Meghrajani Vineet, Wats Karan, Saxena Abhinav, Malik Bilal
Department of Internal Medicine, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USA.
Department of Cardiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, New York 11219, USA.
Case Rep Cardiol. 2018 Oct 25;2018:7089149. doi: 10.1155/2018/7089149. eCollection 2018.
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.
一名66岁女性因胸痛发作被送往急诊室，胸痛持续数分钟后自行缓解。心电图显示左束支传导阻滞、左心室肥厚以及侧壁导联T波倒置。初始心肌肌钙蛋白水平为0.15 ng/ml，6小时和12小时后分别为4 ng/ml和9 ng/ml。记录的最高血压为195/43 mmHg。使用DEFINITY的超声心动图显示左心室腔小且心尖肥厚，冠状动脉造影显示冠状动脉无狭窄或闭塞性病变。该患者因2型心肌梗死合并高血压危象入院。她被诊断为心尖肥厚型心肌病，这是肥厚型心肌病（HCM）的一种变体，其中肥厚主要累及左心室心尖，导致心室中部梗阻，与HCM中所见的左心室流出道梗阻相反。心尖HCM患者可能出现心绞痛、心力衰竭、心肌梗死、晕厥或心律失常，对于有症状的患者通常使用维拉帕米和β受体阻滞剂等药物治疗，对于房颤和室性心律失常则使用胺碘酮和普鲁卡因胺等抗心律失常药物治疗。对于有心脏骤停史或持续性室性心动过速、晕厥以及猝死家族史的高危HCM患者，建议植入植入式心律转复除颤器（ICD）。
