Patel Hiren, Ko Ko Nway L, Kumar Sundeep, Gros Bernard
Internal Medicine, University of Central Florida College of Medicine, Orlando, USA.
Cureus. 2019 Jan 29;11(1):e3979. doi: 10.7759/cureus.3979.
Apical variant hypertrophic cardiomyopathy (AHCM) is a known entity since its first introduction by Sakamoto and Yamaguchi. However, unlike classical hypertrophic cardiomyopathy (HCM), it is less explored in terms of its associated diagnosis and long-term outcomes. Through this case presentation, we aim to have an in-depth review to help physicians identify and better understand several aspects of AHCM. Given the increased availability and utilization of high precision cardiac imaging modalities, apical septal hypertrophic cardiomyopathy will increasingly be recognized as a distinct, clinically significant variant of classical HCM. Contrast echocardiogram is the most effective and diagnostic study when performed in the right setting with high suspicion on clinical examination findings and typical electrocardiogram (EKG) findings. Cardiac magnetic resonance imaging (MRI) has equal diagnostic yield as a contrast echocardiogram. It is associated with a wide spectrum of presentation ranging from asymptomatic course with incidental findings on imaging to rarely being associated with ventricular arrhythmia. The question of utility of implantable defibrillators in individuals, particularly without any underlying arrhythmias, remains unexplained and needs further evidence-based guidance.
自从坂本和山口首次提出心尖部变异型肥厚型心肌病（AHCM）以来，它已是一个已知的病症。然而，与经典肥厚型心肌病（HCM）不同，在其相关诊断和长期预后方面，对它的研究较少。通过本病例报告，我们旨在进行深入回顾，以帮助医生识别并更好地理解AHCM的几个方面。鉴于高精度心脏成像模式的可及性和应用增加，心尖部间隔肥厚型心肌病将越来越被视为经典HCM的一种独特的、具有临床意义的变异型。当在临床检查结果和典型心电图（EKG）结果高度可疑的合适情况下进行时，对比超声心动图是最有效和最具诊断性的检查。心脏磁共振成像（MRI）的诊断率与对比超声心动图相当。它的表现范围广泛，从影像学检查偶然发现的无症状病程到很少与室性心律失常相关。植入式除颤器在个体中的效用问题，特别是在没有任何潜在心律失常的个体中，仍然无法解释，需要进一步基于证据的指导。
