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- W2740400536 abstract "We present an unusual case of a 48-year-old female who presented three times in six months with chest pain, dynamic ECGs and an elevated troponin. There was no significant past medical history, although a second-degree relative deceased with dilated cardiomyopathy. Presenting ECGs showed dynamic biphasic T-waves in V2 and V3, concerning for anterior ischaemia. Her ECG evolved deep T-wave inversion. Troponin levels rapidly peaked at 90 times the upper limit of normal and returned to normal within 72 hours. Echocardiography, cardiac MRI and coronary angiography did not reveal any impairment of systolic function, regional wall abnormalities, abnormal hypertrophy nor coronary occlusive disease. Cardiomyopathy screening was non-contributory. She was treated as a myocarditis and follow-up arranged. She presented three months later with similar symptoms. ECGs and troponin levels followed a similar pattern. Another angiogram was performed and did not demonstrate coronary disease. Coronary vasospasm was suspected and the patient discharged on diltiazem. On her third presentation, six months after index presentation, a repeat cardiac MRI scan revealed an interval change in the septal wall thickness, progressing from 12 mm to 17 mm. On review of her angiogram, there is evidence of contrast blushing adjacent to the distal RCA, suggestive for a coronary fistula. This was confirmed with contrast echocardiogram. Cardiac biopsy revealed septal myocyte hypertrophy with focal myofibre disarray and interstitial fibrosis, suggestive of apical hypertrophic cardiomyopathy. Our patient's myocardial ischaemia is likely secondary to fistula related coronary steal, aggravated by hypertrophic myocardium. This is a rarely described entity (Dresios et al., 2010)." @default.
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- W2740400536 date "2017-01-01" @default.
- W2740400536 modified "2023-10-18" @default.
- W2740400536 title "Rapid Septal Thickening and Coronary Fistulae - An Atypical Presentation of Apical Hypertrophic Cardiomyopathy" @default.
- W2740400536 doi "https://doi.org/10.1016/j.hlc.2017.06.154" @default.
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