1. A Case of Elderly Women with Biventricular Hypertrophic Cardiomyopathy
Sangying Lv1, Danling Guo1, Hongjie Hu1
1Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
1. Introduce
Hypertrophic cardiomyopathy (HC) is defined by the presence of increased left ventricular (LV) wall. However, abnormalities in RV wall thickness and mass were common in HC. In addition, the patients of HC with RV dysfunction are more likely to have sudden cardiac death (SCD) and worse prognosis(1;2). In this article, we will present a case of biventricular hypertrophic cardiomyopathy(BHC).
Case Presentation
A 76-year-old female patient complained of paroxysmal chest tightness with occasional shortness of breath, dyspnea after activities more than ten years. The ultrasound showed asymmetric LV hypertrophy. The interventricular septum measured to be 22 mm; LV apex was 18 mm. Cardiovascular magnetic resonance (CMR) images demonstrated LV diffuse asymmetry thickening. The basal interventricular septum and LV anterior wall were mm. Both short-axis 2-chamber and long-axis 4-chamber image showed remarkable hypertrophy of RV apical. The thickest part of the RV free wall was 13 mm. The long-axis 2-chamber and 4-chamber images revealed the LGE of LV apical.
Both ultrasound and CMR diagnoses were non-obstructive hypertrophic cardiomyopathy, however, only CMR mentioned the RV hypertrophy while the ultrasound missed the abnormalities of RV free wall.
Figure
a.The pole map of LV wall end-diastolic thickness. The basal Interventricular septum and LV anterior wall were measured at mm, which were the thickest. b. The end-diastolic long-axis 2-chamber image. LV was diffuse asymmetry thickening. c. The long-axis 4-chamber LGE image. LV apical showed the delayed enhancement. d-e. The long-axis 4-chamber and the short-axis 2-chamber images. The maximum thickness of RV free wall was measured to be about 13 mm at the end-diastolic phase.
Discussion
Although the ultrasound ignored the condition of RV free wall in this case, echocardiograph could help measure the thickness of RV wall and make the diagnosis of BHC. Furthermore, CMR as the “one-stop shop” examination can visually demonstrate the morphology of the whole heart. Therefore, the diagnosis of BHC patients is not difficult. The biggest challenge is the lack of definition and classification of BHC.
Reference
Mozaffarian D, Caldwell JH Clin Cardiol 24:2-8
Guo X, Fan C, Wang H, Zhao S, Duan F, et al Cardiology 133:35-43
Presented at the 3rd SCMR China Symposium, in Shanghai, China, August 4-7, 2017