Am J Medicine 2015; 128: 879.
[11]
Bogaet J, Olivotto I, MR imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedsise. Radiology 2014; 273: 329.
[12]
Maron MS, Maron BJ. Clinical Impact of Contemporary Cardiovacular Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy: Circulation 2015; 132: 292.
[13]
Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008; 51: 1369–1374.
[14]
Chan RH, Maron BJ, Olivotto I, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014; 130: 484–495.
[15]
Maron MS, Appelbaun E, harrigan CJ, et al. Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail 2008; 1; 184.
Browse journals by subject