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An overlooked diagnosis on transthoracic echocardiography: apical hypertrophic cardiomyopathy

Omer Yiğiner1, Bekir Yilmaz Cingözbay, Omer Uz

  • 1Department of Cardiology, Haydarpaşa Training Hospital, Gülhane Military Medical Academy, Istanbul, Turkey. oyiginer@yahoo.com

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|March 5, 2010
PubMed

Insights

Apical hypertrophic cardiomyopathy (HCM) can be missed on standard echocardiograms. Left ventriculography revealed the characteristic "ace of spades" deformity, confirming this rare cardiac condition.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Genetics

Background:

  • Apical hypertrophic cardiomyopathy (HCM) is a variant of HCM that can be challenging to diagnose.
  • Early detection is crucial for managing symptoms and preventing complications.

Observation:

  • A 54-year-old male with dyslipidemia and family history presented with atypical chest pain.
  • Electrocardiogram showed increased QRS voltage and T-wave inversions.
  • Initial transthoracic echocardiography with poor windows yielded normal results.

Findings:

  • Coronary angiography revealed normal coronary arteries.
  • Left ventriculography demonstrated the classic "ace of spades" apical cavity shape, indicative of apical HCM.
  • Cardiac magnetic resonance imaging confirmed the diagnosis.

Implications:

  • Highlights the importance of considering apical HCM in patients with suggestive symptoms and ECG findings, even with initially normal echocardiograms.
  • Emphasizes the diagnostic utility of left ventriculography and cardiac MRI when echocardiography is inconclusive.
  • Underscores the need for advanced imaging techniques to diagnose challenging cardiovascular conditions.

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