title: Apical hypertrophic cardiomyopathy with hemodynamically unstable ventricular arrhythmia - Atypical presentation.
abstract: We present a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who recently developed cardiac arrhythmias, and shortly discuss the diagnostic modalities, differential diagnosis, and treatment strategy for this condition. AHCM is a rare form of hypertrophic cardiomyopathy, which usually involves the apex of the left ventricle. AHCM can occur with varied presentations such as chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation, and congestive heart failure. The most peculiar electrocardiogram findings are giant T-waves inversion in the precordial leads with left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic modality in the evaluation of AHCM and shows hypertrophy of the LV apex. Other diagnostic modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings, are also valuable tools. Medications used to manage include verapamil, beta-blockers, and antiarrhythmic agents. An implantable cardioverter defibrillator (ICD) is recommended for high-risk patients.
authors.affiliation: Consultant, Non-Invasive Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India. Electronic address: drhemant.chaturvedi@gmail.com.
authors.forename: Hemant
authors.initials: H
authors.lastname: Chaturvedi
authors.affiliation: Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India.
authors.forename: Rudra Dev
authors.initials: RD
authors.lastname: Pandey
authors.affiliation: FCCP Consultant Pulmonologist, Eternal Heart Care Center & Research Institute, Jaipur, India.
authors.forename: Krishna Kumar
authors.initials: KK
authors.lastname: Sharma
authors.affiliation: Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India.
authors.forename: Jitendra Singh
authors.initials: JS
authors.lastname: Makkar
authors.affiliation: Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India.
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: Apical hypertrophic cardiomyopathy; Arrhythmia; Electrocardiogram