Image Modality: Echocardiogram

Description:

(A) Electrocardiogram (ECG) of patient presenting with chest pain, masquerading anterolateral ST-segment elevation myocardial infarction. (B) Continuous wave Doppler across the left ventricle (LV) showing abnormal diastolic forward flow. (C) Pulse wave Doppler to determine site of flow acceleration within the mid-LV. (D) Pulse wave Doppler at the LV outflow tract. (E) LV with contrast.

Figure shows 12 lead ECG of a patient presenting with chest pain showing anterolateral ST elevation, which led an urgent coronary angiogram. Angiography revealed no new legions, and intervention was deferred. An echocardiogram was obtained, and continuous wave Doppler revealed abnormal diastolic forward flow within the long axis of the LV cavity. Pulse wave Doppler within the LV cavity demonstrated the zone of flow acceleration within the mid-LV and non-obstructed flow profile at the outflow tract. A diagnosis of mid-cavitary flow obstruction was entertained, and a contrast-enhanced image of the LV revealed an apical aneurysm associated with an advanced case of apical hypertrophic cardiomyopathy. In this patient, the forward flow in mid-diastole was the result of continued forward flow from the apical region, which is unable to empty in systole because of mid-cavitary systolic obstruction. Patients with apical hypertrophic cardiomyopathy and advanced aneurysm formation face an adverse prognosis with higher risk of thromboembolism and sudden death from arrhythmia.¹

References

1. Rowin EJ, Maron BJ, Haas TS, et al. Hypertrophic Cardiomyopathy With Left Ventricular Apical Aneurysm: Implications for Risk Stratification and Management. J Am Coll Cardiol 2017;69:761-73.

Date: November 29, 2017    

Authors:   Ashish Aneja, MBBS, FACC; Barbara Chrysanthus-Klun, RDCS; Robert S. Finkelhor, MD, FACC

Source: ACC Media File

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Arrhythmias, Cardiac, Diagnostic Imaging, Echocardiography, Chest Pain, Angiography, Cardiomyopathy, Hypertrophic, Echocardiography, Doppler