Hypertrophic obstructive cardiomyopathy with pseudo-myocardial infarction pattern. A case report

Area of Science:

• Cardiology
• Cardiovascular Pathology

Background:

• A 60-year-old woman presented with angina pectoris, hypertension, and suspected ischemic heart disease.
• Initial investigations including ECG and serum enzymes suggested acute myocardial infarction (MI).

Observation:

• Radioisotope imaging ruled out MI.
• Echocardiography revealed hypertrophic obstructive cardiomyopathy (HOCM).
• Cardiac catheterization and endomyocardial biopsy (EMB) were performed for diagnosis.

Findings:

• Left ventricular EMB showed no HOCM features despite a significant intraventricular gradient.
• Right ventricular EMB demonstrated extensive HOCM changes, even with a small gradient.
• Cardiac catheterization excluded prior MI and coronary artery disease.

Implications:

• This case underscores the importance of comprehensive diagnostic approaches in complex cardiac conditions.
• Discrepancies between ventricular biopsies and gradients highlight potential diagnostic challenges in HOCM.
• Accurate diagnosis is crucial for appropriate management, as seen with the patient's congestive cardiac failure requiring therapy modification.