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Hypertrophic obstructive cardiomyopathy with pseudo-myocardial infarction pattern. A case report
Insights
This study highlights hypertrophic obstructive cardiomyopathy (HOCM) misdiagnosed as ischemic heart disease. Right ventricular endomyocardial biopsy confirmed HOCM, revealing diagnostic discrepancies.
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.
Abstract:
A 60-year-old woman with mild hypertension and presumed ischaemic heart disease was followed up over a very long period on account of angina pectoris. Acute myocardial infarction (MI) was suspected on the basis of the history, ECG findings and serum enzyme values, but disproved by radioisotope investigation. Echocardiography demonstrated features of hypertrophic obstructive cardiomyopathy (HOCM), a diagnosis supported by cardiac catheterization and endomyocardial biopsy (EMB). Histological features of HOCM were absent from left ventricular EMB specimens despite a significant intraventricular gradient, but the right ventricular EMB demonstrated extensive changes of HOCM despite a small intraventricular gradient. Cardiac catheterization excluded previous MI and coronary artery disease. A further interesting feature was the development of congestive cardiac failure, which necessitated modification of her drug therapy).