Midventricular Hypertrophic Cardiomyopathy With Apical Aneurysm Presenting as Persistent ST-Segment Elevation
Andreas Kyvetos1, Ioannis Liatakis1, Panagioula Niarchou1
1Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
Insights
Persistent ST-segment elevation on ECG can mimic heart attack but may indicate nonischemic hypertrophic cardiomyopathy. This rare condition requires careful diagnosis using imaging alongside electrocardiography for effective management.
Area of Science:
- Cardiology
- Cardiac Imaging
- Electrocardiography
Background:
- ST-segment elevation typically signifies acute myocardial infarction due to coronary occlusion.
- Persistent ST-segment elevation can also be a sign of nonischemic structural heart disease.
- Differentiating these causes is crucial for appropriate patient management.
Background:
ST-segment elevation on electrocardiography is classically associated with acute transmural myocardial ischemia due to coronary artery occlusion and is central to the diagnosis of ST-segment elevation myocardial infarction. However, persistent ST-segment elevation may also reflect nonischemic structural heart disease.
Case Summary:
A 62-year-old woman presented with chest pain and widespread ST-segment elevation with T-wave inversion. Coronary angiography showed no obstructive disease. Echocardiography and cardiac magnetic resonance revealed midventricular hypertrophic cardiomyopathy with systolic midcavity obstruction and a left ventricular apical aneurysm. Nonsustained ventricular tachycardia was documented, and an implantable cardioverter-defibrillator was placed for primary prevention.
Discussion:
This case illustrates a rare, high-risk hypertrophic cardiomyopathy phenotype in which persistent ST-segment elevation mimics acute myocardial infarction.
Take-Home Messages:
Midventricular hypertrophic cardiomyopathy with apical aneurysm can present with persistent ST-segment elevation and T-wave inversion, mimicking myocardial infarction. Electrocardiography is a valuable diagnostic and surveillance tool in this phenotype, as characteristic ST-segment abnormalities may precede or complement imaging findings.
Related Concept Videos
Cardiomyopathy III: Hypertrophic Cardiomyopathy
Mitral Stenosis II: Clinical features and Diagnostic Tests
Myocarditis II: Clinical Features and Diagnostic Tests
Mitral Stenosis I: Introduction
Acute Coronary Syndrome I: Introduction
Myocarditis I: Introduction

