Prepared by David A. Berman, MD, FACC, Staff Cardiologist, Aspen Medical Clinic, Minneapolis, Minn
An electrocardiogram (ECG) taken during a routine preoperative examination of a 79-year-old black woman who was scheduled for hemorrhoid surgery is shown (Figure 1). The physical examination revealed no cardiac symptoms, including no murmurs or abnormal heart sounds, and normal blood pressure.
What's your diagnosis?
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| Figure 1. |
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Apical hypertrophic cardiomyopathy ?The
ECG shows marked voltage of left ventricular (LV) hypertrophy, with deeply inverted T waves in leads V2 through V4 characteristic of apical hypertrophic cardiomyopathy. The echocardiogram (Figure 2) confirmed the diagnosis of apical hypertrophic cardiomyopathy, demonstrating that the apical myocardium is markedly thickened.
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| Figure 2—Apical hypertrophic cardiomyopathy, with markedly thickened myocardium (arrow). The broken lines outline the location of the endocardium. |
This form of hypertrophic cardiomyopathy is relatively common in Japan and is increasingly being recognized in Europe and in the United States. Although this condition is considered benign, some patients may be at increased risk for ventricular arrhythmias. The ECG findings in this case, in the absence of clinical symptoms, heart murmur, or hypertension, suggest the diagnosis of apical hypertrophic cardiomyopathy, which was confirmed by the echocardiogram. Our patient was approved for hemorrhoidectomy.
