Subaortic and mid-ventricular obstructive hypertrophic cardiomyopathy with an apical aneurysm: a case report.
BACKGROUND
Most patients with hypertrophic cardiomyopathy (HCM) have asymmetric septal hypertrophy and among them, 25% present dynamic subaortic obstruction. Apical HCM is unusual and mid-ventricular HCM is the most infrequent presentation, but both variants may be associated to an apical aneurysm. An even more rare presentation is the coexistence mid-ventricular and apical HCM. This case is a combination of obstructive HCM with mid-ventricular HCM and an apical aneurysm, which to date, has not been reported in the literature.


METHODS
The patient is a 49 year-old lady who presents a combination of septal asymmetric hypertrophic cardiomyopathy (HCM) and midventricular HCM, a subaortic gradient of 65 mm Hg and a midventricular gradient of 20 mm Hg, plus an apical aneurysm. Her clinical presentation was an acute myocardial infarction in June 2005. One month after hospital discharge, the electrocardiogram (ECG) showed a right bundle branch block (RBBB) with no Q waves or ST segment elevation. Coronary angiography revealed normal coronary arteries, left ventricular hypertrophy and an apical aneurysm.


CONCLUSIONS
This case is a rare example of an asymptomatic patient with subaortic and mid-ventricular hypertrophic cardiomyopathy, who presents a myocardial infarction and normal coronary arteries, and during the course of her disease develops an apical aneurysm.
Cianciulli
Tomás Francisco
TF
Department of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires Dr, Cosme Argerich, Buenos Aires, Argentina. tcianciulli@fibertel.com.ar
Saccheri
María Cristina
MC
Konopka
Isabel Victoria
IV
Serans
Dora Faustina
DF
Acunzo
Rafael Salvador
RS
Escudero
Alejandro Mario García
AM
Masoli
Osvaldo Horacio
OH
Prezioso
Horacio Alberto
HA
D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006322:Heart Aneurysm / Q000150:complications* / Q000175:diagnosis; D006352:Heart Ventricles; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008875:Middle Aged