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ECG Abnormalities Preceding Structural Changes of Apical Hypertrophic Cardiomyopathy by up to 10 Years
Taylor McManus1, John J Straub1, Austin Triana2
1Cardiology, University of Texas Medical Branch at Galveston, Galveston, USA.
Insights
An abnormal ECG in a 48-year-old man initially showed no cardiac abnormalities but later preceded structural changes. He was diagnosed with apical hypertrophic cardiomyopathy, highlighting a rare 10-year diagnostic gap.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- A 48-year-old male patient presented with hypertension and hypercholesterolemia.
- Initial electrocardiogram (ECG) revealed signs of myocardial ischemia and ventricular hypertrophy.
Observation:
- Extensive cardiac workup including MRI, echocardiogram, and stress test showed no structural cardiac abnormalities.
- The patient remained asymptomatic with normal cardiac structure for 10 years post-initial ECG.
Findings:
- Ten years after the initial ECG, the patient developed structural changes consistent with the prior ECG findings.
- Diagnosis of apical hypertrophic cardiomyopathy was confirmed.
- Treatment involved an automatic implantable cardiac defibrillator.
Implications:
- This case highlights an unusual 10-year discrepancy between ECG abnormalities and structural cardiac changes.
- Emphasizes the importance of long-term patient monitoring for subtle cardiac conditions.
- Suggests potential for earlier detection strategies in hypertrophic cardiomyopathy.
Abstract:
A 48-year-old man with hypertension and hypercholesterolemia was referred with an abnormal ECG showing signs of myocardial ischemia and structural change consistent with ventricular hypertrophy. Upon further workup with MRI, echocardiogram, and exercise stress test with perfusion images, it was determined that the man had no cardiac abnormalities. Ten years later, the patient developed structural changes consistent with the abnormal ECG. The patient was diagnosed with apical hypertrophic cardiomyopathy and was treated appropriately with an automatic implantable cardiac defibrillator. The objective of this clinical case report is to highlight this unusual incident where ECG changes preceded structural changes within the heart by 10 years.
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