Korean Circ J.  2009 May;39(5):213-216. 10.4070/kcj.2009.39.5.213.

An Unusual Type of Hypertrophic Cardiomyopathy

• Seo HS
• Kim DH
• Kim EJ
• Yoo HY
• Kim C
• Lee CH
• Kim BY
• Chung CH
• Suh J
• Cho YH
• Lee NH

• KMID: 1826022
• DOI: http://doi.org/10.4070/kcj.2009.39.5.213

Abstract

An unusual type of hypertrophic cardiomyopathy was diagnosed in a 17-year-old girl who presented with dyspnea on exertion. The hypertrophied myocardium was localized to the anterior portion of the left ventricle from the base to the apex without left ventricular outflow tract obstruction. On cardiac magnetic resonance imaging (MRI), patchy and linear delayed hyperenhancement was shown in the anterior and inferior mid-wall, which is not concordant with the coronary artery territory.

Keyword

Cardiomyopathy, hypertrophic; Magnetic resonance imaging

MeSH Terms

Adolescent
Cardiomyopathy, Hypertrophic
Coronary Vessels
Dyspnea
Heart Ventricles
Humans
Magnetic Resonance Imaging
Myocardium

Figure

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  Fig. 1 Twelve-lead ECG showing sinus rhythm with ST segment elevation in leads III/aVF/aVR, ST depression in I/aVL/V5-6, and T inversion in leads V1-4. ECG: electrocardiogram.

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  Fig. 2 Parasternal short axis view of transthoracic echocardiography. Hypertrophic myocardium was (white arrows) localized to the anterior wall from base (A), mid-level (B), to the apex (C).

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  Fig. 3 Two-dimensional strain analysis. Each color represents each mid-LV segment as described in the left side of the images. The hypertrophied anterior segment, expressed as sky blue, decreased systolic deformation (strain) compared with other segments. A: circumferential strain. B: radial strain. LV: left ventricle.

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  Fig. 4 Consecutive static images of short axis cines {steady-state free precession (SSFP)} in diastole (A-F). Asymmetric hypertrophy of the anterior wall extended progressively from the base (A) to the apex (F) and iso-signal intensity of hypertrophied tissue compared with surrounding myocardium was seen.

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  Fig. 5 Delayed contrast-enhanced MR (A-C) showed patch and linear hyperenhancement (arrows) in anterior and inferior mid-wall (different coronary artery territories).

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