Unveiling Mixed Apical Hypertrophic Cardiomyopathy: A Case Study on Hypovolemia-Induced Syncope

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Mixed apical hypertrophic cardiomyopathy (MAHCM) is a rare cardiac condition.
• It is characterized by left ventricular apex hypertrophy and septal involvement.
• MAHCM increases the risk of left ventricular outflow tract (LVOT) obstruction and adverse cardiovascular events.

Observation:

• An 84-year-old female with hypertension presented with syncope, dizziness, and weight loss.
• She exhibited orthostatic changes and acute kidney injury, suggesting hypovolemia.
• Transthoracic echocardiography revealed LV apical hypertrophy, diastolic dysfunction, and signs of LVOT obstruction.

Findings:

• The patient's presentation and echocardiographic findings were consistent with MAHCM.
• Dehydration-induced hypovolemia precipitated the syncopal episode.
• Treatment with intravenous fluids and carvedilol resolved her symptoms.

Implications:

• This case highlights the importance of recognizing MAHCM in elderly patients with unexplained syncope, particularly with hypovolemia.
• Early identification and management of MAHCM are vital for preventing complications like arrhythmias and sudden cardiac death.
• Clinicians should consider MAHCM in elderly hypertensive patients presenting with syncope, even with other potential diagnoses like hypertensive heart disease.