"Ischemic" ST elevation in a woman with left ventricular hypertrophy
Natale Daniele Brunetti1, Michele Correale, Rafel Sai
1Cardiology Department, University of Foggia, viale Pinto 1, 71100, Foggia, Italy. nd.brunetti@unifg.it
Journal of Thrombosis and Thrombolysis
|August 21, 2012
Summary
This case report highlights that ST elevation and chest pain can mimic heart attacks. These ECG changes were actually caused by asymmetric left ventricular hypertrophy and aortic stenosis, not coronary artery disease.
Area of Science:
- Cardiology
- Clinical Case Reports
- Cardiovascular Imaging
Background:
- ST elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and intervention.
- Differential diagnosis of chest pain and ST elevation is crucial to avoid unnecessary treatments.
- Left ventricular hypertrophy (LVH) and aortic stenosis (AS) can present with atypical cardiac symptoms.
Observation:
- A female patient presented with symptoms suggestive of acute myocardial infarction, including ST elevation on electrocardiogram (ECG).
- Coronary angiography was performed to assess for coronary artery disease.
- The patient exhibited ECG anomalies not attributable to coronary blockages.
Findings:
- Coronary angiography revealed no significant coronary stenosis.
- The observed ECG abnormalities were correlated with underlying asymmetric left ventricular hypertrophy.
- Aortic stenosis was identified as a contributing factor to the patient's presentation.
Implications:
- This case underscores the importance of considering non-coronary causes for ST elevation and chest pain.
- Accurate diagnosis of conditions like LVH and AS is vital for appropriate patient management.
- Clinicians should maintain a broad differential diagnosis in patients presenting with acute cardiac symptoms.
Related Concept Videos
01:22Mitral Stenosis I: Introduction
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
01:30Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
01:29Heart Failure II: Pathophysiology
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...