[Hypertrophic cardiomyopathy presenting ECG changes mimicking myocardial infarction during 18 years: report of a...

This report describes a 54-year-old man with hypertrophic cardiomyopathy whose electrocardiogram had developed abnormal changes characterized by progressive ST-segment elevation with Q waves during eighteen years period. The ECG taken on the initial examination at his age of 36 showed a high voltage QRS complex with deep inverted T waves in V3-6. Twelve years later, these inverted T waves became shallow and ST-segment elevation was recognized. Since the age of 49, the ECG showed persistent ST-segment elevation and Q waves in V3-6 mimicking anterolateral myocardial infarction. At the age of 54, he suddenly died of ventricular tachycardia. At necropsy the heart showed the thickened ventricular septum and transmurally infarcted scar in the anteroseptal area near the apex with patent epicardial coronary arteries. Microscopic examination revealed myofibrillar disarray in the ventricular septum and significant intramural coronary artery narrowing in the left ventricular free wall and ventricular septum. The association of myocardial infarction in hypertrophic cardiomyopathy with the patent epicardial coronary artery has been reported by Maron et al, who stressed the role of the narrowing of intramural coronary arteries in such cases. In the present report, we discussed the pathogenesis of myocardial infarction in hypertrophic cardiomyopathy with a review of literature.