Miocardiopatía Hipertrófica Apical que Simula un Síndrome Coronario Agudo

Abstract

Hypertrophic cardiomyopathy is a myocardial disease that is caused by genetic alterations in genes encoding different sarcomeric proteins, is presented as a thickening of the ventricular wall variable location, and has a wide clinical spectrum of expression ranging from asymptomatic carriers to those which they present sudden death as the first manifestation of the disease.

Apical hypertrophic cardiomyopathy is a rare variant, with circumscribed hypertrophy to ventricular apex. It has well-established electrocardiographic characteristics; but it can mimic other diseases. Starting from this premise, the analysis of this case report is to establish guidelines therapeutic diagnosis, and mention of the major complications for the proper management of apical hypertrophic cardiomyopathy.

The case of a male patient, 49 years old, diabetic, with a family history of sudden death. Go to the emergency with severe pain in the left lower limb, after physical exertion and referred occasional palpitations, he has never presented dyspnea, angina or syncope. Examination revealed: rhythmic heart sounds of low intensity, and positive signs Lasègue Bragard. The electrocardiogram reveals deep negative T waves in precordial leads V3-V6. Suspecting acute coronary syndrome admitted with antithrombotic therapy. The obtained negative cardiac enzymes, and once passed the lower limb painful picture because ciatalgia the patient undergoes a stress test without registering electrocardiographic changes. Having no conclusive diagnosis, magnetic resonance imaging, which identifies severe hypertrophy in the ventricular apex is requested. Antithrombotic drugs are suspended and beta blockers start. The final diagnosis was apical hypertrophic cardiomyopathy and sciatica. Patient evolved properly.