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Hypertrophic Obstructive Cardiomyopathy Present as Acute Myocardial Infarction in a Nonagenarian
Xiaojing Wan1, Yuji Zhan1, Zeyu Gao1
1Graduate School of the Chinese PLA General Hospital, Beijing, China.
Insights
Hypertrophic obstructive cardiomyopathy can mimic acute myocardial infarction, challenging diagnosis in elderly patients. Early recognition through physical exam and imaging is key to accurate diagnosis and management.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents diagnostic challenges by mimicking acute myocardial infarction.
- Elderly patients are particularly susceptible to this diagnostic confusion.
Background:
Hypertrophic obstructive cardiomyopathy (HOCM) may appear as acute myocardial infarction in patients, posing diagnostic challenges.
Case Summary:
A 95-year-old male presented with dizziness, hypotension, and electrocardiogram changes suggesting left main disease, alongside a dynamic rise in cardiac biomarkers. Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR), revealed no functionally significant ischemia. Physical examination showed a systolic murmur, followed by echocardiography, which confirmed HOCM by demonstrating asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, and a left ventricular outflow tract gradient of 40 mm Hg. Management with bisoprolol and mavacamten led to significant symptomatic improvement.
Discussion:
This case emphasizes that HOCM may present like acute myocardial infarction. Physical examination and multimodal cardiac imaging are crucial to avoid misdiagnosis.
Take-Home Messages:
HOCM is a differential diagnosis for acute coronary syndrome in elderly patients. Cardiac auscultation is crucial in differential diagnosis, combined with multimodal cardiac imaging.
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