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Published on: August 8, 2022
Apical hypertrophic cardiomyopathy presenting as recurrent unexplained syncope
Yusuf Kasirye1, Janaki Ram Manne, Narendranath Epperla
1Department of Internal Medicine, Marshfield Clinic, 50 Sherry Avenue, Park Falls, WI 54552, USA. kasirye.yusuf@marshfieldclinic.org
Insights
Apical hypertrophic cardiomyopathy (AHC) is a rare heart condition. Early diagnosis is crucial, and unique electrocardiogram (ECG) findings can provide vital clues, even when cardiac MRI is the gold standard.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Apical hypertrophic cardiomyopathy (AHC) is a rare variant of hypertrophic cardiomyopathy.
- First described in 1976, understanding of AHC has evolved significantly.
- Cardiac magnetic resonance imaging (CMR) is the gold standard for diagnosing AHC.
Observation:
- This case highlights a 47-year-old male patient presenting with recurrent syncope.
- Electrocardiogram (ECG) anomalies suggestive of AHC were initially overlooked.
- Classical ECG findings were evident upon admission, leading to rapid diagnosis.
Findings:
- Unique electrocardiographic features are critical for the initial diagnosis of AHC.
- ECG analysis can provide early diagnostic clues for AHC.
- The case underscores the importance of recognizing subtle ECG patterns in AHC.
Implications:
- Increased clinical awareness of ECG findings in AHC is essential.
- Prompt ECG interpretation can expedite AHC diagnosis.
- This emphasizes the complementary role of ECG alongside advanced imaging like CMR.
Abstract:
Apical hypertrophic cardiomyopathy (AHC) is a rare variant of hypertrophic cardiomyopathy. Since its description by Sakamoto in 1976 in Japanese patients, our understanding of this entity has evolved. Although cardiac magnetic resonance imaging has emerged as the gold standard for diagnosing AHC, clinical attention must be drawn to the unique electrocardiographic features that provide the initial clues to making the diagnosis. In this case, we present a 47-year-old man with AHC who presented with recurrent syncope, but anomalies on his electrocardiogram went unnoticed on two clinical encounters. He was subsequently admitted to our service and rapidly diagnosed after we observed the very classical findings in the plain twelve lead electrocardiogram done at the time of admission. In a clinical encounter involving a patient presenting with recurrent syncope, special attention must be focused on the electrocardiogram to decipher the unique diagnostic features it might show.
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