All That Glitters is not Gold: Apical Hypertrophic Cardiomyopathy Mimicking Acute Coronary Syndrome
Umashankar Lakshmanadoss1, Abhishek Kulkarni1, Shobana Balakrishnan2
1Division of Cardiology, Department of Medicine, Guthrie Health System, Sayre, PA, 18840, USA.
Insights
Hypertrophic cardiomyopathy (HCM) can affect the heart
Area of Science:
- Cardiology
- Genetics
- Internal Medicine
Background:
- Hypertrophic cardiomyopathy (HCM) is an autosomal dominant genetic condition.
- Characterized by idiopathic left ventricular hypertrophy, HCM presents with variable penetrance.
- Apical HCM is prevalent in Asian populations (25%) but rare in Caucasians (0.2%).
Observation:
- Patients with HCM often experience exertional chest pain and shortness of breath.
- Apical HCM cases typically exhibit milder symptoms.
- Clinical and electrocardiographic findings in Apical HCM can mimic acute coronary syndrome.
Findings:
- Apical HCM diagnosis requires a high index of suspicion due to overlapping symptoms with acute coronary syndrome.
- Electrocardiographic changes in Apical HCM can be mistaken for acute ischemic events.
- Apical HCM patients generally have a better prognosis compared to other forms of HCM.
Implications:
- Differentiating Apical HCM from acute coronary syndrome is crucial for appropriate patient management.
- Early recognition of Apical HCM can prevent misdiagnosis and unnecessary interventions.
- Understanding the distinct presentation of Apical HCM aids in tailoring treatment strategies and improving patient outcomes.
Abstract:
Hypertrophic cardiomyopathy is characterized by the idiopathic hypertrophy of the left ventricle (and occasionally right ventricle). HCM is an autosomal dominant disease, with variable penetration. In Asian population, apical hypertrophic cardiomyopathy is relatively common (25%). However, this is relatively rare in Caucasian population (0.2%). Patients with HCM, often presents with typical exertional chest pain and shortness of breath. Apical HCM patients tend to have milder symptoms. However, the clinical presentation and electrocardiographic features of Apical HCM often mimic acute coronary syndrome and high index of suspicion is warranted in differentiating this condition. Patients with apical HCM have relatively better prognosis when compare to the other varieties. Here, we are presenting a patient who presented with typical exertional chest pain whose electrocardiographic changes are concerning for acute ischemic changes.
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