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[Atypical hypertrophic cardiomyopathy with calcified, left ventricular apical thrombosis]
R Gradaus1, M Lentschig, T Wichter
1Med. Klinik und Poliklinik, Westfälische Wilhelms-Universität Münster.
Insights
This case report details an asymptomatic patient with atypical hypertrophic cardiomyopathy (HCM). An abnormal ECG led to the discovery of a calcified apical thrombus within the left ventricle.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- Atypical presentations of HCM can pose diagnostic challenges.
Observation:
- An asymptomatic 42-year-old patient presented with an abnormal electrocardiogram (ECG) showing giant negative T-waves and high QRS voltages.
- Chest imaging revealed apical calcification.
- Echocardiography and left ventricular (LV) cineangiography demonstrated apical LV hypertrophy and cavity obliteration.
Findings:
- Magnetic resonance imaging (MRI) confirmed a calcified thrombus within the apical LV cavity.
- The findings were consistent with an atypical form of hypertrophic cardiomyopathy.
Implications:
- This case highlights the importance of advanced imaging in diagnosing rare HCM variants.
- Recognition of apical thrombus in HCM is crucial for risk stratification and management.
- Further research into the specific mechanisms of thrombus formation in atypical HCM is warranted.
Abstract:
A case of atypical hypertrophic cardiomyopathy (HCM) with a calcified apical thrombus is presented. A 42 year old asymptomatic patient was admitted for evaluation of an abnormal electrocardiogram (ECG) which was recorded when the patient suffered from a bronchitis. The ECG showed giant negative T-waves in leads II, III, aVF, V3 to V6 associated with high QRS voltages in the precordial leads. The chest X-ray and fluoroscopy demonstrated a calcification in projection to the apical region of the heart. Echocardiography and the left ventricular (LV) cineangiography showed hypertrophy of the apical LV myocardium and an obliteration of the apical LV cavity. Magnetic resonance imaging identified a calcified thrombus in the apical cavity of the LV in the setting of an atypical HCM.