Persistent elevation of cardiac enzymes in a patient with hypertrophic cardiomyopathy--with special reference to electrocardiographic, echocardiographic and 201-thallium myocardial scintigraphic findings.
A 17-year-old female patient with hypertrophic cardiomyopathy whose serum cardiac enzymes (creatine phosphokinase = CPK, lactic dehydrogenase = LDH) showed persistent elevation was presented. Percent of CPK-MB and LDH1 in 6-year-follow-up period ranged from 3.2% to 8.5%, and 58.0% to 63.2%, respectively. This finding strongly suggests the existence of a small amount of continuous myocardial necrosis for a long time. The influence of cardiac enzyme release on the heart was assessed by serial checks of electrocardiogram, echocardiogram and 201-thallium myocardial scintigram. In serial checks of electrocardiograms, markedly decreased R wave amplitude ranging between 31% and 47% was observed in II, III, aVF and V3-6. On echocardiograms, asymmetric septal hypertrophy and a narrow left ventricular cavity were observed in all echocardiograms through the follow-up period. But, in most recent apical two-dimensional echocardiograms, hourglass appearance of the left ventricle due to a distinct cavity-formation at the apex was observed. In 201-thallium single photon emission computed tomogram, hypoperfusion area markedly extended in anterior and lateral parts. These changes in electrocardiograms, echocardiograms and 201-thallium myocardial scintigrams seemed to reflect myocardial necrosis. Our case points to a mechanism for hypertrophic cardiomyopathy to change, over time, to dilated cardiomyopathy-like features.
2nd Department of Internal Medicine, Ehime University School of Medicine, Japan.
M
M
Hamada
Y
Y
Shigematsu
Y
Y
Fujiwara
T
T
Sumimoto
K
K
Hiwada
T
T
Kokubu
D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000201:enzymology*; D003402:Creatine Kinase / Q000097:blood*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D007527:Isoenzymes; D013794:Thallium Radioisotopes; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase