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One heart, two cardiomyopathies

Vassilis Vassiliou1, Bobby Agrawal, Alisdair Ryding

  • 1Department of Cardiology, Papworth Hospital, Cambridge, UK. vassiliou@doctors.org.uk

BMJ Case Reports
|June 8, 2012
PubMed

Insights

This case highlights a rare presentation of chest pain mimicking myocardial infarction. The patient experienced both Tako-tsubo cardiomyopathy and hypertrophic cardiomyopathy, despite having clear coronary arteries.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Internal Medicine

Background:

  • Acute chest pain with ECG changes often indicates myocardial infarction.
  • Coronary artery disease is the most common cause of acute myocardial infarction.

Observation:

  • A 63-year-old woman presented with symptoms of acute myocardial infarction but had unobstructed coronary arteries.
  • Left ventriculography revealed apical hypokinesis and basal hyperkinesis, characteristic of Tako-tsubo cardiomyopathy.
  • Echocardiography showed left ventricular hypertrophy and dynamic outflow obstruction with mitral regurgitation.

Findings:

  • The patient was diagnosed with both Tako-tsubo cardiomyopathy and hypertrophic cardiomyopathy.
  • Despite initial recovery, persistent left ventricular hypertrophy and dynamic obstruction were noted on outpatient MRI.
  • This case underscores the importance of considering non-coronary causes of myocardial infarction symptoms.

Implications:

  • This presentation challenges typical diagnostic pathways for acute chest pain.
  • It emphasizes the need for comprehensive cardiovascular assessment beyond coronary angiography.
  • Understanding the coexistence of these cardiomyopathies is crucial for accurate diagnosis and management.

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