Bulgarian Cardiology · Published 2024-12-31 · DOI 10.3897/bgcardio.30.e141268
We present a clinical case of a patient with hypertrophic cardiomyopathy (HCM) characterized by an inverted septal curvature phenotype, accompanied by angina and presyncope symptoms. Patients with this type of presentation remain a diagnostic and therapeutic challenge due to their association with midventricular obstruction, apical aneurysm formation, and an increased risk of arrhythmias and sudden cardiac death (SCD). Their treatment and follow-up require a multidisciplinary approach to improve quality of life and prognosis. Various imaging modalities were applied in this case, confirming the presence of severe left ventricular hypertrophy, posterior wall hypertrophy of the right ventricle, and a midventricular gradient. Magnetic resonance imaging (MRI) demonstrated fibrosis involving approximately 25% of the myocardium. The patient was stratified as high-risk patient for SCD. To improve the patient’s quality of life and prognosis, pharmacological therapy was optimized, and an implantable cardioverter-defibrillator (ICD) was placed.
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