Page 22 - Delaware Medical Journal - February 2017
P. 22
Not All Chest Pains Are Made Equal: A Case of Apica Hypertrophic Cardiomyopathy
Ahmed S. Abuzaid, MD; Syed Ali Hamid, MBBS; Mandip Gakhal, MD; Sandra Weiss, MD; Robin Horn, MD; William Weintraub, MD
An 84-year-old Caucasian female patient was admitted following sudden onset chest discomfort and near syncope associated with shortness of breath and diaphoresis secondary to recurrent episodes of monomorphic ventricular tachycardia. Physical examination showed stable vital signs and
a normal respiratory exam. Intravenous amiodarone bolus and subsequent infusion was initiated and successfully aborted the tachyarrhythmia.
dyslipidemia, Type II Diabetes mellitus, and paroxysmal atrial
left atrium, apical aneurysm and mild concentric left ventricular
after Valsalva. Home medications included aspirin, atorvastatin, nebivolol, lisinopril and glimepiride.
The Electrocardiogram on admission was compatible with prior EKGs showing ST elevation in inferior and lateral leads without reciprocal changes with borderline cardiac biomarker elevation. aneurysmal dilatation and preserved ejection fraction (Figures 1 and 2). No evidence of apical free wall rupture was noted. Right ventricular function was preserved.
FIGURE 1
Rhythm strip showing monochromic VT.
Coronary angiography demonstrated minimal non-obstructive coronary artery disease. Left ventriculography demonstrated
a preserved ejection fraction and marked hypertrophy towards contrast suggestive of apical hypertrophy or pseudoaneurysm (Figure 3). A multi planar multi sequence cardiac MRI (Figure 4) revealed a localized hypertrophic cardiomyopathy involving the left ventricular apical segments (apical septal, anterior, inferior and lateral segments; 18,17,17,17 mm respectively).
The patient had an uneventful inpatient stay with successful
prior to discharge.
DISCUSSION
Ventricular apical aneurysm is infrequently discovered in patients with normal coronaries.1 Differential diagnosis includes transmural myocardial infarction, repaired cardiac anomalies, focal myocarditis, trans-catheter aortic valve replacement,
stress cardiomyopathy and left ventricular diverticulum.1-4 Contained cardiac rupture by adherent pericardium or scar tissue characterizes left ventricular pseudo-aneurysms.3
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Del Med J | February 2017 | Vol. 89 | No. 2
