One heart, two cardiomyopathies

Abstract

A 63-year-old woman with no previous medical problems presented with acute chest pain and an ECG consistent with an acute anterior myocardial infarction. At emergency angiography, she was found to have smooth unobstructed coronary arteries. On invasive left ventriculography, overall poor systolic function was noted with apical hypokinesis and basal hyperkinesis, consistent with Tako-tsubo phenomenon. Echocardiography demonstrated a hypertrophic left ventricle and left ventricular outflow obstruction due to systolic anterior motion of the mitral valve and moderate mitral regurgitation. Following appropriate management, she was discharged 6 days later. An outpatient MRI confirmed normalisation of the left ventricular systolic function; however, there was still significant left ventricular hypertrophy and dynamic obstruction. Although most patients presenting with chest pain and an ECG with ST elevation will have an acute coronary event, our patient had normal coronaries but both Tako-tsubo and hypertrophic cardiomyopathies.