DOI: http://dx.doi.org/10.18203/2349-3933.ijam20211481

Hypertrophic cardiomyopathy mimicking inferior wall myocardial infarction

Prachi Sharma, Akshyaya Pradhan, Pravesh Vishwakarma

Abstract


Electrocardiogram is most often the first-hand diagnostic tool with a cardiologist. Promptly identifying life threatening arrhythmias and myocardial infarction with ECG saves many lives. Quite often the electrocardiogram may have dubious findings and further testing helps arriving at the right diagnosis. Herein, we present a case of hypertrophic cardiomyopathy where the ECG mimicked inferior wall myocardial infarction along with a raised high sensitive Troponin T (hsTnT). A coronary angiogram failed to reveal any acute or chronic obstructive lesion in the coronary arteries. We discussed the varied ECG patterns in hypertrophic cardiomyopathy and causes of troponin elevation apart from myocardial infarction. We also discussed other causes of ‘pseudo-infarct’ pattern on ECG. This provides insight into a more comprehensive approach in management of each patient.


Keywords


Hypertrophic cardiomyopathy, Myocardial infarction, Cardiac biomarker

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References


Agarwal S, Kapadia S. Hypertrophic Cardiomyopathy. In: Topol EJ, Teirstein PS, eds. Textbook of Interventional Cardiology. 7th ed. Philadelphia, PA: Elsevier/Saunders; 2016:847-60.

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Executive Group on behalf of the Joint European Society of Cardiology/American College of Cardiology/American Heart Association World Heart Federation Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. Circulation. 2018;138(20):618-51.

Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation. 1995;92(4):785-9.

Maron BJ, Maron MS, Olivotta I. Hypertrophic Cardiomyopathy. In: Mann DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier/Saunders; 2019:1601-15.

Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology. Eur Heart J. 2014;35(39):2733-79.

Daralammouri Y, El Garhy M, Same K, Lauer B. Hypertrophic cardiomyopathy mimicking acute anterior myocardial infarction associated with sudden cardiac death. Case Rep Med. 2012;236154.

Bella G, Bramanti O, Russo MS, Migliorato A, Anfuso C, Minutoli F, et al. Hypertrophic cardiomyopathy mimicking acute myocardial infarction: diagnostic role of cardiac magnetic resonance. Int J Cardiol. 2008;125(3):34-6.

Maron BJ. Clinical Course and Management of Hypertrophic Cardiomyopathy. N Engl J Med. 2018;379(7):655-68.

Parthasarathy S, Ravishankar M. Pseudo-infarct in ECG in a Case of Asymmetric Septal Hypertrophy. Indian J Clinical Practice 2012;22(9):466-67.