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Left Ventricular Hypertrophy With Pre-Excitation: Thinking Beyond the Usual Hypertrophic Cardiomyopathy Diagnosis
Syed Bukhari1, Andreas S Barth1, Bryana Rivers1
1Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
PRKAG2 cardiomyopathy, a genetic condition causing glycogen buildup, mimics hypertrophic cardiomyopathy (HCM). Recognizing pre-excitation on ECG is key for diagnosing this non-sarcomeric form of HCM.
Area of Science:
- Cardiology
- Genetics
- Molecular Biology
Background:
- PRKAG2 cardiomyopathy is a genetic disorder characterized by myocardial glycogen accumulation, presenting similarly to hypertrophic cardiomyopathy (HCM).
- It is associated with left ventricular hypertrophy (LVH), ventricular pre-excitation, conduction disease, and tachyarrhythmias.
Background:
PRKAG2 cardiomyopathy is a genetic cardiomyopathy that phenotypically resembles hypertrophic cardiomyopathy (HCM) and results from myocardial glycogen accumulation. In addition to left ventricular hypertrophy (LVH), PRKAG2 cardiomyopathy is associated with ventricular pre-excitation, cardiac conduction disease, and ventricular tachyarrhythmias.
Case Summary:
A 34-year-old woman with a family history of HCM and Wolff-Parkinson-White syndrome presented with exertional dyspnea, chest discomfort, and near-syncope. Electrocardiogram revealed LVH, T-wave inversions, and pre-excitation. Echocardiography demonstrated severe LVH with outflow tract obstruction. Based on family history, LVH, and pre-excitation, PRKAG2 syndrome was suspected and later confirmed by genetic testing.
Discussion:
PRKAG2 cardiomyopathy results from glycogen accumulation rather than sarcomeric hypertrophy. This case highlights the diagnostic importance of electrocardiography-detected pre-excitation in a patient with severe LVH, raising suspicion for nonsarcomeric HCM.
Take-Home Messages:
Consider PRKAG2 mutations in HCM patients with pre-excitation or conduction disease. Early genetic diagnosis guides management and informs family screening.
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