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Deng L, Zuo H, Li A, Yang C, Huang X. Numerical Simulation Study on the Mechanism of Formation of Apical Aneurysm in Hypertrophic Cardiomyopathy With Midventricular Obstruction. Front Physiol 2021; 12:717717. [PMID: 34366902 PMCID: PMC8334850 DOI: 10.3389/fphys.2021.717717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Apical aneurysm was observed to be associated with midventricular obstruction (MVO) in hypertrophic cardiomyopathy (HCM). To investigate the genesis of the apical aneurysm, the idealized numerical left ventricular models (finite-element left ventricle models) of the healthy left ventricle, subaortic obstruction, and midventricular obstruction in HCM of left ventricle were created. The mechanical effects in the formation of apical aneurysm were determined by comparing the myofiber stress on the apical wall between these three models (healthy, subaortic obstruction, and midventricular obstruction models). In comparing the subaortic obstruction model and MVO model with HCM, it was found that, at the time of maximum pressure, the maximum value of myofiber stress in MVO model was 75.0% higher than that in the subaortic obstruction model (654.5 kPa vs. 373.9 kPa). The maximum stress on the apex of LV increased 79.9, 69.3, 117.8% than that on the myocardium around the apex in healthy model, subaortic obstruction model, and MVO model, respectively. Our results indicated that high myofiber stress on the apical wall might initiate the formation process of the apical aneurysm.
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Affiliation(s)
- Long Deng
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Heng Zuo
- School of Mathematical Sciences, Sichuan Normal University, Chengdu, China
| | - An Li
- School of Mathematical Sciences, Xiamen University, Xiamen, China
| | - Chun Yang
- Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, China.,Department of Mathematics, Worcester Polytechnic Institute, Worcester, MA, United States
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Tezuka A, Higo K, Nakamukae Y, Nishihara S, Kamikawa M, Shimofuku C, Kawazoe K, Ohishi M. Bisoprolol Successfully Improved the Intraventricular Pressure Gradient in a Patient with Midventricular Obstructive Hypertrophic Cardiomyopathy with an Apex Aneurysm due to Apical Myocardial Damage. Intern Med 2019; 58:535-539. [PMID: 30333393 PMCID: PMC6421145 DOI: 10.2169/internalmedicine.0997-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/20/2018] [Indexed: 01/19/2023] Open
Abstract
Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy (HCM). An 80-year-old man was administered bisoprolol and warfarin therapies as treatment for MVOHCM with an apex aneurysm due to myocardial damage and intra-aneurysmal thrombus not complicated by atrial fibrillation. The pressure gradient in the midventricle successfully improved from 53.9 to 21.8 mmHg, and the intra-aneurysmal thrombus disappeared.
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Affiliation(s)
- Ayano Tezuka
- Departments of Cardiovascular Medicine, Japanese Red Cross Kagoshima Hospital, Japan
| | - Kenjuro Higo
- Departments of Cardiovascular Medicine, Japanese Red Cross Kagoshima Hospital, Japan
| | - Yuta Nakamukae
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Sanae Nishihara
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Masaki Kamikawa
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Chihiro Shimofuku
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Kazumasa Kawazoe
- Departments of Neurosurgery, Japanese Red Cross Kagoshima Hospital, Japan
| | - Mitsuru Ohishi
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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Abstract
Cardiac MRI (CMR) is an essential tool for the evaluation of the patient with hypertrophic cardiomyopathy (HCM). First, the accurate morphologic imaging and measures that are possible with CMR help to ascertain the diagnosis. Second, the tissue characterization that can be done with MRI helps to define the abnormalities in the myocardium and to identify areas of fibrosis that have been linked to increase risk of sudden cardiac death and heart failure. In addition, CMR can help distinguish HCM from similar disease processes.
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Affiliation(s)
- Abdallah Sanaani
- Gunderson Health System, La Crosse Campus, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Anthon Fuisz
- Westchester Medical Center, 100 Woods Road, Macy 132, Valhalla, NY 10595, USA.
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Elsheshtawy MO, Mahmoud AN, Abdelghany M, Suen IH, Sadiq A, Shani J. Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:854-865. [PMID: 29786883 DOI: 10.1111/pace.13380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/11/2018] [Accepted: 05/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) with or without left ventricular apical aneurysm (LVA) had been studied in the past. Midventricular obstruction associated with HCM and LVA is a unique entity that has not been distinguished previously as a separate phenotypic disease in HCM patients. METHODS A systematic review of Pubmed and Google Scholar was conducted from inception until September 2017 for all observational studies conducted on HCM with midventricular obstruction and LVA. RESULTS A total of 94 patients from 39 studies were included in our analysis. The mean age of the patients was 58.05 ± 11.76 years with 59.6% being males. The most common electrocardiographic finding was T wave inversion occurring in 13.8% of the cases followed by ST elevation (9.5%). Maximal left ventricle (LV) wall thickness was reported 18.89 ± 5.19 mm on transthoracic echocardiography and paradoxical jet flow was detected in 29.8% of patients. Beta-blockers (58.5%) were the most common drug therapy at baseline and amiodarone (10.6%) was the most common antiarrhythmic used for ventricular tachycardia (VT). The most common complication, VT, occurred in 39.3% of cases and the incidence of all-cause mortality was 13.8 % over 16 ± 20.1 months follow-up. Implantable cardioverter defibrillator (ICD) was used in 37.2% of patients; 25.7% of patients with ICD received appropriate shock therapy. CONCLUSION HCM with LVA and midventricular obstruction is a unique entity that appears to be associated with high incidence of morbidity and mortality. Thus, early diagnosis and therapeutic intervention is recommended for management of this condition.
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Affiliation(s)
- Moustafa O Elsheshtawy
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA.,Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mahmoud Abdelghany
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Ida H Suen
- Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Adnan Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jacob Shani
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Pérez-Riera AR, Barbosa-Barros R, de Lucca AA, Viana MJ, de Abreu LC. Mid-ventricular Hypertrophic Obstructive Cardiomyopathy with Apical Aneurysm Complicated with Syncope by Sustained Monomorphic Ventricular Tachycardia. Ann Noninvasive Electrocardiol 2016; 21:618-621. [PMID: 27422472 DOI: 10.1111/anec.12377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mid-ventricular hypertrophic obstructive cardiomyopathy with secondary formation of apical aneurysm is a rare variant of hypertrophic cardiomyopathy. They have a unique behavior because unlike other variants it causes sustained monomorphic ventricular tachycardia, which makes it particularly severe.
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Affiliation(s)
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
| | | | - Mujimbi Jose Viana
- ABC Faculty of Medicine - ABC Foundation, Santo André, São Paulo, Brazil
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Clinical Profile and Prognosis of Left Ventricular Apical Aneurysm in Hypertrophic Cardiomyopathy. Am J Med Sci 2016; 351:101-10. [PMID: 26802765 DOI: 10.1016/j.amjms.2015.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 08/19/2015] [Indexed: 01/05/2023]
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Po JRF, Kim B, Aslam F, Arabadjian M, Winson G, Cantales D, Kushner J, Kornberg R, Sherrid MV. Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities. J Am Soc Echocardiogr 2015; 28:1462-73. [DOI: 10.1016/j.echo.2015.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Indexed: 12/28/2022]
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Misumi I, Honda T, Kurokawa H, Kubota Y, Ishii M, Sato R, Yamabe H, Yasuda H, Kaikita K, Hokimoto S, Ogawa H. Systolic Flow Reversal in a Case of Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy. Intern Med 2015; 54:1765-9. [PMID: 26179533 DOI: 10.2169/internalmedicine.54.4153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old man presented to our hospital with chest pain. Two-dimensional transthoracic echocardiography showed hypertrophy of the left ventricle, mid-ventricular obstruction and an apical aneurysm. Color-flow imaging at the obstruction site on the apical four-chamber view demonstrated systolic flow reversal in addition to a paradoxical jet flow. The systolic flow reversal may have been caused by a decreased apical contractility and pressure during systole.
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Affiliation(s)
- Ikuo Misumi
- Department of Cardiology, Kumamoto Saisyunsou Hospital, Japan
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Phenotypic overlap in hypertrophic cardiomyopathy: Apical hypertrophy, midventricular obstruction, and apical aneurysm. J Cardiol 2014; 64:463-9. [DOI: 10.1016/j.jjcc.2014.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/19/2014] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
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Hanaoka Y, Misumi I, Rokutanda T, Akahoshi R, Matsumoto M, Sakamoto T, Kaikita K, Yamamuro M, Sugiyama S, Ogawa H. Simultaneous pressure recording in mid-ventricular obstructive hypertrophic cardiomyopathy. Intern Med 2012; 51:387-90. [PMID: 22333374 DOI: 10.2169/internalmedicine.51.6542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old man was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) with apical aneurysm and paradoxic jet flow. At cardiac catheterization, pressure study showed that there was a markedly high pressure-gradient of 90 mmHg between the apex and the base in systole. Apical pressure was 350 mmHg after premature ventricular contraction. The apical aneurysm was already dilated and spherical in late systole; the absence of active relaxation was considered to be the cause of the paradoxic jet flow. In this report, we suggest the pathogenesis of left ventricular apical aneurysm and paradoxic jet flow in MVOHCM.
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Sasaki Y, Inoue T, Beppu H, Shirasawa K, Kida Y, Takeda S, Ayukawa H, Shirasaka A, Kakio T, Doi T, Hashimoto T, Kawai C. A case of hypertrophic cardiomyopathy with mid-ventricular obstruction (MVO) — Dramatic long-term improvement with a DDD pacemaker as assessed by diastolic paradoxical jet flow velocity. Int J Cardiol 2011; 150:217-9. [DOI: 10.1016/j.ijcard.2011.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022]
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Shah DK, Schaff HV, Abel MD, Gersh BJ. Ventricular Tachycardia in Hypertrophic Cardiomyopathy With Apical Aneurysm. Ann Thorac Surg 2011; 91:1263-5. [DOI: 10.1016/j.athoracsur.2010.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/28/2010] [Accepted: 09/17/2010] [Indexed: 11/29/2022]
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Incidental detection of apical hypertrophic cardiomyopathy by myocardial perfusion imaging. Nucl Med Commun 2010; 31:286-93. [PMID: 20087240 DOI: 10.1097/mnm.0b013e328334fc41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Echocardiography plays a central role in the diagnosis of hypertrophic cardiomyopathy (HCM). However, apical involvement of HCM may be missed because of foreshortening and inadequate clinical suspicion. These patients may be referred for single-photon emission computed tomography imaging. METHODS We present three cases of HCM predominantly involving the cardiac apex, whose diagnosis was first suspected on myocardial perfusion imaging. These patients were referred for chest pain syndromes to exclude significant coronary artery disease. All were undiagnosed on initial routine transthoracic echocardiography, and none were specifically suspected by the referring clinicians. All cases underwent an adenosine stress rest technetium-99m tetrofosmin myocardial perfusion protocol, and were subsequently referred for transpulmonary contrast echocardiography. RESULTS Single-photon emission computed tomography imaging revealed increased tracer uptake in all cases, most marked in the apical myocardium. Inferior wall ischaemia was detected in one case, consistent with a coronary stenosis seen at angiography. Apical hypokinesia was noted in two patients on gated studies. Contrast echocardiography confirmed the diagnosis of HCM with apical involvement in all cases. CONCLUSION Echocardiography is the first-line imaging technique for the diagnosis of HCM, but apical involvement may be missed unless a contrast study is performed. The presence of increased apical tracer uptake on perfusion imaging should alert the referring physician to the possibility of apical HCM, irrespective of earlier echocardiographic findings.
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Sato Y, Matsumoto N, Yoda S, Kunimasa T, Matsuo S, Komatsu S, Tani S, Kasamaki Y, Kunimoto S, Achenbach S, Saito S, Hirayama A. Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: Report of 2 cases. Int J Cardiol 2008; 129:e88-90. [PMID: 17888531 DOI: 10.1016/j.ijcard.2007.06.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 06/30/2007] [Indexed: 10/22/2022]
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Duygu H, Zoghi M, Nalbantgil S, Ozerkan F, Akilli A, Akin M, Onder R, Erturk U. Apical hypertrophic cardiomyopathy might lead to misdiagnosis of ischaemic heart disease. Int J Cardiovasc Imaging 2008; 24:675-81. [PMID: 18373279 DOI: 10.1007/s10554-008-9311-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 03/26/2008] [Indexed: 12/14/2022]
Abstract
PURPOSE In this study, demographic, clinic, electrocardiographic and angiographic properties of patients, on whom coronary angiography was performed with the pre-diagnosis of coronary artery disease (CAD) and whose ventriculography demonstrated typical apical hypertrophic cardiomyopathy (AHCM), were investigated. METHODS Seventeen patients (mean age 58 +/- 10 years, 10 male) with CAD pre-diagnosis, on whom coronary angiography was performed and had typical spade-like appearance on left ventriculography, were included in the study between January 2000 and May 2005. RESULTS As risk factor for CAD, 8 (47%) patients had hypertension, 8 (47%) patients had dyslipidaemia, 2 (11%) patients had type 2 diabetes mellitus, 13 (77%) patients had a history of smoking, and 2 (11%) patients had family history. Seven (42%) patients presented unstable angina pectoris, 8 (47%) patients presented stable angina pectoris and 2 (11%) patients were asymptomatic. On coronary angiography, it was determined that 10 (58%) patients had normal coronary arteries, 3 (17%) patients had non-significant stenosis and 4 (25%) patients had myocardial bridging. Five (30%) patients revealed mid-ventricular obstruction and intraventricular gradient was 25 +/- 5 mmHg by the catheterization. All patients showed ''giant'' negative (> or = 10 mm) T waves in the precordial leads, whereas 2 patients had atrial fibrillation. Maximum wall thickness was measured as 18 +/- 4 mm in the apical region by transthoracic echocardiography. One patient (5%) who had mid-ventricular obstruction developed atrial fibrillation during 2 years follow-up, though any other events did not occur during hospitalization or follow-up period. CONCLUSIONS Physicians caring for patients with chest pain should consider AHCM in their differential diagnosis in case of a patient with chest pain and electrocardiographic changes suggestive of CAD.
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Affiliation(s)
- Hamza Duygu
- Department of Cardiology, Ege University Medical Faculty, Bornova, Izmir 35100, Turkey.
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Sato Y, Matsumoto N, Matsuo S, Yoda S, Tani S, Kasamaki Y, Takayama T, Kunimoto S, Saito S. Mid-ventricular obstructive hypertrophic cardiomyopathy associated with an apical aneurysm: evaluation of possible causes of aneurysm formation. Yonsei Med J 2007; 48:879-82. [PMID: 17963350 PMCID: PMC2628158 DOI: 10.3349/ymj.2007.48.5.879] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
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Affiliation(s)
- Yuichi Sato
- Department of Cardiology, Nihon University School of Medicine, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, Japan.
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, Ohkawa K, Maruhashi T, Kagawa E, Dai K, Aokage T. Variant form of tako-tsubo cardiomyopathy. Int J Cardiol 2007; 119:e56-8. [PMID: 17459500 DOI: 10.1016/j.ijcard.2007.01.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 01/05/2007] [Indexed: 11/21/2022]
Abstract
We report a female case of variant form of tako-tsubo cardiomyopathy in which wall motion of the distal segment was preserved. In the current case, left ventriculography showed akinesia of the mid portion and normokinesia of the distal and basal portions of the left ventricular chamber. ST-segment elevation was obvious in leads V1-3 rather than in leads V4-6. Because ST-segment elevation is absent in left precordial leads, cardiologists should take care not to fail to diagnose variant form of tako-tsubo cardiomyopathy.
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Gulel O, Ozturk O, Elmali M, Yazici M. Rare clinical presentation of nonobstructive hypertrophic cardiomyopathy: Apical aneurysm with thrombus. Int J Cardiol 2007; 114:e31-3. [PMID: 17081637 DOI: 10.1016/j.ijcard.2006.07.221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 07/29/2006] [Indexed: 11/21/2022]
Abstract
Hypertrophic cardiomyopathy patients rarely have left ventricular apical aneurysms without coronary artery disease and the pathophysiological processes responsible for apical wall thinning and aneurysm formation are not known exactly today. Here we present a rare nonobstructive hypertrophic cardiomyopathy case with an apical thrombotic aneurysm.
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Georgiadou P, Sbarouni E, Kremastinos DT. Midventricular hypertrophic cardiomyopathy coexistent with anomalous origin of circumflex artery. Int J Cardiol 2006; 110:102-3. [PMID: 15993500 DOI: 10.1016/j.ijcard.2005.05.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/21/2005] [Indexed: 10/25/2022]
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Cianciulli TF, Saccheri MC, Konopka IV, Serans DF, Acunzo RS, Escudero AMG, Masoli OH, Prezioso HA. Subaortic and mid-ventricular obstructive hypertrophic cardiomyopathy with an apical aneurysm: a case report. Cardiovasc Ultrasound 2006; 4:15. [PMID: 16553961 PMCID: PMC1501052 DOI: 10.1186/1476-7120-4-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 03/22/2006] [Indexed: 11/10/2022] Open
Abstract
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. CASE PRESENTATION 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. CONCLUSION 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.
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Affiliation(s)
- Tomás Francisco Cianciulli
- Department of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires Dr, Cosme Argerich, Buenos Aires, Argentina.
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