A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram
A 66-year-old female presented to the emergency room with an episode of chest pain that lasted for a few minutes before resolving spontaneously. Electrocardiogram showed a left bundle branch block, left ventricular hypertrophy, and T wave inversions in the lateral leads. Initial cardiac troponin lev...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2018/7089149 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849686112328482816 |
|---|---|
| author | Vineet Meghrajani Karan Wats Abhinav Saxena Bilal Malik |
| author_facet | Vineet Meghrajani Karan Wats Abhinav Saxena Bilal Malik |
| author_sort | Vineet Meghrajani |
| collection | DOAJ |
| description | A 66-year-old female presented to the emergency room with an episode of chest pain that lasted for a few minutes before resolving spontaneously. Electrocardiogram showed a left bundle branch block, left ventricular hypertrophy, and T wave inversions in the lateral leads. Initial cardiac troponin level was 0.15 ng/ml, with levels of 4 ng/ml and 9 ng/ml obtained 6 and 12 hours later, respectively. The peak blood pressure recorded was 195/43 mmHg. Echocardiogram with DEFINITY showed a small left ventricular cavity with apical hypertrophy, and coronary angiogram showed no stenotic or occluding lesions in the coronary arteries. The patient was admitted for a type 2 myocardial infarction with hypertensive crises. She was diagnosed with having apical hypertrophic cardiomyopathy, which is a variant of hypertrophic cardiomyopathy (HCM) in which the hypertrophy predominantly involves the apex of the left ventricle resulting in midventricular obstruction, as opposed to the left ventricular outflow tract obstruction seen in HCM. Patients with apical HCM may present with angina, heart failure, myocardial infarction, syncope, or arrhythmias and are typically managed with medications like verapamil and beta-blockers for those who have symptoms and antiarrhythmic agents like amiodarone and procainamide for treatment of atrial fibrillation and ventricular arrhythmias. An implantable cardioverter defibrillator (ICD) is recommended for high-risk HCM patients with a history of previous cardiac arrest or sustained episodes of ventricular tachycardia, syncope, and a family history of sudden death. |
| format | Article |
| id | doaj-art-b8895b4bfb104976afa0f7e36e95e6f2 |
| institution | DOAJ |
| issn | 2090-6404 2090-6412 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-b8895b4bfb104976afa0f7e36e95e6f22025-08-20T03:22:49ZengWileyCase Reports in Cardiology2090-64042090-64122018-01-01201810.1155/2018/70891497089149A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary AngiogramVineet Meghrajani0Karan Wats1Abhinav Saxena2Bilal Malik3Department of Internal Medicine, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USADepartment of Cardiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USADepartment of Cardiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USADepartment of Cardiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USAA 66-year-old female presented to the emergency room with an episode of chest pain that lasted for a few minutes before resolving spontaneously. Electrocardiogram showed a left bundle branch block, left ventricular hypertrophy, and T wave inversions in the lateral leads. Initial cardiac troponin level was 0.15 ng/ml, with levels of 4 ng/ml and 9 ng/ml obtained 6 and 12 hours later, respectively. The peak blood pressure recorded was 195/43 mmHg. Echocardiogram with DEFINITY showed a small left ventricular cavity with apical hypertrophy, and coronary angiogram showed no stenotic or occluding lesions in the coronary arteries. The patient was admitted for a type 2 myocardial infarction with hypertensive crises. She was diagnosed with having apical hypertrophic cardiomyopathy, which is a variant of hypertrophic cardiomyopathy (HCM) in which the hypertrophy predominantly involves the apex of the left ventricle resulting in midventricular obstruction, as opposed to the left ventricular outflow tract obstruction seen in HCM. Patients with apical HCM may present with angina, heart failure, myocardial infarction, syncope, or arrhythmias and are typically managed with medications like verapamil and beta-blockers for those who have symptoms and antiarrhythmic agents like amiodarone and procainamide for treatment of atrial fibrillation and ventricular arrhythmias. An implantable cardioverter defibrillator (ICD) is recommended for high-risk HCM patients with a history of previous cardiac arrest or sustained episodes of ventricular tachycardia, syncope, and a family history of sudden death.http://dx.doi.org/10.1155/2018/7089149 |
| spellingShingle | Vineet Meghrajani Karan Wats Abhinav Saxena Bilal Malik A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram Case Reports in Cardiology |
| title | A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram |
| title_full | A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram |
| title_fullStr | A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram |
| title_full_unstemmed | A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram |
| title_short | A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram |
| title_sort | 66 year old female with apical hypertrophic cardiomyopathy presenting with hypertensive crises and type 2 myocardial infarction and a normal coronary angiogram |
| url | http://dx.doi.org/10.1155/2018/7089149 |
| work_keys_str_mv | AT vineetmeghrajani a66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT karanwats a66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT abhinavsaxena a66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT bilalmalik a66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT vineetmeghrajani 66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT karanwats 66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT abhinavsaxena 66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram AT bilalmalik 66yearoldfemalewithapicalhypertrophiccardiomyopathypresentingwithhypertensivecrisesandtype2myocardialinfarctionandanormalcoronaryangiogram |