Uncommon Cause of a Common Disease
Uncommon Cause of a Common Disease
Myocardial infarction is a common life-threatening condition. Multiple agents can be used to treat acute coronary syndrome (ACS). These therapeutic agents pose potential life-threatening complications when used outside the realm of the acute coronary syndrome. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder, occurring in 1 in 500 individuals, which may mimic ACS. The hypertrophy most typically involves the septum in patients with HCM. As many as 25% of Japanese patients with HCM have predominately apical involvement. Apical hypertrophic cardiomyopathy (AHC) occurs in only 1 to 2% of the non-Japanese population. Despite its low incidence, physicians caring for patients with chest pain need to consider AHC in their differential diagnosis. We present the case of a patient with chest pain and electrocardiographic changes suggestive of ACS who was later found to have AHC.
The annual incidence of acute coronary syndrome in the United States is approximately 1 million. Today, physicians rapidly evaluate and treat patients presenting with chest pain. Multiple treatment options are available. Agents of proven benefit such as
-blockers, aspirin, nitrates, angiotensin-converting enzyme inhibitors, and others are coupled with percutaneous coronary intervention, thrombolytics, and aggressive anticoagulation. Although potentially life saving for patients with symptomatic coronary artery disease (CAD), the use of the same interventions could be disastrous in other conditions. Before offering anticoagulation, thrombolysis, or percutaneous coronary intervention for acute coronary syndrome (ACS), one must consider other abnormalities that can mimic symptomatic CAD. Pericardial tamponade, pneumonia, tension pneumothorax, aortic dissection, pulmonary embolism, and esophageal rupture are known to present with chest pain. These entities need to be considered as one goes through the evaluation process for a patient presenting with symptoms consistent with ACS. Hypertrophic cardiomyopathy, a less common disease, can present with chest pain, electrocardiographic (ECG) changes, and potentially abnormally elevated cardiac isoenzymes, mimicking ACS.
Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac disorder and the most common cause of cardiac death in children and adolescents. Typically, the hypertrophy in HCM is asymmetric and involves the septum. However, muscular enlargement may occur in almost any area of the heart. As many as 25% of Japanese patients with HCM have predominately apical hypertrophy. Apical hypertrophic cardiomyopathy (AHC), or Yamaguchi syndrome, occurs in only 1 to 2% of the non-Japanese population. Both HCM and AHC can present initially with symptoms similar to ACS. The physician caring for patients with chest pain needs to be aware of this disorder and the fact that it is not limited to the Japanese population.
Myocardial infarction is a common life-threatening condition. Multiple agents can be used to treat acute coronary syndrome (ACS). These therapeutic agents pose potential life-threatening complications when used outside the realm of the acute coronary syndrome. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder, occurring in 1 in 500 individuals, which may mimic ACS. The hypertrophy most typically involves the septum in patients with HCM. As many as 25% of Japanese patients with HCM have predominately apical involvement. Apical hypertrophic cardiomyopathy (AHC) occurs in only 1 to 2% of the non-Japanese population. Despite its low incidence, physicians caring for patients with chest pain need to consider AHC in their differential diagnosis. We present the case of a patient with chest pain and electrocardiographic changes suggestive of ACS who was later found to have AHC.
The annual incidence of acute coronary syndrome in the United States is approximately 1 million. Today, physicians rapidly evaluate and treat patients presenting with chest pain. Multiple treatment options are available. Agents of proven benefit such as
-blockers, aspirin, nitrates, angiotensin-converting enzyme inhibitors, and others are coupled with percutaneous coronary intervention, thrombolytics, and aggressive anticoagulation. Although potentially life saving for patients with symptomatic coronary artery disease (CAD), the use of the same interventions could be disastrous in other conditions. Before offering anticoagulation, thrombolysis, or percutaneous coronary intervention for acute coronary syndrome (ACS), one must consider other abnormalities that can mimic symptomatic CAD. Pericardial tamponade, pneumonia, tension pneumothorax, aortic dissection, pulmonary embolism, and esophageal rupture are known to present with chest pain. These entities need to be considered as one goes through the evaluation process for a patient presenting with symptoms consistent with ACS. Hypertrophic cardiomyopathy, a less common disease, can present with chest pain, electrocardiographic (ECG) changes, and potentially abnormally elevated cardiac isoenzymes, mimicking ACS.
Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac disorder and the most common cause of cardiac death in children and adolescents. Typically, the hypertrophy in HCM is asymmetric and involves the septum. However, muscular enlargement may occur in almost any area of the heart. As many as 25% of Japanese patients with HCM have predominately apical hypertrophy. Apical hypertrophic cardiomyopathy (AHC), or Yamaguchi syndrome, occurs in only 1 to 2% of the non-Japanese population. Both HCM and AHC can present initially with symptoms similar to ACS. The physician caring for patients with chest pain needs to be aware of this disorder and the fact that it is not limited to the Japanese population.
