Apical Hypertrophic Cardiomyopathy: A Case Report

Abugroun, Ashraf; Ahmed, Fátima; Vilchez, Daniel; Turaga, Lalita Prabha

doi:10.14740/cr619w

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…The hallmarks include giant T wave inversions in the precordial leads on electrocardiogram and the aforementioned spade like appearance of the left ventricular cavity [1, 2]. Most of the available data based on studies done in the Japanese population have suggested a benign prognosis in patients with ApHCM.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular apical hypertrophic cardiomyopathy is a rare presentation of hypertrophic cardiomyopathy associated with thickening of the apical segment of the left ventricle. It was initially described in Japan in 1976 [1] and is characterized by electrocardiogram findings showing giant T wave inversions in the precordial leads as well as a spade shaped appearance of the apical cavity on imaging [2]. In western countries, the reported incidence is between 1 and 2% [3].…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular apical hypertrophy in a transplanted heart: a case report

Ibe

Balakumaran

Arora

2019

BMC Cardiovasc Disord

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Background Left ventricular apical hypertrophic cardiomyopathy is a rare presentation of hypertrophic cardiomyopathy associated with thickening of the apical segment of the left ventricle. It was initially described in Japan in 1976 and is characterized by electrocardiogram findings showing giant T wave inversions in the precordial leads as well as a spade shaped appearance of the apical cavity on imaging (Abugroun et al., Cardiol Res 8:265-268, 2017). In this case, we present a patient with a heart transplant with a stable post-transplant course who was found to have apical hypertrophic cardiomyopathy. There have been a few cases of apical hypertrophy in a transplanted heart documented in the literature. Making this case even more unique is that this presentation is evident 17 years after heart transplantation. Case presentation Fifty-four year-old male with a history of orthotropic heart transplant in 2001 on immunosuppressive therapy presented with palpitations and associated lightheadedness. He had a blood pressure of 184/89 mmHg on arrival but otherwise had stable vital signs and physical examination. Cardiac biomarkers revealed a CK of 59 U/L and a troponin of 0.11NG/ML(normal < 0.04NG/ML). B type natriuretic peptide was 371 PG/ML(normal 0-100PG/ML). Routine laboratory studies demonstrated normal sodium, magnesium, serum creatinine, and a potassium of 3.3 mmol/L(normal 3.5–5.1 mmol/L). His hemoglobin and hematocrit were normal. His EKG showed sinus rhythm with old T wave inversions in the anterior and lateral leads. Echocardiogram revealed a left ventricular ejection fraction of 55–65%, left posterior wall of 1.3 cm and interventricular septal wall 1.2 cm, thickened trabeculated apex, with severely dilated left atrium. He had a stress test that showed mild inferior wall thinning and a cardiac MRI performed to further evaluate apical hypertrophy revealed prominent apical hypertrophy of the left ventricle with near obliteration of the apical cavity. He had no events on cardiac monitoring and was discharged with close followup with the transplant team. Conclusion While there are many etiologies of ApHCM, it has not been well described in transplanted patients who are on chronic immunosuppressive therapy. It is unclear if these groups of patients are at an increased risk of developing this condition. The literature suggests that ApHCM is associated with a being prognosis but there is new data suggesting increased mortality in a subset of patients with this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left ventricular apical hypertrophy in a transplanted heart: a case report

Ibe

Balakumaran

Arora

2019

BMC Cardiovasc Disord

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“…AHCM is a rare non-obstructive morphological variant of HCM [ 5 ]. AHCM is rarely reported in African American patients [ 6 ], and is most prevalent in the Japanese population. The prevalence of AHCM among HCM patients in Japan was 15%, whereas in the USA the prevalence was only 3% [ 1 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…As with the treatment of obstructive HCM, where the use of beta-blockers and calcium channel blockers is a mainstay of therapy [ 16 ], symptomatic AHCM patients may also benefit from the negative inotropic effects of beta blockers and calcium channel blockers like verapamil [ 6 , 12 ]. Unlike HCM patients with an elevated outflow gradient at rest, where a reduction of LV afterload can worsen symptoms [ 17 ], the reduction of afterload with angiotensin-converting enzyme inhibitors has also been recommended for symptomatic patients with AHCM [ 6 ]. For patients who present with atrial fibrillation and ventricular arrhythmias, antiarrhythmics such as amiodarone and procainamide can be used [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol ablation has been used as palliative treatment in mixed AHCM – with severe mid-LV cavity gradient and symptoms refractory to medical management, and to eliminate monomorphic ventricular tachycardia after failed radiofrequency ablation [ 3 ]. Apical myectomy and heart transplant have been considered as options for the subset of AHCM patients with severe heart failure symptoms refractory to medical therapy [ 6 ]. Such patients often have diastolic heart failure with low cardiac output.…”

Section: Discussionmentioning

confidence: 99%

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Ventricular Fibrillation Cardiac Arrest in African American Male with Apical Hypertrophic Cardiomyopathy

Volney¹,

Wada²,

Tatusov³

2018

Cureus

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Apical hypertrophic cardiomyopathy (AHCM) is a rare form of non-obstructive hypertrophic cardiomyopathy. It is rarely reported in African American patients, and more commonly reported in Japanese patients. AHCM involves hypertrophy of the apex of the left ventricle. It is considered to have a benign prognosis in terms of cardiovascular mortality, however arrhythmias and sudden cardiac death have been reported. We report a case of a 49-year-old African American male with a history of hypertension, who presented to the emergency department after in field defibrillation for ventricular fibrillation cardiac arrest with return of spontaneous circulation after 10 minutes of cardiopulmonary resuscitation. Features of left ventricular hypertrophy and deep T-wave inversions in V3-V6 were noted on a 12-lead electrocardiogram which were suggestive of AHCM. Left heart catheterization with left ventriculography and coronary angiography confirmed the diagnosis of AHCM with the classic “ace of spades” sign. This case highlights the rare occurrence of AHCM with ventricular fibrillation cardiac arrest in an African American male, treated with hypertension management, aspirin, atorvastatin and automated implantable cardioverter-defibrillator placement.

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Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

Abugroun

Tyle

Faizan

et al. 2020

Case Reports in Emergency Medicine

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ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. e authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. is case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.

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Apical Hypertrophic Cardiomyopathy: A Case Report

Cited by 8 publications

References 23 publications

Left ventricular apical hypertrophy in a transplanted heart: a case report

Left ventricular apical hypertrophy in a transplanted heart: a case report

Ventricular Fibrillation Cardiac Arrest in African American Male with Apical Hypertrophic Cardiomyopathy

Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

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