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(Circulation. 2001;103:1605.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Apical Hypertrophic Cardiomyopathy Developing at a Relatively Advanced Age

Anis I. Obeid, MD; Barry J. Maron, MD

From Crouse Hospital, Syracuse, NY (A.I.O.), and Minneapolis Heart Institute Foundation, Minneapolis Minn (B.J.M.).

Correspondence to Anis I. Obeid, MD, FACC, Crouse Hospital, Echocardiography Department, 736 Irving Avenue, Syracuse NY 13210. E-mail AnisObeidMD{at}Crouse.org

A56-year-old asymptomatic man was identified in 1984 with an abnormal 12-lead ECG during a routine examination for a recreational pilot license. An ECG 2 years earlier was normal (Figure 1). Extensive work-up in 1984, including stress testing and coronary arteriography, showed no significant abnormality. In addition, an echocardiogram was within normal limits (Figure 2). In 1994, at 66 years of age, he underwent stress echocardiography, and the diagnosis of nonobstructive hypertrophic cardio-myopathy with ventricular hypertrophy confined to the cardiac apex (apical hypertrophic cardiomyopathy) was made. The abnormal ECG and echocardiographic findings have persisted without significant change to the present time. The patient remains asymptomatic.

View larger version (18K): [in this window] [in a new window]   Figure 1. ECG tracings in 1982 (left) and 1984 (right) showing development of deep T wave inversion, largely in lateral precordial leads, in 1984.

View larger version (95K): [in this window] [in a new window]   Figure 2. Echocardiographic images in apical 4-chamber view obtained in 1984 (top) and in 1994 (bottom), showing de novo development of apical hypertrophy. LV indicates left ventricle; RV, right ventricle; LA, left atrium; and RA, right atrium. Endocardial surface of left ventricular apex is demarcated by arrows in top and arrowheads in bottom panel. Calibration marks are 10 mm apart.

This case demonstrates de novo development of apical hypertrophic cardiomyopathy at a relatively advanced age. Note that the ECG abnormalities evolved before the echocardiogram demonstrated left ventricular hypertrophy.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Obeid, A. I. Articles by Maron, B. J. Search for Related Content PubMed PubMed Citation Articles by Obeid, A. I. Articles by Maron, B. J. Related Collections Developmental biology Hypertrophy Myogenesis Myocardial cardiomyopathy disease Cerebral Lacunes