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[Apical hypertrophic myocardiopathy: differential diagnosis with ischemic cardiopathy]
1Servicios de Medicina Interna y Cardiología, Hospital General Vall d'Hebron, Barcelona.
Insights
Apical hypertrophic cardiomyopathy can present with exertional angina and ECG changes. Early clinical suspicion is crucial for diagnosing this condition, even in asymptomatic individuals.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Diagnostics
Background:
- Exertional angina and electrocardiographic changes are common presenting symptoms for various heart conditions.
- Ischemic heart disease is a frequent diagnosis considered in patients with these symptoms.
- Hypertrophic cardiomyopathy, particularly the apical form, requires specific diagnostic considerations.
Observation:
- A 53-year-old patient presented with exertional angina and ECG findings suggestive of ischemic heart disease.
- Echocardiogram and cardiac catheterization revealed apical hypertrophic cardiomyopathy.
- Coronary angiogram results were normal, ruling out significant coronary artery disease.
Findings:
- Apical hypertrophic cardiomyopathy (AHC) is a distinct form of hypertrophic cardiomyopathy.
- AHC can mimic ischemic heart disease based on clinical presentation and ECG.
- Giant negative T waves in the presence of left ventricular hypertrophy are key ECG features.
Implications:
- Clinicians must maintain a high index of suspicion for AHC in patients presenting with cardiac symptoms or even asymptomatically.
- Diagnostic workup should include advanced imaging like echocardiography and potentially cardiac catheterization.
- Accurate diagnosis of AHC is essential for appropriate management and prognosis, differentiating it from ischemic heart disease.
Abstract:
A 53-year-old patient was admitted to our hospital because of exertional angina and electrocardiographic changes suggesting ischemic heart disease. The echocardiogram and cardiac catheterization demonstrated apical hypertrophic cardiomyopathy with normal coronary angiogram. We review the clinical features, treatment and prognosis of this condition. We insist on the importance of clinically suspecting it in any asymptomatic patient, or with any type of cardiac symptoms, and giant negative T waves with electrocardiographic features of left ventricular hypertrophy.