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Heart, Lung and Circulation

Regression of Left Ventricular Hypertrophy in a Case of Adult Hypertrophic Cardiomyopathy: Importance of Clinical Context at Initial Diagnosis

  • Zach Liang
    Affiliations
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Flinders Medical Centre, Adelaide, SA, Australia
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  • Rajiv Ananthakrishna
    Affiliations
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Flinders Medical Centre, Adelaide, SA, Australia

    South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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  • Joseph B. Selvanayagam
    Correspondence
    Corresponding author at: Professor Joseph B. Selvanayagam, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
    Affiliations
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Flinders Medical Centre, Adelaide, SA, Australia

    South Australian Health and Medical Research Institute, Adelaide, SA, Australia
    Search for articles by this author
Published:August 15, 2022DOI:https://doi.org/10.1016/j.hlc.2022.06.692
      A 24-year-old male with no significant past medical or family history of cardiovascular or neurological disease presented with bilateral paresthesia and weakness of his upper and lower limbs, along with a left facial droop. A few days later he developed a persistent dull left-sided chest pain that was not pleuritic, positional, or exertional in nature. He was initially evaluated in a regional primary health care centre and referred 3 weeks later to a tertiary care hospital. The workup of the patient—including extensive genetic testing and family screening—led to the diagnoses of mild Guillain-Barré syndrome (GBS) with associated Bell’s palsy, as well as hypertrophic cardiomyopathy (HCM). Cardiac troponins were not performed in the regional primary health care centre during the episode of chest pain. However, electrocardiography (ECG) displayed normal sinus rhythm and widespread T-wave inversion (Figure 1A).
      Figure thumbnail gr1
      Figure 1Electrocardiograph (ECG) and cardiac magnetic resonance (CMR) findings at diagnosis and during follow-up at 18 months.
      A-C: Imaging during initial diagnostic evaluation.
      A: Electrocardiogram showing sinus rhythm, incomplete right bundle branch block and widespread T-wave inversion.
      B: CMR imaging in short axis demonstrating asymmetrical septal hypertrophy with a maximum septal thickness of 18 mm.
      C: Fluffy mid-myocardial late gadolinium enhancement in the septal wall.
      D-F: Repeat imaging at follow-up.
      D: Electrocardiogram highlighting resolution of T-wave inversion in precordial leads.
      E: CMR imaging in short axis illustrating regression of septal hypertrophy (maximum septal thickness of 15 mm).
      F. Mid-myocardial late gadolinium enhancement of septal wall is less prominent compared to baseline imaging.

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