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Subaortic and mid-ventricular obstructive hypertrophic cardiomyopathy with an apical aneurysm: a case report

Tomás Francisco Cianciulli1, María Cristina Saccheri, Isabel Victoria Konopka

  • 1Department of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires Dr, Cosme Argerich, Buenos Aires, Argentina. tcianciulli@fibertel.com.ar

Cardiovascular Ultrasound
|March 24, 2006
PubMed

Insights

This rare case report details a patient with hypertrophic cardiomyopathy (HCM) exhibiting both mid-ventricular and apical variants, alongside an apical aneurysm. This unique combination, presenting with myocardial infarction and normal coronary arteries, highlights unusual HCM manifestations.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) commonly presents with asymmetric septal hypertrophy, often leading to dynamic subaortic obstruction in 25% of cases.
  • Apical and mid-ventricular HCM are rare variants, sometimes associated with apical aneurysms.
  • The coexistence of mid-ventricular and apical HCM is exceptionally infrequent.

Observation:

  • A 49-year-old female patient presented with combined septal asymmetric HCM and midventricular HCM.
  • She exhibited a subaortic gradient of 65 mm Hg and a midventricular gradient of 20 mm Hg, along with an apical aneurysm.
  • Clinical presentation included acute myocardial infarction, normal coronary arteries, and left ventricular hypertrophy.

Findings:

  • The patient had a rare combination of obstructive HCM, mid-ventricular HCM, and an apical aneurysm.
  • Coronary angiography revealed no coronary artery disease, despite the myocardial infarction.
  • Electrocardiogram showed a right bundle branch block without ST-segment elevation or Q waves post-infarction.

Implications:

  • This case represents a unique presentation of hypertrophic cardiomyopathy, previously unreported in medical literature.
  • It underscores the importance of considering rare HCM variants and their potential complications, such as apical aneurysms.
  • Further research into the genetic and pathophysiological mechanisms of these rare HCM presentations is warranted.
Abstract

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