Author + information
- Received December 2, 2009
- Revision received January 12, 2010
- Accepted January 18, 2010
- Published online November 30, 2010.
- Cameron J. Holloway, MBBS(Hons), DPhil,
- Timothy R. Betts, MD, MBCHb,
- Stefan Neubauer, MD, FMedSci and
- Saul G. Myerson, MD
A previously asymptomatic 28-year-old man with a family history of hypertrophic cardiomyopathy (HCM) presented with sudden palpitations and dizziness. An electrocardiogram revealed ventricular tachycardia (VT) with a left ventricular origin and North-West axis (A), and after cardioversion, demonstrated sinus rhythm with left-axis deviation, inferolateral T-wave inversion, and lateral Q waves (B). A cardiac magnetic resonance scan showed HCM, with gross asymmetrical left ventricular hypertrophy (septal thickness 30 mm), increased mass index (129 g/m2), a large thin-walled apical aneurysm and a large (4 cm) apical thrombus (C).Coronary angiography showed normal vessels. He was treated with beta-blockade and warfarin, but declined an implantable cardioverter-defibrillator.
Apical aneurysms are present in up to 2% of patients with hypertrophic HCM (1), although the exact cause, natural history, and optimal therapies are not well defined. This case demonstrates multiple complications of nonobstructive HCM.
Dr. Myerson is partly funded by the Oxford Biomedical Research Centre.
- Received December 2, 2009.
- Revision received January 12, 2010.
- Accepted January 18, 2010.
- American College of Cardiology Foundation