An uncommon variant of an uncommon disease: A Caucasian adolescent with apical hypertrophic cardiomyopathy diagnosed with myocardial perfusion imaging

• Published in: World journal of nuclear medicine Vol. 16; no. 3; pp. 251 - 254
• Main Authors: Zein, Rami, Al-Faham, Zaid, Mouabbi, Jason, Daher, Edouard
• Format: Journal Article
• Language: English
• Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Thieme Medical and Scientific Publishers Pvt. Ltd 01.07.2017; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Asian people; Bone surgery; Cardiac arrhythmia; Cardiac patients; Cardiomyopathy; Case Report; Chest; Computed tomography; Crack propagation; Diagnosis; Diagnostic imaging; Diagnostic systems; Discomfort; Electrocardiography; Fatigue failure; Health aspects; Heart; Heart diseases; Hospitals; Hypertrophic cardiomyopathy; Imaging; Internal medicine; Magnetic resonance; Medical imaging; Mortality; Mutation; Myocardial infarction; Patients; Photon emission; Syncope; Japan; hypertrophic; Apical; myocardial perfusion; myocardial perfusion imaging; solar polar map; cardiomyopathy
• ISSN: 1450-1147; 1607-3312
• DOI: 10.4103/1450-1147.207285

Apical hypertrophic cardiomyopathy (ApHCM) is a subtype of HCM. This variant is more common in the Asian population when compared to North American patients. Patients may present with arrhythmias, heart failure, myocardial infarction, chest discomfort, fatigue, and presyncope or syncope. Initial evaluation requires electrocardiogram and two-dimensional echocardiogram. T-wave inversion in the precordial leads as well as hypertrophy of the left ventricle is hallmarks of the disease. Cardiac magnetic resonance (CMR) imaging is the most specific and sensitive imaging modality. In patients with contraindications for CMR, myocardial perfusion imaging (MPI) has been described to have diagnostic characteristics for ApHCM. MPI images demonstrating a “solar polar” map pattern and increased apical tracer uptake in single-photon emission computed tomography horizontally and vertical long-axis slices are consistent with the diagnosis of ApHCM. Herein, we present a case of a Caucasian adolescent female who underwent a cardiac screening to rule out hypertrophic obstructive cardiomyopathy. Initially, the patient was unable to undergo CMR, and an MPI was utilized to assist with the diagnosis of ApHCM.