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Late onset apical hypertrophic cardiomyopathy: a case report
Patrick Doeblin1,2, Rolf Gebker1, Burkert Pieske1,2,3
1Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.
Insights
Relative apical hypertrophy may signal early apical hypertrophic cardiomyopathy. This condition evolves, necessitating follow-up for cardiac symptoms and imaging findings.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Disease
Background:
- Apical hypertrophic cardiomyopathy (AHC) presents diagnostic challenges due to variable presentation and imaging difficulties.
- Standard hypertrophic cardiomyopathy (HCM) criteria require ≥15 mm wall thickness; a relative apical hypertrophy ratio of 1.5 is proposed for AHC.
- Echocardiography visualization can be impaired, complicating AHC diagnosis.
Background:
Apical hypertrophic cardiomyopathy provides diagnostic challenges through varying presentation, impaired visualization on echocardiography and dissent on diagnostic criteria. While hypertrophic cardiomyopathy in general requires an absolute wall thickness ≥15 mm, a threshold for relative apical hypertrophy (ratio 1.5) has been proposed.
Case Summary:
We report the case of a 57-year-old man with newly arisen chest pain and slight T-wave inversions. Serial cardiac magnetic resonance imaging over 9 years documented the gradual evolvement of late-onset apical hypertrophy with apical fibrosis and strain abnormalities. Symptoms, electrocardiographic changes, and relative apical hypertrophy preceded the traditional imaging criteria of hypertrophic cardiomyopathy.
Discussion:
Relative apical hypertrophy can be an early manifestation of apical hypertrophic cardiomyopathy. Persistent cardiac signs and symptoms warrant a follow-up, as apical hypertrophic cardiomyopathy can evolve over time. Cardiac magnetic resonance imaging readily visualizes apical hypertrophic cardiomyopathy and associated changes in tissue composition and function.
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