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Li J, Fang J, Liu Y, Wei X. Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. Clin Res Cardiol 2024; 113:680-693. [PMID: 37982860 PMCID: PMC11026226 DOI: 10.1007/s00392-023-02328-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
Since the first description of apical hypertrophic cardiomyopathy (ApHCM) in 1976, contrasting information from all over the world has emerged regarding the natural history of the disease. However, the recommended guidelines on hypertrophic cardiomyopathy (HCM) pay a cursory reference to ApHCM, without ApHCM-specific recommendations to guide the diagnosis and management. In addition, cardiologists may not be aware of certain aspects that are specific to this disease subtype, and a robust understanding of specific disease features can facilitate recognition and timely diagnosis. Therefore, the review covers the incidence, pathogenesis, and characteristics of ApHCM and imaging methods. Echocardiography and cardiovascular magnetic resonance imaging (CMR) are the most commonly used imaging methods. Moreover, this review presents the management strategies of this heterogeneous clinical entity. In this review, we introduce a novel transapical beating-heart septal myectomy procedure for ApHCM patients with a promising short-time result.
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Affiliation(s)
- Jiangtao Li
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Jing Fang
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
| | - Xiang Wei
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China.
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Rugbeer Y, Ismail M, Nadar S, Naidoo DR. The Ace of Spades: Apical Hypertrophic Cardiomyopathy in an African Male Patient. Cureus 2022; 14:e22514. [PMID: 35345737 PMCID: PMC8956493 DOI: 10.7759/cureus.22514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Abstract
We present a case of a 52-year-old African male patient diagnosed with apical hypertrophic cardiomyopathy. He was initially diagnosed with hypertensive heart disease and placed on anti-failure treatment. Following multiple subsequent presentations and on closer review of his signs and symptoms, apical hypertrophic cardiomyopathy was considered. The diagnosis was made five years after his initial presentation and confirmed by echocardiography and cardiac magnetic resonance imaging. This case report explores his presentation and aims to provide further literature on the aetiology, description, and management of apical hypertrophic cardiomyopathy, particularly within the African population.
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Shah FA, Fujikawa P, Miller JB, Singh H. A Novel Case of Yamaguchi Syndrome in a Hispanic Male. Cureus 2021; 13:e17651. [PMID: 34646697 PMCID: PMC8486365 DOI: 10.7759/cureus.17651] [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] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Yamaguchi syndrome or apical hypertrophic cardiomyopathy (HCM) is a unique variant of HCM. It is characterized by localized hypertrophy involving the left ventricular apex rather than the left ventricular septum. This syndrome has been traditionally seen in the Asian population, particularly those of Japanese descent. We present an interesting case of Yamaguchi syndrome seen in a Hispanic male. A 48-year-old Hispanic male presented with epigastric tenderness and was admitted to the hospital for a non-ST-segment elevation myocardial infarction. His diagnostic catheterization revealed no significant coronary artery disease. However, his echocardiogram revealed apical hypertrophy and narrowing of the left ventricular cavity at the apex, consistent with Yamaguchi syndrome. Case reports such as ours serve to help clinicians broaden their differential diagnoses when approaching patients with acute coronary syndrome-like symptoms to include diagnoses such as Yamaguchi syndrome.
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Affiliation(s)
- Farhan A Shah
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | | | | | - Harleen Singh
- Internal Medicine, Edward Via College of Osteopathic Medicine-Virginia, Blacksburg, USA
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Perez Y, Gupta R, Mazzaccaro R. Case 3: A Rare Cause of Syncope in an Adolescent Boy. Pediatr Rev 2020; 41:489-491. [PMID: 32873564 DOI: 10.1542/pir.2018-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yalile Perez
- Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA
| | - Ruchi Gupta
- Department of Pediatric Cardiology, Children's Hospital of Philadelphia Cardiac Center Allentown, Allentown, PA
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Diagnostic considerations in detecting apical hypertrophic cardiomyopathy while utilizing point-of-care ultrasound. Am J Emerg Med 2019; 37:1596-1598. [DOI: 10.1016/j.ajem.2019.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
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Apical hypertrophic cardiomyopathy: diagnosis, medical and surgical treatment. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:246-253. [PMID: 30647749 PMCID: PMC6329883 DOI: 10.5114/kitp.2018.80922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/02/2018] [Indexed: 01/14/2023]
Abstract
Apical hypertrophic cardiomyopathy (AHCM) is a rare form of hypertrophic cardiomyopathy, occasionally resulting in severe complications. The paper covers the etiology and pathogenesis of AHCM, different imaging methods and characteristic appearance of the disease in each of them. Echocardiography and cardiovascular magnetic resonance imaging (CMR) are known to be the most valuable imaging methods. Moreover, this review presents medical and surgical treatment, as well as the clinical course and prognosis. Despite possible morbid events the overall cardiovascular mortality rate of AHCM patients is low, and the prognosis is relatively optimistic.
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Volney G, Wada H, Tatusov M. Ventricular Fibrillation Cardiac Arrest in African American Male with Apical Hypertrophic Cardiomyopathy. Cureus 2018; 10:e3267. [PMID: 30430056 PMCID: PMC6221513 DOI: 10.7759/cureus.3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Apical hypertrophic cardiomyopathy (AHCM) is a rare form of non-obstructive hypertrophic cardiomyopathy. It is rarely reported in African American patients, and more commonly reported in Japanese patients. AHCM involves hypertrophy of the apex of the left ventricle. It is considered to have a benign prognosis in terms of cardiovascular mortality, however arrhythmias and sudden cardiac death have been reported. We report a case of a 49-year-old African American male with a history of hypertension, who presented to the emergency department after in field defibrillation for ventricular fibrillation cardiac arrest with return of spontaneous circulation after 10 minutes of cardiopulmonary resuscitation. Features of left ventricular hypertrophy and deep T-wave inversions in V3-V6 were noted on a 12-lead electrocardiogram which were suggestive of AHCM. Left heart catheterization with left ventriculography and coronary angiography confirmed the diagnosis of AHCM with the classic “ace of spades” sign. This case highlights the rare occurrence of AHCM with ventricular fibrillation cardiac arrest in an African American male, treated with hypertension management, aspirin, atorvastatin and automated implantable cardioverter-defibrillator placement.
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Affiliation(s)
- Giselle Volney
- Internal Medicine, Ross University School of Medicine, Roseau, DMA
| | - Habiba Wada
- Internal Medicine, Ross University School of Medicine, Bowie, USA
| | - Michael Tatusov
- Medicine/Trauma and Critical Care, University of Maryland School of Medicine, Baltimore, USA
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Mirabbasi SA, Khalighi K, Mukkamala S, Kodali A. A rare case of apical hypertrophic cardiomyopathy (AHCM). J Community Hosp Intern Med Perspect 2017. [PMID: 28638577 PMCID: PMC5473187 DOI: 10.1080/20009666.2017.1324238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Apical hypertrophic cardiomyopathy is a rare form of hypertrophic cardiomyopathy that involves thickening of the distal portion of the left ventricular wall. Most commonly seen in the Japan, with a prevalence rate of about 15% of all HCM patient, its incidence in the USA is approximately 3% of HCM cases. We report a case of a 46-year-old woman with history of hypertension who presented to emergency department with worsening dyspnea and orthopnea with features of left ventricular hypertrophy (LVH) and diffuse large T-wave inversions in the lateral leads on a 12-lead ECG. Further work up revealed severe concentric LVH, with near obliteration of the LV cavity. Ventriculogram showed severe symmetric hypertrophy of the mid to lower septum, extending to the apex of left ventricle with significant pressure gradient of at least 160 mmHg across the apex to mid septal cavity, with no significant gradient across the left ventricular outflow tract. These findings were consistent with apical hypertrophic cardiomyopathy. She was treated with verapamil and metoprolol and has remained asymptomatic over last 2.5 years of follow-up. Although the clinical presentation of AHCM can be variable and nonspecific; however, hallmark findings on ECG and echo can be extremely important in its diagnosis. Abbreviations: AHCM: Apical hypertrophic cardiomyopathy; ECG: Electrocardiogram; LVH: Left ventricular hypertrophy; LVOT: Left ventricular outflow tract
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Affiliation(s)
- Seyed Abbas Mirabbasi
- Department of Medicine, Easton Hospital, Drexel University School of Medicine, Easton, PA, USA
| | - Koroush Khalighi
- Department of Medicine, Easton Hospital, Drexel University School of Medicine, Easton, PA, USA.,Easton Cardiovascular Associates, Electrophysiology Department, Easton, PA, USA
| | - Suresh Mukkamala
- Department of Medicine, Easton Hospital, Drexel University School of Medicine, Easton, PA, USA
| | - Archana Kodali
- Department of Cardiology, Kettering Medical Center, Kettering, OH, USA
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Fleeman BE, Avitall B. Progressive electrical remodeling in apical hypertrophic cardiomyopathy leading to implantable cardioverter-defibrillator sensing failure during ventricular fibrillation. HeartRhythm Case Rep 2017; 3:43-48. [PMID: 28491766 PMCID: PMC5420022 DOI: 10.1016/j.hrcr.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Boaz Avitall
- Address reprint requests and correspondence: Dr Boaz Avitall, 840 S Wood St, Suite 920 S, Chicago, IL 60612-7323.840 S Wood St, Suite 920 SChicagoIL60612-7323
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Chest Discomfort, Abnormal Electrocardiogram, Clean Coronaries. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kapoor K, Chaudhry A, Evans MC, Sura A. Apical Hypertrophic Cardiomyopathy Among Non-Asians: A Case Series and Review of the Literature. Cardiol Res 2016; 7:46-50. [PMID: 28197268 PMCID: PMC5295534 DOI: 10.14740/cr459w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 12/28/2022] Open
Abstract
Apical hypertrophic cardiomyopathy (AHCM) has been rarely described in the Western world. More recently, improved sensitivity of diagnostic modalities and increased diagnostic awareness have increased detection rates, suggesting that the prevalence outside of Asia may have been previously understated. Hallmark features of AHCM include deeply negative, “giant” T-wave inversions on electrocardiography and a “spade-like” configuration of the left ventricle on ventriculography. We present two cases of AHCM, one in an African-American female and another in a Caucasian male.
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Affiliation(s)
- Karan Kapoor
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Amal Chaudhry
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Amish Sura
- Mercy Medical Center, Baltimore, MD, USA
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Wu JJ, Seco M, Medi C, Semsarian C, Richmond DR, Dearani JA, Schaff HV, Byrom MJ, Bannon PG. Surgery for hypertrophic cardiomyopathy. Biophys Rev 2015; 7:117-125. [PMID: 28509978 PMCID: PMC5418425 DOI: 10.1007/s12551-014-0153-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/25/2014] [Indexed: 01/17/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically determined cardiac disease characterised by otherwise unexplained myocardial hypertrophy of the left ventricle, and may result in left ventricular outflow tract obstruction. It is the most common cause of sudden cardiac death in young adults due to arrhythmias. Septal myectomy is a surgical treatment for HCM with moderate to severe outflow tract obstruction, and is indicated for patients with severe symptoms refractory to medical therapy. The surgical approach involves obtaining access to the interventricular septum via transaortic, transapical or transmitral approaches, and excising a portion of the hypertrophied myocardium to relieve the outflow tract obstruction. Large, contemporary series from centres experienced in septal myectomy patients have demonstrated a low early mortality of <2 %, excellent long-term survival that matches the general population, and durable relief of symptoms.
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Affiliation(s)
- James J Wu
- Sydney Medical School, The University of Sydney, Sydney, Australia
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Caroline Medi
- Molecular Cardiology Group, Centenary Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chris Semsarian
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Molecular Cardiology Group, Centenary Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David R Richmond
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Michael J Byrom
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia.
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.
- Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia.
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Said SAM, Bloo R, Nooijer RD, Slootweg A. Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature. World J Cardiol 2015; 7:86-100. [PMID: 25717356 PMCID: PMC4325305 DOI: 10.4330/wjc.v7.i2.86] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/14/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the electrocardiographic (ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis.
METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT (QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality non-invasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.
RESULTS: Eight adult subjects (5 females) with a mean age of 66 years (range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval (639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion (≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3 (5 ×). In 3 patients presented with mild T-wave inversion (patients 1, 5 and 4 mm), the QTc interval was not prolonged (432, 409 and 424 msec), respectively.
CONCLUSION: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.
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Angelis A, Aggeli C, Tsiamis E, Tousoulis D. Apical hypertrophic cardiomyopathy: An echocardiography challenging case report. Int J Cardiol 2015; 179:188-9. [DOI: 10.1016/j.ijcard.2014.11.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023]
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Toufan M, Shahvalizadeh R, Khalili M. Myocardial infarction in a patient with left ventricular noncompaction: a case report. Int J Gen Med 2012; 5:661-5. [PMID: 22924011 PMCID: PMC3422902 DOI: 10.2147/ijgm.s28902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We describe a 73-year-old male patient with left ventricular noncompaction (LVNC) who was diagnosed with acute myocardial infarction (MI), three-vessel coronary artery disease, a fresh intraventricular thrombus, and mitral regurgitation. He was treated with full anticoagulant therapy, coronary artery bypass grafting, and mitral valve repair. This case adds to a small but growing literature showing association between LVNC and MI and/or coronary artery disease. We suggest that patients with LVNC could be considered at heightened risk for MI, and the two conditions might have a common genetic underpinning in some cases.
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Affiliation(s)
- Mehrnoush Toufan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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