Acute Limb Ischemia in a Previously Undiagnosed Case of Mid-Ventricular Non-Obstructive Hypertrophic Cardiomyopathy

Abstract

Mid-ventricular hypertrophic cardiomyopathy (HCM) is rare and when associated with an apical aneurysm has a high risk of thrombus formation and embolization. We report a case of a 70-year-old man with peripheral vascular disease who presented with acute progressive right leg pain. Peripheral angiography showed complete thrombotic occlusion of his right superficial femoral artery. Thrombolysis was successfully performed using alteplase. His post-procedure angiography which was obtained the next day showed complete revascularization with no residual stenosis. His echocardiogram showed an ill-defined mass in the left ventricular apex. The absence of residual atheroma on peripheral angiography suggested a primary embolic event. We obtained cardiac MRI which showed mid-ventricular HCM complicated by an apical aneurysm and small thrombus. Left ventricular apical aneurysm occurs commonly in mid-ventricular HCM and is associated with a worse prognosis. Cardiac magnetic resonance imaging (MRI) is superior to echocardiography in identifying left ventricular apical aneurysms and apical thrombi.