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Left ventricular hypertrophy: hypertensive or hypertrophic cardiomyopathy? What a dilemma! A case report
Albina Aldomà-Balasch1, Marta Z Zielonka1, Pedro K Rivera-Aguilar1
1Department of Cardiology, Cardiology Critical Care Unit, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica, Lleida, Spain.
Insights
Differentiating severe left ventricle hypertrophy (LVH) from hypertrophic cardiomyopathy (HCM) can be challenging, especially with homogeneous hypertrophy and hypertension. Clinical features are key to diagnosis when patients present with exertional angina.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Left ventricle hypertrophy (LVH) diagnosis requires differentiating between hypertrophic cardiomyopathy (HCM) and other causes.
- Homogeneous LVH in hypertensive patients poses diagnostic challenges.
- Exertional angina in LVH patients may stem from HCM or concurrent coronary artery disease.
Purpose of the Study:
- To review clinical features aiding differential diagnosis of LVH.
- To highlight challenges in distinguishing hypertensive LVH from HCM.
- To discuss angina causes in LVH patients.
Main Methods:
- Case presentation of a 46-year-old man with hypertension and severe LVH.
- Review of clinical features for differential diagnosis.
- Discussion of angina etiology in LVH.
Main Results:
- The case highlights the difficulty in differentiating hypertensive LVH from HCM.
- Clinical features can suggest HCM even with homogeneous hypertrophy.
- Coronary artery disease must be considered in angina with LVH.
Conclusions:
- Accurate diagnosis of LVH requires careful consideration of clinical presentation.
- Distinguishing between hypertensive heart disease and HCM is crucial.
- Exertional angina necessitates a thorough evaluation for underlying causes.
Abstract:
In the presence of the left ventricle hypertrophy (LVH), the differential diagnosis with hypertrophic cardiomyopathy (HCM) or some phenocopy must be always considered, which can be easily suspected when the hypertrophy is markedly asymmetric. However, when the hypertrophy is homogeneous, especially if the patient has concomitant hypertension, it may be a challenge to distinguish between hypertensive and HCM, although some clinical features may help us to suspect it. In addition, patients with HCM may present with exertional angina due to microcirculation involvement in the setting of the hypertrophy itself or dynamic obstruction in the left ventricular outflow tract, but in some cases, the presence of concomitant coronary artery disease must be suspected as the cause of angina, especially if the patient has an intermediate or high-risk probability of having ischemic heart disease. We present the case of a 46-year-old Afro-American man with poorly controlled hypertension who was found to have severe LVH, and who presented with symptoms of exertional angina during follow-up. We will review the clinical features that can help us in the differential diagnosis in this context.
