Apical hypertrophic cardiomyopathy: evaluation by noninvasive and invasive techniques in 23 patients.

Abstract

Over a 3 year period we evaluated 23 patients (16 men, seven women) with apical hypertrophic cardiomyopathy by noninvasive and invasive methods. Sixteen patients had chest pain. In 17, results of cardiovascular examination were normal. The electrocardiogram showed precordial inverted T waves in all patients and these were of mild-to-moderate amplitude (<10 mm) in 18 and giant (>10 mm) in five. M mode echocardiography revealed a typical pattem of contraction and relaxation in the apical region of the left ventricle that was associated with significant hypertrophy. These findings were confirmed by two-dimensional echocardiography. Systolic anterior motion of the mitral valve was not observed nor was there any evidence of obstruction of the left ventricular outflow tract. Results of Doppler echocardiographic study of the mitral and aortic flow were normal in all patients but one who had mild mitral insufficiency. Radionuclide studies of 14 patients revealed a mean left ventricular ejection fraction of 66 + 6% (range 55% to 79%), with normal left ventricular contraction in all patients but two with apical hypokinesis. In all six patients who underwent catheterization a characteristic appearance of the left ventricle at end-systole as well as abnormal end-diastolic contour were noted on the left ventricular angiogram, but the "ace of spades" configuration was seen in only one. We conclude that the 23 patients studied form a homogeneous group of individuals with nonobstructive apical hypertrophic cardiomyopathy, which differs in many respects from cardiomyopathies reported by other investigators. Circulation 71, No. 1, 45-56, 1985. HYPERTROPHIC CARDIOMYOPATHY is defined as a heart muscle disorder of unknown origin that is characterized by hypertrophy of a nondilated left ventricle. ' The hypertrophy may be obstructive or nonobstructive and its distribution may exhibit marked variation.2 Recently, Japanese investigators34 described a form of nonobstructive hypertrophic cardiomyopathy characterized by disproportionate hypertrophy of the left ventricular apical region associated with giant precordial negative T waves and high QRS voltage. A characteristic "ace of spades" configuration at end-diastole was observed on left ventriculograms of patients with this disorder. 5' 6 Reviewing their extensive experience with hypertrophic cardiomyopathy, Maron et pertrophy similar to that observed by the Japanese investigators. However, the electrocardiograms of their patients showed relatively mild T wave inversion and left ventricular angiograms showed a characteristic appearance of mid left ventricular constriction and a small, often poorly contracting apical segment.No other extensive study of apical hypertrophic cardiomyopathy has appeared in the literature and only a few cases have been reported with findings similar to those of the Japanese group.tt-4 The present study reports a series of 23 patients with apical hypertrophic cardiomyopathy who were evaluated at our institution by both noninvasive and invasive...

Apical Hypertrophic Cardiomyopathy - Masquerade of Acute Coronary Syndrome

“…Clinically, it resembles acute coronary syndrome in symptomatology (unstable angina, dyspnea on exertion), EKG changes (T wave inversion, ST-T changes), echocardiographic features (apical regional wall motion abnormalities), scintigraphic appearance (perfusion defects with reversible ischemia) [2]. Mismatch between the myocardial oxygen demand and supply explains the clinical presentation, EKG findings and perfusion defects.…”

Cardiomiopatia hipertrófica apical associada a doença arterial coronária

“…Poucos são os relatos de casos da forma apical, que evoluíram com infarto agudo do miocárdio (IAM), sem 8,9 ou com aterosclerose associada [10][11][12] . O encontro de angina do peito é comum nos pacientes mais idosos com este tipo de agressão 11 .…”

“…Poucos são os relatos de casos da forma apical, que evoluíram com infarto agudo do miocárdio (IAM), sem 8,9 ou com aterosclerose associada [10][11][12] . O encontro de angina do peito é comum nos pacientes mais idosos com este tipo de agressão 11 . A DAC esteve presente em 3,79% dos nossos pacientes com CMH 7 , sendo inferior ao referido por vários autores, que estimam sua freqüência entre 7,6 e 19%, elevada para, aproximadamente, 25% na faixa etária acima dos 45 anos [13][14][15][16][17] .…”

“…O paciente referido por Vacek e col 10 era homem branco de 59 anos, com angina do peito e que, submetido a prova de tolerância ao esforço, apresentou dor, associada a alteração isquêmica na parede inferior, e a cinecoronariografia mostrou lesão de 70% devido a constrição sistólica por ponte miocárdica na ADA, e lesões obstrutivas de 40% na artéria coronária direita e de 50% no 1/3 proximal da artéria descendente posterior. Entre os 23 pacientes vistos em Israel por Keren e col 11 , sete tinham antecedentes de infarto do miocárdio, e 18 referiam angina do peito, seis foram submetidos a cinecoronariografia sendo que em três com antecedentes de infarto, apenas um apresentava pequenas irregularidade da luz dos vasos, porém não sendo significativas para explicar o quadro anginoso. Esta série era composta por pacientes com maior faixa etária (62±11 anos) 11 .…”

“…Entre os 23 pacientes vistos em Israel por Keren e col 11 , sete tinham antecedentes de infarto do miocárdio, e 18 referiam angina do peito, seis foram submetidos a cinecoronariografia sendo que em três com antecedentes de infarto, apenas um apresentava pequenas irregularidade da luz dos vasos, porém não sendo significativas para explicar o quadro anginoso. Esta série era composta por pacientes com maior faixa etária (62±11 anos) 11 . Na sé-rie de Webb e col 8 em Toronto, dos 26 pacientes com CMHA, apenas um apresentou aos 33 anos infarto do miocárdio apical e formação de aneurisma, estava em seguimento ambulatorial desde os 17 anos, tendo ocorrido o desaparecimento das alterações da onda T e surgido elevação persistente de supra desnível do segmento ST-T entre V 3 -V 6 .…”