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Hypertrophic obstructive cardiomyopathy complicated with acute myocardial infarction and diffuse fibrosis: surgery or

Yunhong Wang1, Xuemei Zhao1, Mei Zhai1

  • 1Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North Lishi Road, Beijing, 100037, People's Republic of China.

BMC Cardiovascular Disorders
|April 14, 2022
PubMed

Insights

Hypertrophic cardiomyopathy with myocardial infarction without coronary artery disease is rare. Septal reduction surgery may cautiously treat this condition, improving patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Hypertrophic cardiomyopathy (HCM) with extreme hypertrophy, biventricular obstruction, and myocardial fibrosis is a rare phenotype.
  • Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) complicates this presentation.
  • Limited evidence and guidelines exist for managing this rare condition.

Observation:

  • A 38-year-old male with a 2-year history of nonobstructive HCM presented with acute myocardial infarction.
  • Coronary angiography revealed no obstructive lesions but showed slow flow in the left descending artery.
  • Diagnostic workup confirmed anterior wall myocardial infarction, severe biventricular hypertrophy, and outflow tract obstruction.

Findings:

  • Cardiac MRI confirmed a concentric HCM subtype with diffuse left ventricular late gadolinium enhancement.
  • The patient underwent extended septal myectomy one month after diagnosis.
  • The patient experienced a good recovery following the surgical intervention.

Implications:

  • Acute myocardial infarction in hypertrophic obstructive cardiomyopathy warrants coronary angiography.
  • Septal reduction surgery may be a viable, albeit cautious, treatment option for select HCM patients with MINOCA.
  • This case highlights a potential therapeutic strategy for a rare and complex cardiovascular presentation.
Abstract

Keywords:
Extreme hypertrophyHypertrophic obstructive cardiomyopathyLate gadolinium enhancementMyocardial infarction in the absence of obstructive coronary artery disease

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