Apical hypertrophic cardiomyopathy, intraventricular pressure gradients and ST segment elevation

Recently, Sayin et al. [1] described in this journal formation in these patients may be a chronic increase the interesting case of a patient with apical hyin apical pressure and ischemia due to cavity obliterapertrophic cardiomyopathy with electrocardiographic tion and midventricular obstruction secondary to the manifestations mimicking an acute myocardial infarcapical hypertrophy [7]. Identification of this tion. In their paper, the authors make reference to syndrome may have more important clinical implicaseveral similar cases previously reported [2], includtions than simply the possible confusion with an ing one described by one of us as co-author [3]. acute myocardial infarction, since it has been related Nevertheless, important differences do exist between to a higher incidence of embolic events, myocardial the case of Sayin et al. [1], and other reported in the ischemia and necrosis and ventricular arrhythmias or literature [2], and the case described [3]. Also, even sudden death [9,10]. several aspects concerning the pathophysiology and On the other hand, although the electrocarclinical implications of this striking syndrome should diographic manifestations in the case of Sayin et al. be discussed further. (chronic ST segment elevation and T wave inversion As occurred in other previously reported cases without Q waves) (1) are very similar to those [2,4], in the patient described by Sayin et al. [1] there present in our patient (3), the unique feature of our was a significant intraventricular pressure gradient case is that neither an apical aneurysm nor an between the apex and the main left ventricular cavity. intraventricular pressure gradient was detected by This systolic gradient, sometimes associated with a echocardiography or angiography. paradoxic diastolic jet flow [5,6], indicates the existence of a discrete apical chamber, not always detected by echocardiography, or a true apical References aneurysm [7,8]. Some of these cases show ST segment elevation, with or without Q waves, which [1] Sayin T, Kocum T, Kervancioglu C. Apical hypertrophic cardiomyopathy mimics acute coronary syndrome. Int J Cardiol may lead, as occurred in the discussed case, to 2001;80:77–9. problems of differential diagnosis with acute athero[2] Lin CS, Chen CH, Ding PY. Apical hypertrophic cardiomyopathy sclerotic heart disease [2,5]. The pathophysiologic mimicking acute myocardial infarction. Int J Cardiol 1998;64:305– 7. mechanism of the apical necrosis and aneurysm [3] Penas Lado M, Mosquera Perez I, Bouzas Zubeldia B, Vazquez Rodriguez JM, Castro Beiras A. The electrocardiogram of apical *Corresponding author. hypertrophic cardiomyopathy. Report of a case with unique features. E-mail address: manuel.penas.lado@sergas.es (M. Penas-Lado). Rev Esp Cardiol 1999;52:1148–50.