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• W1893781935 abstract "Hypertrophic cardiomyopathy (HCM) is an inherited disease of great genetic heterogeneity. While signs subaortic obstruction has been extensively investigated, the involvement in the apical portion is often undervalued and not recognized. In the mid-ventricular obstructive hypertrophic cardiomyopathy (MOHC) it is shown that the involvement of the apex can result in embolic stroke. Ventricular tachycardia associated with MOHC and apical aneurysm is very rare [ 1 Maron B.J. McKenna W.J. Danielson G.K. Kappenberger L.J. Kuhn H.J. Seidman C.E. Shah P.M. Spencer III, W.H. Spirito P. Ten Cate F.J. Wigle E.D. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J. Am. Coll. Cardiol. Nov 5 2003; 42: 1687-1713 Abstract Full Text Full Text PDF PubMed Scopus (1300) Google Scholar , 2 Lazaros G. Kouvousis N. Kotsanis A. Matsakas E. Apical hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm. Int. J. Cardiol. Jan 8 2007; 114: E45-E47 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 3 Georgiadou P. Sbarouni E. Kremastinos D.T. Midventricular hypertrophic cardiomyopathy coexistent with anomalous origin of circumflex artery. Int. J. Cardiol. Jun 7 2006; 110: 102-103 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 4 Xie M. Zhou H. Cheng T.O. Wang J. Wang X. Lu Q. Yang Y. Shi B. Fu Q. Left ventricular apical aneurysm associated with normal coronary arteries following cardiac surgery: echocardiographic features and differential diagnosis. Int. J. Cardiol. Oct 9 2013; 168: 3665-3670 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , 5 Mandraffino G. Sardo M.A. Riggio S. D'Ascola A. Loddo S. Alibrandi A. Saitta C. Imbalzano E. Mandraffino R. Venza M. Mormina E.M. David A. Saitta A. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin. Biochem. Dec 2010; 43: 1436-1442 Crossref PubMed Scopus (40) Google Scholar , 6 Mörner S. Johansson B. Henein M. Arrhythmogenic left ventricular apical aneurysm in hypertrophic cardiomyopathy. Int. J. Cardiol. Aug 18 2011; 151: e8-e9 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 7 Patanè S. Marte F. Dattilo G. Intermittent changing axis deviation during acute myocarditis. Int. J. Cardiol. Nov 5 2010; 145: e13-e16 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , 8 Takeda I. Sekine M. Matsushima H. Hosomi N. Nakamura T. Ohtsuki T. Yamawaki T. Matsumoto M. Two cases of cerebral embolism caused by apical thrombi in midventricular obstructive cardiomyopathy. Intern. Med. 2011; 50: 1059-1060 Crossref PubMed Scopus (12) Google Scholar , 9 Maron B.J. Historical perspectives on the implantable cardioverter–defibrillator and prevention of sudden death in hypertrophic cardiomyopathy. Card. Electrophysiol. Clin. Jun 2015; 7: 165-171 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 10 Dattilo G. Scarano M. Casale M. Sergi M. Quattrocchi S. Parato M. Imbalzano E. An atypical manifestation of Twiddler syndrome. Int. J. Cardiol. May 1 2015; 186: 1-2 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 11 Maron B.J. Rowin E.J. Casey S.A. Link M.S. Lesser J.R. Chan R.H. Garberich R.F. Udelson J.E. Maron M.S. Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies. J. Am. Coll. Cardiol. May 12 2015; 65: 1915-1928 Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar ]. We report a case of a 68-years old man who came to the emergency department because of a stroke preceded by episodes of fainting. The ECG showed a fast ventricular tachycardia associated with hypotension. Urgent electrical cardioversion was performed (Fig. 1). A stabilization of the patient was obtained only after different shocks and concomitant use of beta-blockers and amiodarone. Transthoracic echocardiography showed clear evidence of HCM with systolic muscular apposition of the septum and the lateral wall of the left ventricle at the mid ventricle, associated with a high pressure systolic gradient between the apical and basal part of the chamber (Fig. 2A and B ). Also, because of an hourglass shape of the left ventricle, the presence of an apical aneurysm was better investigated and confirmed by Cardiac Magnetic Resonance (CMR) (Fig. 2C). The correct treatment of these forms remains often difficult. The patient refused surgical treatment and was subjected to ICD implantation [ 10 Dattilo G. Scarano M. Casale M. Sergi M. Quattrocchi S. Parato M. Imbalzano E. An atypical manifestation of Twiddler syndrome. Int. J. Cardiol. May 1 2015; 186: 1-2 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 11 Maron B.J. Rowin E.J. Casey S.A. Link M.S. Lesser J.R. Chan R.H. Garberich R.F. Udelson J.E. Maron M.S. Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies. J. Am. Coll. Cardiol. May 12 2015; 65: 1915-1928 Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar , 12 Maron B.J. Nishimura R.A. Surgical septal myectomy versus alcohol septal ablation: assessing the status of the controversy in 2014. Circulation. Oct 28 2014; 130: 1617-1624 Crossref PubMed Scopus (57) Google Scholar , 13 Imbalzano E. Saitta A. Lamari A. Trapani G. Lizio G. Creazzo M. Mandraffino G. Scarano M. Dattilo G. Echo-Doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role?. Recenti Prog. Med. Nov 2013; 104: 569-573 Crossref PubMed Scopus (22) Google Scholar , 14 Maron M.S. Finley J.J. Bos J.M. Hauser T.H. Manning W.J. Haas T.S. Lesser J.R. Udelson J.E. Ackerman M.J. Maron B.J. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. Oct 7 2008; 118: 1541-1549 Crossref PubMed Scopus (372) Google Scholar ]. This case focuses on the fact that the detection of apical aneurysm in MOHC patients often requires a high index of suspicion because of the low diagnostic accuracy of echocardiography (57%) and of the incidence of concealed apical aneurysm with mid-ventricular cavity obliteration is approximately 1–2% of all HCM cases [ 14 Maron M.S. Finley J.J. Bos J.M. Hauser T.H. Manning W.J. Haas T.S. Lesser J.R. Udelson J.E. Ackerman M.J. Maron B.J. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. Oct 7 2008; 118: 1541-1549 Crossref PubMed Scopus (372) Google Scholar , 15 Maron M.S. Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J. Cardiovasc. Magn. Reson. Feb 1 2012; 14 (Review): 13 Crossref PubMed Scopus (203) Google Scholar , 16 Hsieh B.P. Tauras J. Taub C. Continuous apex to left ventricle blood flow pattern in hypertrophic cardiomyopathy with apical aneurysm and midventricular obstruction. Echocardiography. Jul 2012; 29: E131-E133 Crossref PubMed Scopus (5) Google Scholar ]. CMR is often necessary to confirm the diagnosis although contrast-enhanced echocardiography is an elegant bedside alternative to assess left ventricular apical segments [ 15 Maron M.S. Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J. Cardiovasc. Magn. Reson. Feb 1 2012; 14 (Review): 13 Crossref PubMed Scopus (203) Google Scholar , 16 Hsieh B.P. Tauras J. Taub C. Continuous apex to left ventricle blood flow pattern in hypertrophic cardiomyopathy with apical aneurysm and midventricular obstruction. Echocardiography. Jul 2012; 29: E131-E133 Crossref PubMed Scopus (5) Google Scholar ]." @default.
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• W1893781935 title "Ventricular tachycardia associated with mid-ventricular obstructive hypertrophic cardiomyopathy and apical aneurysm" @default.
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