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Hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm: a case report

K Harada1, T Shimizu, Y Sugishita

  • 1Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan. harada-2im@h.u-tokyo.ac.jp

Japanese Circulation Journal
|October 23, 2001
PubMed

Insights

This case study highlights a rare combination of hypertrophic cardiomyopathy, midventricular obstruction, and apical aneurysm in an elderly woman. Myocardial ischemia is suggested as a potential cause for the apical aneurysm.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Pathophysiology

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
  • Midventricular obstruction and apical aneurysms are rare complications of HCM.

Observation:

  • A 71-year-old woman presented with a history of abnormal electrocardiograms, dizziness, and low blood pressure.
  • Holter monitoring revealed significant ventricular arrhythmias, including nonsustained ventricular tachycardia.
  • Doppler echocardiography, MRI, and angiography confirmed midventricular hypertrophy, apical aneurysm, and aberrant coronary artery compression.

Findings:

  • Hemodynamic study showed low cardiac output and a significant intraventricular pressure gradient.
  • Stress thallium-201 imaging indicated severe persistent defect in the left ventricular apex.
  • The findings suggest myocardial ischemia may contribute to apical aneurysm formation in HCM.

Implications:

  • This case underscores the complex interplay of structural abnormalities and potential ischemia in HCM.
  • Understanding these rare presentations is crucial for accurate diagnosis and management of hypertrophic cardiomyopathy.
  • Further research into the role of ischemia in HCM complications is warranted.

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