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[Acute ischemia in myocardial hypertrophy: a report of 2 clinical cases]
1Servizio di Cardiologia, UTIC, Ospedale Civile, Guastalla, RE.
Insights
Two cases with chest pain and giant negative T waves showed left ventricular hypertrophy, not coronary artery disease. Non-coronary factors caused these ischemic events, highlighting a diagnostic challenge.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute myocardial ischemia can present with chest pain and electrocardiogram (ECG) abnormalities like giant negative T waves.
- Left ventricular hypertrophy (LVH) from conditions such as hypertrophic cardiomyopathy and hypertensive heart disease can mimic ischemic changes.
Observation:
- Two patients presented with acute myocardial ischemia, chest pain, and new-onset giant negative T waves on ECG.
- Echocardiography revealed asymmetric left ventricular hypertrophy in both cases.
- Electrocardiograms normalized spontaneously; echo-dipyridamole tests and coronary angiography ruled out coronary artery disease.
Findings:
- The ischemic events were attributed to non-coronary factors: acute anemia in one patient and severe hypertension in the other.
- Giant negative T waves in hypertrophic cardiomyopathy do not exclusively indicate myocardial hypertrophy but can be associated with acute myocardial ischemia.
Implications:
- This presentation underscores the diagnostic challenge in differentiating LVH from acute myocardial ischemia.
- Accurate diagnosis is crucial for appropriate clinical management, therapeutic strategies, and prognostic assessment.
- Recognizing non-coronary causes of ischemic symptoms in LVH is vital for patient care.
Abstract:
We report two cases presented with a clinical picture of acute myocardial ischemia, chest pain and giant negative T waves on electrocardiogram (absent in previous tracings). The echocardiogram B-Mode showed in both cases an asymmetric left ventricular hypertrophy caused, respectively, by hypertrophic cardiomyopathy and hypertensive heart disease. Short-term electrocardiographic evolution to complete normalization was observed in both cases. The echo-dipyridamole test did not show dissynergias and this fact suggested the absence of coronary artery disease; this hypothesis was confirmed by a normal coronary angiography. We suppose that in both patients a few factors contributed to the ischemic events: respectively an acute anemia due to gastric bleeding and high blood pressure values. This clinical presentation is an example of a difficult differential diagnostic problem between left ventricular hypertrophy and acute myocardial ischemia, as it shows that giant negative T waves in hypertrophic cardiomyopathy do not necessarily depend on left myocardial hypertrophy involving the apex or other segments but may be associated to an acute myocardial ischemia related or not to a coronary artery disease. A correct evaluation of these clinical cases is important for clinical, therapeutic and prognostic implications.